An explanation of how statins cause low rates of muscle symptoms

In the January 2009 issue of the American Journal of Medicine, Florida Atlantic University researcher Charles H. Hennekens, M.D., the first Sir Richard Doll Research Professor in the Charles E. Schmidt College of Biomedical Science and a renowned expert who has revealed numerous causal, therapeutic and preventive factors in the treatment and prevention of cardiovascular disease (CVD), most notably low-dose aspirin, explains why statins cause low rates of muscle symptoms.

Statins are used for the treatment of lipid disorders, in particular, elevated LDL (bad) cholesterol in patients with and without prior CVD.

According to the American Heart Association, approximately 105 million Americans age 20 and older have total blood cholesterol levels of 200 mg/dL and higher, 50 million are men and 55 million are women. Of these, about 42 million have total blood cholesterol levels of 240 mg/dL or higher, 18 million are men and 24 million are women. The higher the LDL cholesterol levels, the greater the risks of heart attacks, strokes and deaths from CVD.

“Statins need to be more widely used in evidence based doses for the treatment of lipid disorders, in particular, elevated LDL cholesterol in patients with and without prior cardiovascular disease,” said Hennekens. “They reduce the risks of heart attacks by about one third, strokes by about one quarter and deaths from cardiovascular disease by about one fifth.”

In the U.S. today, for secondary prevention, approximately 12.4 million people are eligible for treatment with statins, and for primary prevention, approximately 24 million are eligible. “Unfortunately, in the U.S. today, only about one in three eligible patients are receiving statins, and of those, only about 37% are getting to their U.S. federal goal for LDL,” said Hennekens.

Part of the problem is the perception by patients that statins increase the risk of muscle symptoms. Hennekens points out that in a major randomized trial using the highest dose of the most potent statin for two years, one in eight patients taking a placebo complained of muscle symptoms. In addition, however, one in eight patients on the statin also complained of muscle symptoms. In contrast, in most clinical practices it would not be uncommon for one in eight patients on a statin to complain of muscle symptoms. Hennekens speculates that consumer advertising of these drugs which, by federal law, must mention even rare side effects prominently may be playing a role.

Hennekens believes that the more widespread and appropriate use of evidence based doses of the more potent statins would avoid tens of thousands of premature deaths from CVD in the U.S. each year. “Health care providers are doing more good for more patients than perhaps ever before, due to earlier diagnoses and aggressive management of their patients, contributing to the greatest life expectancy ever in the U.S.,” said Hennekens.

Florida Atlantic University opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 26,000 undergraduate and graduate students on seven campuses strategically located along 150 miles of Florida's southeastern coastline. Building on its rich tradition as a teaching university, with a world-class faculty, FAU hosts ten colleges: College of Architecture, Urban & Public Affairs, Dorothy F. Schmidt College of Arts & Letters, the Charles E. Schmidt College of Biomedical Science, the Barry Kaye College of Business, the College of Education, the College of Engineering & Computer Science, the Harriet L. Wilkes Honors College, the Graduate College, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science.