By Dr. Timothy Swinn, edited by Dr. Ahmed El-Medany
A recent meta-analysis published in the Lancet[1] has concluded that fewer than 1 in 15 muscle pains reported by patients taking statins are due to the statin itself. The authors included 19 double-blind randomised controlled trials, all with >1,000 participants and mean follow up of >2 years, comparing statin therapy to placebo; and 4 trials comparing high to low intensity statin therapy (154,664 patients total). Median follow up was 4.3 years.
27.1% of patients taking a statin reported muscle pain or weakness, compared to 26.6% of patients taking a placebo (relative rate 1.03; 95% confidence interval 1.01-1.06). There was a slightly higher rate when looking only at the first year following initiation of statin therapy (RR 1.07; 1.04-1.10) but subsequent years did not demonstrate a statistically significant increase compared to placebo. There was no evidence of difference in relative rate between statins or any clear dose-response effect.
The clinical significance of these results is best seen in the low absolute excess rate of muscle pains in the statin cohort. Statins led to an excess of 11 (6-16) reports of muscle pain/weakness per 1,000 person-years, meaning that fewer than 1-in-15 of reported muscle pains are likely to be caused by the statin. This result may influence clinician-patient discussions around statin therapy and encourage persistence with statins in patients reporting muscle aches, given the proven large benefit in prevention of cardiovascular disease.
References
- Blazing M, Braunwald E, Lemos J de, Murphy S, Pedersen T, Pfeffer M, et al. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. The Lancet [Internet]. 2022 Aug 29 [cited 2022 Sep 8];0(0). Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01545-8/fulltext
