Active Voice: Does Statin-Associated Muscle Pain Affect Physical Performance?
By Thomas Morville, M.D., Ph.D.

Thomas Morville, M.D., Ph.D.
Statins are cholesterol-lowering medications and, currently, some of the most prescribed drugs worldwide. By now, the benefits of reduced cardiovascular mortality and morbidity are well established, yet great debate remains concerning the reports of possible side effects. These include increased risk of diabetes and, most commonly, increased risk of muscle pain. Despite many attempts to explain this phenomenon of statin-associated muscle pain, no consensus presently exists on the matter. Unfortunately, discontinuation of statin treatment may be the only way to alleviate the muscle symptoms, and this clearly presents a dilemma for both patients and physicians.

Physical activity has pleiotropic health effects, including reduced cardiovascular mortality and morbidity. However, muscle pain may prevent some people from performing regular physical activity. The muscle pain associated with statin use may, therefore, have a negative metabolic effect on the individual—further complicating the picture regarding statin treatment. Thus, statin-associated muscle pain remains a topic of continuous debate.

In our study, as reported in the July 2019 issue of Medicine & Science in Sports & Exercise® (MSSE), my colleagues and I conducted a population-based study (6,000 people) and found a 19% prevalence of statin-associated muscle pain among statin users in the Danish population. With more than 10% of the Danish population using statins (use is even greater in the U.S. with one in three adults using statins), this high prevalence underscores the importance of research in this field.

We also examined the relationship between statin users experiencing muscle pain and their abilities to perform endurance exercise (including the type that would elicit maximal fat oxidation) as well as muscle strength exercise. We compared two groups of statin users with (n=25) and without (n=39) muscle pain to a control group (n=20) not using statins. We used graded exercise tests and indirect calorimetry for the endurance and maximal fat oxidation measurements. Muscle strength tests were performed using an isokinetic dynamometer, a leg extensor power rig as well as a handheld dynamometer. We found no differences in aerobic capacity, maximal fat oxidation or muscle strength between the three groups tested.

Our research demonstrates that, although 19% of statin users in Denmark report muscle symptoms, we found no sign of impairment of their abilities to perform aerobic exercise or strength exercises. While this study does not answer the question whether an individual person suffering from statin-associated muscle pain should or should not discontinue treatment with statins, it does provide new and important information to aid the discussion between patients and physicians.

The demographic changes toward an aging population increase the need for further research in the elderly regarding statin treatment and the maintenance of an active lifestyle.

About the author:
Thomas Morville, M.D., Ph.D., is a postdoctoral scientist at the Novo Nordisk Foundation Center for Basic Metabolic Research in Copenhagen, Denmark. He is a medical doctor and holds a bachelor’s degree in sport science. His research areas include metabolic regulation in relation to exercise, cholesterol and obesity.

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic, must disclose such relationships at the time they accept an invitation to write for SMB.