The vast majority of people with high cholesterol can use statin drugs without fear of serious muscle side effects, according to a large study using a new calculator for assessing such risks.
Concerns about muscle weakness and aches keep many people from using the medicines, unnecessarily it turns out.
More than 98% of people identified by their doctors as eligible for statin treatment were predicted to be at low risk of serious muscle disorders over the next decade in the study published in The Lancet Digital Health.
Using health records from more than 5.6 million people across England, researchers developed and then tested a calculator that estimates a person's risk of developing serious muscle disorders from statins.
The model incorporates 22 routinely recorded factors including age, sex, ethnicity, body mass index, smoking status, existing health conditions, previous muscle problems, vitamin D deficiency, and medication use to estimate an individual's risk of serious muscle disorders over one, five and 10 years.
More than 60% of people eligible for statin treatment were not taking them, despite some being at high risk of heart attack or stroke, the analysis also showed. Statins have been shown to significantly reduce the risk of heart attacks and strokes.
The researchers focused on serious muscle disorders leading to hospital admission or death, rather than milder symptoms such as aches and pains. Many mild muscle symptoms reported during statin treatment are not actually caused by statins and shouldn’t prevent patients from starting statin treatment, the researchers said.
"Serious muscle disorders are one of the most widely discussed concerns about statins, but our findings suggest that the risk is very low for the vast majority of people who may benefit from treatment,” study leader Dr. Ting Cai at the University of Oxford said in a statement.
“For the small number of people at higher risk, it gives clinicians a clearer basis for discussing monitoring, checks or alternative treatment options,” Cai said.
Her team called for additional studies to test the tool in more diverse populations.
Separately, in studies in mice, researchers investigating why some people do develop statin myopathies found that when the drugs block the pathways that produce cholesterol, they also block production of other molecules. Those alterations may lead to metabolic stress and act as danger signals that activate inflammatory processes that can contribute to muscle wasting and cell death.
Therefore, some side effects might arise from the loss of these other molecules rather than from cholesterol reduction itself, the researchers reported in Science Advances.
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