If you or someone you know has experienced side effects from cholesterol medications, a mouse study recently published in the journal Nature Journal of Clinical Investigation Maybe there will be an answer. Scientists outline how despite being one of the most commonly prescribed drugs, Treatment for high cholesterola large proportion of people are intolerant to statins. While many people take the drug without any problems, about 10% of users develop a painful side effect called statin-associated muscle symptoms (SAMS), which causes muscle soreness. Historically, the cause of SAMS has been unclear. Now, scientists say they have discovered a potential cause of painful symptoms associated with statins, which could lead to breakthroughs in limiting these side effects.
Meet the experts: Katherine Benziger, MDmember of the American College of Cardiology Committee on Cardiovascular Disease Prevention; Chen Chenghan, MDBoard-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California
Researchers believe they have found a plausible mechanistic explanation for why some people experience muscle weakness, aches and pains while taking statins. Research suggests that the culprit may not be the drug itself, but a genetic mutation that affects skeletal muscle receptors, which in turn causes changes in calcium release when statins are introduced into the system.
The study was conducted using mouse models, with one group containing wild-type or unmodified mice and another group containing mice with the genetic mutation. After giving both groups of patients a statin called simvastatin, the researchers found that the group with the mutation was more likely to develop SAMS due to the influx of calcium into muscle cells.
Next, we spoke with cardiologists to break down the findings and their implications.
Why are the findings important?
While the side effects of statin use may make some users intolerant to the drug class, the drug remains one of the most effective ways to lower LDL (or “bad”) cholesterol levels, so it’s important to understand why some patients may experience these symptoms. “Statins are a very effective and proven therapy that lower cholesterol and reduce the risk of heart attack, strokes,” explained Katherine Benziger, MDa member of the American College of Cardiology Committee on Cardiovascular Disease Prevention. “But I see many patients in my clinic complaining of muscle pain and cramping after starting statins… Sometimes the symptoms are mild and the medication can be continued, but sometimes the symptoms are severe and the medication must be stopped.”
“Statin-related muscle symptoms are the most common reason people stop taking statins,” says Chen Chenghan, MDis a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California. “Better understanding of the causes of these symptoms may help us find ways to reduce these effects and help patients continue to take these important medications.”
Dr. Benziger said the study’s findings are significant because they identify specific biological mechanisms that may lead to SAMS. “When a mechanism is supported by basic science and clinical research, it becomes easier to counsel patients and educate them about what the possible side effects are,” she explains. “It can also improve our understanding of who may be more susceptible, particularly those with genetic mutations, and how we can prevent them.”
Dr. Chen added that the findings not only suggest that a genetic mutation may cause SAMS, but that “drugs targeting this mutation could prevent these symptoms.” This “may help us treat these side effects and help patients continue to take the statins they need.”
What does this mean to you?
If you are starting or already taking a statin, do not stop. It is important to closely monitor any side effects you experience and communicate them to your doctor. “If a patient experiences muscle side effects, I tell [them] “Stop taking your statin for five to seven days to make sure the muscle side effects go away, and then start again,” says Dr. Benziger. If symptoms return, she recommends working with your doctor to switch to a different drug or reduce the dose.
Are there alternatives to statins?
Dr. Chen said that in many cases, the side effects disappear once you switch to a different strain. Still, some people may not be able to tolerate statins at all. Dr. Benziger warns that this doesn’t mean you should stop treatment altogether. “The key is to get your LDL to target! It’s critical not to neglect cholesterol management, especially for people with diabetes, kidney disease, a history of heart disease, an elevated coronary calcium score, or other risk factors.” If you are intolerant to statins, Dr. Chen and Dr. Benziger recommend working with your doctor to find alternative medications, such as PCSK9 inhibitors or benzoic acid.
bottom line
While the biological mechanisms revealed by these results provide a promising new perspective on why some statin users experience SAMS, there is still much we don’t know. “These findings have only been studied in mouse models. Future studies are needed to determine whether these findings also apply to humans,” Dr. Chen noted.
Still, if future studies further validate these findings and show they can be replicated, Dr. Benziger is optimistic that those who are eligible to take statins to treat high cholesterol will benefit, given the findings.”[offer] Hypotheses for future therapies that could reduce these side effects or improve treatments without this limitation. “
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