June 20, 2013
Statin Use Incurs Risk for Musculoskeletal Conditions
Thomas L. Schwenk, MD reviewing Mansi I et al. JAMA Intern Med 2013 Jun 3.
Muscle injuries as well as myalgia and weakness might be attributable to these drugs.
Statin use has been associated with excess risk for myalgia, muscle weakness, muscle cramps, and rhabdomyolysis. Many clinicians would say the more they ask statin users about muscle conditions, the more they uncover.
In a retrospective cohort study from the military healthcare system, investigators identified about 14,000 patients who used statins for at least 90 days and 37,000 nonusers. Statin users were significantly more likely to have a wide range of cardiac risk factors and diagnoses, as well as other chronic diseases, but the investigators were able to match about 7000 patients in each group for 42 baseline characteristics. During 4.5 years of observation, the likelihood of statin users (compared with nonusers) developing one or more of a large diagnostic cluster of musculoskeletal conditions was 19% higher; risk for acute musculoskeletal injuries such as strains and sprains was 13% higher, and musculoskeletal pain was 9% more common (all between-group differences were significant). The likelihood of having osteoarthritis and other arthropathies was 7% higher (P=0.07).
Comment
The excess risk for strains, sprains, and other injuries is biologically plausible, based on the known problems of muscle weakness, concerns about associated tendinopathies, and inhibition of coenzyme Q10 synthesis (which affects muscle metabolism). Muscle conditions are of sufficient importance and prevalence to constitute an essential factor in deciding whether statin use is appropriate for a given patient.
