Statin Intolerance • Statin Associated Muscle Symptoms
How do I treat my high cholesterol?
High cholesterol is unhealthy. To treat high cholesterol, it is important to have a healthy diet and lifestyle. Some people will also need medicine. Statins are the most common medicine to lower high cholesterol and most people can tolerate taking a statin.
What is Statin Intolerance?
Statin intolerance is a problem, most commonly muscle related, that started after taking a statin medicine. This problem goes away when you stop or decrease the amount (dose) of your statin. You should try at least 2 statins, 1 at its lowest dose, before you and your healthcare clinician say you are statin intolerant.
Statin Associated Muscle Symptoms
The most common reason for statin intolerance is statin-associated muscle symptoms or “SAMS.” SAMS are musclerelated symptoms like muscle pain, aching, tenderness, stiffness, cramps, and weakness.
Where is the pain?
SAMS are usually on the thighs, buttocks, back, and shoulder muscles. You might also experience cramps in the hands and feet. The pain is usually, but not always, on both sides of your body, for example both thighs or shoulders.
When did the pain start?
Symptoms usually appear within 30 days after starting a statin or after an increase in the amount (dose) of a statin. Pain that you felt before starting a statin does not apply towards statin intolerance.
Should I keep taking my statin if I feel muscle pain?
Most people can take some amount of a statin, even if it is only a little. Talk to your healthcare clinician about strategies to help your ability to take a statin before stopping because stopping your statin may increase your risk of a heart attack or stroke.
I know it is important to lower my cholesterol but how do I help the muscle pain?
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Lower the amount of the same statin
Even a small amount of statin medicine can lower your cholesterol. Your healthcare clinician may lower the dose of your statin or tell you not to take your statin every day to help your muscle pain.
Try a different statin
Your healthcare clinician might try a different kind of statin to see if your pain gets better. There are many different statins that can help lower your cholesterol. They are each unique and every person reacts differently to each one.
Try other medicines that are not statins
There are many other medicines that can lower your cholesterol that are not statins, called “non-statins.” After you have tried at least two different statins, you and your healthcare clinician should discuss other medicines to lower your cholesterol as well as healthy diet and lifestyle. Even while you are taking a non-statin, you and your healthcare clinician should continue to try to find a dose of statin that works for you.
Should I take supplements to fix the muscle pain?
Whether supplements like vitamin D, red yeast rice, and CoQ10 help to improve muscle pain has not been studied. Although these may be helpful while you continue to take your statin and non-statin medication, you should talk to your healthcare clinician before taking any supplements.
I am Statin Intolerant?
Some people have trouble taking statins, but most people (95%) can take some dose of a statin. Ask yourself the following questions if you are taking a statin and having a problem while you are taking a statin?
- Did the problem, pain, or hurt start after starting a statin?
If the problem, pain, or hurt started before taking a statin, the problem, pain, or hurt is not related to taking a statin and you are unlikely to be statin intolerant.
2. Did my healthcare clinician and I change my statin to a different statin?
If you have only tried one statin, you and your healthcare clinician should discuss trying a second different statin to see if the problem, pain, or hurt still happens.
3. Was one of my statins at the lowest dose?
Statins have different possible doses, including higher and lower doses. If you haven’t tried one of your statins at the lowest available daily dose, you and your healthcare clinician should discuss changing your dose to the lowest available dose to see if the problem, pain, or hurt still happens.
How do I lower my cholesterol if I am not able to take a statin?
After you have tried at least two different statins, you and your healthcare clinician should discuss an appropriate non-statin medicine or medicines to lower your cholesterol while continuing a healthy diet and lifestyle.
References:
- Cheeley MK, Saseen JJ, Agarwala A, Ravilla S, Ciffone N, Jacobson TA, Dixon DL, Maki KC. NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient. J Clin Lipidol. 2022 Jul-Aug;16(4):361-375. doi: 10.1016/j.jacl.2022.05.068. Epub 2022 Jun 9. PMID: 35718660.
- Warden BA, Guyton JR, Kovacs AC, Durham JA, Jones LK, Dixon DL, Jacobson TA, Duell PB. Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association. J Clin Lipidol. 2022 Sep 11:S1933-2874(22)00245-8. doi: 10.1016/j.jacl.2022.09.001. Epub ahead of print. PMID: 36115813.