Potential Adverse Effects of Statins on Muscle

Many people have high blood cholesterol that may lead to coronary heart disease (CHD). A multifaceted approach consisting of diet, exercise, and pharmacological management is recommended to lower the risk of CHD.1 Elevated low-density lipoprotein-cholesterol (LDL-C) has been established as a major cause of CHD.1 The group of cholesterol-lowering drugs known as statins (3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors) are widely and successfully used in the management of atherosclerotic disease processes that include CHD, myocardial infarction, stroke, and peripheral vascular disease.2 Statins inhibit the formation of HMG-CoA reductase, which is essential in forming mevalonate, a precursor to cholesterol and other compounds. Lowering LDL-C is the goal of statin therapy, and multiple studies indicate that lowering LDL-C decreases the risk for CHD in people without a history of CHD and decreases the risk for cardiovascular events in people with a history of CHD.1Six statins are currently available, and they are known by a variety of brand names: atorvastatin (Lipitor*), fluvastatin (Lescol†), lovastatin (Mevacor,‡ Altoprev§), pravastatin (Pravachol‖), rosuvastatin (Crestor#), and simvastatin (Zocor‡)2–4 (Table). Although these drugs have been very successful in managing the cardiovascular health of many patients, there are also potential adverse effects that have been identified. The most common adverse effects reported include muscle pain or weakness that can progress to rhabdomyolysis and mortality.5 If detected early, statin-related symptoms are reversible after withdrawal of the statin.6,7 Early identification of these potentially serious adverse effects makes the information in this update critical for physical therapists, because they frequently screen patients with musculoskeletal complaints.View this table: Table. Available Statins and Recommended DosagesConsidering that more than 76 million prescriptions for statins were filled in 2000,8 there was increased concern in the medical and lay …