Statins and Muscle Pain:
Rhabdomyolysis is the rapid breakdown of skeletal muscle (or rhabdomyo). It is due to muscle damage caused by physical force or biological or chemical influence. The muscle damage results in the release of products into the bloodstream such as myoglobin… a protein which is harmful to the kidney and can result in kidney failure.
Some estimates state that about 1 in 10,000 statin users develop rhabdomyolysis. The percentage goes up significantly if fibrate treatment is added. Grapefruit juice can also cause problems.
Muscle damage is normally associated with high levels of an enzyme known as creatine phosphokinase. A CPK isoenzymes test can detect CPK thereby suggesting that muscle damage has occurred. However, according to Richard H. Karas, MD, PhD, the test is not flawless. In an interview with WebTV he said…
"We found that these patients can have evidence of microscopic damage to their muscles even with a normal CPK."In other words... muscle damage due to statin use can be present even when the CPK test is negative.
"Our findings call into question whether normal or mildly elevated levels of serum (CPK) can be used to exclude underlying and possibly ongoing muscle injury."Does that mean heart patients should discontinue use of statins for fear of having undetected muscle damage? No! The percentage of patients using statins that suffer from life threatening rhabdomyolysis is extremely rare. However it is important to be aware of the slight – but potentially serious – side effects of muscle damage associated with statin use.
Statins and Muscle Pain on a Less Serious Level
Even when there is no threat to life, the combination of statins and muscle pain can be a nagging irritation. But do some statins cause muscle pain more than others?
There are actually two classifications of statins. Some are fat soluble. Others are water soluble. Fat soluble statins enter inside the muscle cell much more readily than water soluble statins. In theory – then – water soluble statins should be less likely to cause muscle pain.
So is the association of statins and muscle pain more prevalent in fat soluble statins?
There is no direct evidence to suggest that fat soluble statins cause more muscle pain than water soluble ones. However the connection of statins and muscle pain varies from patient to patient. That is… most patients experience no muscle pain with statin use.
Some patients experience muscle pain with one statin drug but not with another. Further… some patients experience muscle pain at the early stages of statin treatment. However, with continued use the pain goes away.
But what if it doesn't?Many doctors recommend discontinuing statin use until muscle pain symptoms subside. Some will prescribe a different statin and monitor the patient’s response.
CoQ10, Statins, and Muscle Pain
A number of doctors associate the connection of statins and muscle pain with CoQ10 deficiency.
It is widely accepted that Coenzyme Q10 is essential for the production of cellular energy. Because of the high metabolic needs of the heart – Congestive heart failure has been linked to CoQ10 deficiency as well.
It is also known that statin use depletes CoQ10 levels. It is therefore suggested by many holistic doctors that patients using statins should supplement with CoQ10.
An article appearing in PubMed entitled "Effect of coenzyme q10 on myopathic symptoms in patients treated with statins" tested the relationship between statin induced muscle pain and CoQ10 supplementation. Patients were randomly assigned to two groups and evaluated after 30 days. The first group received 100 mg/day CoQ10. The other group received 400IU/day vitamin-E.
After a 30-day intervention, pain severity decreased by 40% (p <0.001) and pain interference with daily activities decreased by 38% (p <0.02) in the group treated with coenzyme Q10. In contrast, no changes in pain severity (+9%, p = NS) or pain interference with daily activities (-11%, p = NS) was observed in the group treated with vitamin E.If the connection between statins and muscle pain is related to insufficient cellular energy then CoQ10 supplementing may help. Since CoQ10 deficiency has been connected to congestive heart failure, and statins are known to deplete CoQ10 levels - It is no wonder a number of doctors recommend CoQ10 supplements for patients using statins.
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