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Javier
medicine forum addict
Joined: 20 Jun 2005
Posts: 99
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 Posted: Sat May 27, 2006 8:28 pm Post subject:
Statins and muscle damage
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How would I know if statins are damaging any of my muscles. I have no
aches or pains except after I train hard, at which point my legs may be
a bit sore. After a year of being on Vytorin am I out of the woods as
far as muscle damage goes?
Javier |
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William Wagner
medicine forum Guru
Joined: 29 Apr 2005
Posts: 809
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| Posted: Sat May 27, 2006 8:41 pm Post subject:
Re: Statins and muscle damage
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In article <1148761694.693735.242460@j33g2000cwa.googlegroups.com>,
"Javier" <rojasj@gmail.com> wrote:
| Quote: | How would I know if statins are damaging any of my muscles. I have no
aches or pains except after I train hard, at which point my legs may be
a bit sore. After a year of being on Vytorin am I out of the woods as
far as muscle damage goes?
Javier
Measure your calf and forearms. Document with your doctors. |
I lost 22 % so please monitor. Gradual loss is hard to perceive so
check often ,
Rare but hurts like hell when it is you.
Bill no Doctor
--
S Jersey USA Zone 5 Shade
This article is posted under fair use rules in accordance with
Title 17 U.S.C. Section 107, and is strictly for the educational
and informative purposes. This material is distributed without profit. |
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Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
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| Posted: Sat May 27, 2006 8:56 pm Post subject:
Re: Statins and muscle damage
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In article <1148761694.693735.242460@j33g2000cwa.googlegroups.com>,
"Javier" <rojasj@gmail.com> wrote:
How would I know if statins are damaging any of my muscles. I have no
aches or pains except after I train hard, at which point my legs may be
a bit sore. After a year of being on Vytorin am I out of the woods as
far as muscle damage goes?
Javier
Javier,
I am not a doctor. I did have similar problems. You should have a blood
creatinine and a blood creatine kinase test ASAP. You should have kidney
function and liver function blood and urine tests. Also, download this
report:
http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm
Some other blood and urine tests are mentioned in that report.
Also, read this book ASAP
WHAT YOU MUST KNOW ABOUT STATIN DRUGS AND THEIR NATURAL ALTERNATIVES
by Jay S. Cohen, M.D.
I hope that the muscle problems were not the result of statin side effects.
Jason |
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
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| Posted: Sat May 27, 2006 11:42 pm Post subject:
Re: Statins and muscle damage
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Javier wrote:
| Quote: | How would I know if statins are damaging any of my muscles. I have no
aches or pains except after I train hard, at which point my legs may be
a bit sore. After a year of being on Vytorin am I out of the woods as
far as muscle damage goes?
Javier
|
Despite the other replies you got to this, the correct answer is that no
one really knows for sure. Very little has been published on the time
course of statin-induced muscle injury -- one study (perhaps the best)
looked at only 44 patients with statin myopathy and found that 2/3 had
developed it within 6 months, but some seemed to develop myopathy out
past a year. Since there's no way to be absolutely certain that all
these patients had myopathy due to statins, though, it's not possible to
be sure particularly as to the longest time periods.
Most people would agree that statin myopathy can occur anytime the dose
is increased. Whether there is cumulative injury to muscles in people
without any symptoms remains uncertain, but, despite the frequent
reports on this newsgroup of bad outcomes, most people tolerate statins
for years without any evidence of injury.
There's no simple way you can know for sure. A blood test is unlikely to
be of help since people can have high muscle enzyme values without
injury and normal values despite injury. A muscle biopsy would likely
provide an answer, but seems like overkill since in someone without
symptoms the likelihood of finding any damage is probably very small.
--
David Rind
drind@caregroup.harvard.edu |
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William Wagner
medicine forum Guru
Joined: 29 Apr 2005
Posts: 809
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| Posted: Sat May 27, 2006 11:51 pm Post subject:
Re: Statins and muscle damage
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In article <e5ao2c$p1g$1@reader1.panix.com>,
David Rind <drind@caregroup.harvard.edu> wrote:
| Quote: | Javier wrote:
How would I know if statins are damaging any of my muscles. I have no
aches or pains except after I train hard, at which point my legs may be
a bit sore. After a year of being on Vytorin am I out of the woods as
far as muscle damage goes?
Javier
Despite the other replies you got to this, the correct answer is that no
one really knows for sure. Very little has been published on the time
course of statin-induced muscle injury -- one study (perhaps the best)
looked at only 44 patients with statin myopathy and found that 2/3 had
developed it within 6 months, but some seemed to develop myopathy out
past a year. Since there's no way to be absolutely certain that all
these patients had myopathy due to statins, though, it's not possible to
be sure particularly as to the longest time periods.
Most people would agree that statin myopathy can occur anytime the dose
is increased. Whether there is cumulative injury to muscles in people
without any symptoms remains uncertain, but, despite the frequent
reports on this newsgroup of bad outcomes, most people tolerate statins
for years without any evidence of injury.
There's no simple way you can know for sure. A blood test is unlikely to
be of help since people can have high muscle enzyme values without
injury and normal values despite injury. A muscle biopsy would likely
provide an answer, but seems like overkill since in someone without
symptoms the likelihood of finding any damage is probably very small.
|
So Would it prudent to measure calf and forearm dimensions ?
Bill
--
S Jersey USA Zone 5 Shade
This article is posted under fair use rules in accordance with
Title 17 U.S.C. Section 107, and is strictly for the educational
and informative purposes. This material is distributed without profit. |
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Javier
medicine forum addict
Joined: 20 Jun 2005
Posts: 99
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| Posted: Sun May 28, 2006 12:08 am Post subject:
Re: Statins and muscle damage
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| Quote: | Measure your calf and forearms. Document with your doctors.
I lost 22 % so please monitor. Gradual loss is hard to perceive so
check often ,
Rare but hurts like hell when it is you.
|
Thanks Bill, I'll have to keep an eye on things. I'll ask my doctor
about the tests. As of now my calfs and legs are bigger due to my
constant bike rididng ( I mostly train up hill) and my forearms are a
bit smaller due to all the fat I lost but they are much more defined,
vascular and stronger. |
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Joe Doe
medicine forum beginner
Joined: 24 Jan 2006
Posts: 35
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| Posted: Sun May 28, 2006 2:05 am Post subject:
Re: Statins and muscle damage
|
|
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In article <1148774898.566651.306910@38g2000cwa.googlegroups.com>,
"Javier" <rojasj@gmail.com> wrote:
| Quote: | Measure your calf and forearms. Document with your doctors.
I lost 22 % so please monitor. Gradual loss is hard to perceive so
check often ,
Rare but hurts like hell when it is you.
Thanks Bill, I'll have to keep an eye on things. I'll ask my doctor
about the tests. As of now my calfs and legs are bigger due to my
constant bike rididng ( I mostly train up hill) and my forearms are a
bit smaller due to all the fat I lost but they are much more defined,
vascular and stronger.
|
Ironically heavy exercise is one of the risk factors for developing
rhabdomyolysis. For example see a recent review in Am J Med. 2006
May;119(5):400-9
Clinical perspectives of statin-induced rhabdomyolysis.
Antons KA, Williams CD, Baker SK, Phillips PS.
Scripps Mercy Clinical Research Center, Scripps Mercy Hospital, San
Diego, Calif 92103, USA.
Fear of muscle toxicity remains a major reason that patients with
hyperlipidemia are undertreated. Recent evaluations of statin-induced
rhabdomyolysis offer new insights on the clinical management of both
muscle symptoms and hyperlipidemia after rhabdomyolysis. The incidence
of statin-induced rhabdomyolysis is higher in practice than in
controlled trials in which high-risk subjects are excluded. Accepted
risks include age; renal, hepatic, and thyroid dysfunction; and
hypertriglyceridemia. New findings suggest that exercise, Asian race,
and perioperative status also may increase the risk of statin muscle
toxicity. The proposed causes and the relationship of drug levels to
statin rhabdomyolysis are briefly reviewed along with the problems with
the pharmacokinetic theory. Data suggesting that patients with certain
metabolic abnormalities are predisposed to statin rhabdomyolysis are
presented. The evaluation and treatment of patients' muscle symptoms and
hyperlipidemia after statin rhabdomyolysis are presented. Patients whose
symptoms are related to other disorders need to be identified. Lipid
management of those whose symptoms are statin-related is reviewed
including treatment suggestions.
Roland |
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
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| Posted: Sun May 28, 2006 2:43 am Post subject:
Re: Statins and muscle damage
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William Wagner wrote:
| Quote: | So Would it prudent to measure calf and forearm dimensions ?
Bill
|
Not unless there's some evidence that such measurements can separate
people with muscle toxicity from people without muscle toxicity. Do you
know of a study showing this?
--
David Rind
drind@caregroup.harvard.edu |
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David Rollo
medicine forum beginner
Joined: 27 May 2006
Posts: 2
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| Posted: Sun May 28, 2006 1:02 pm Post subject:
Re: Statins and muscle damage
|
|
|
David Rind wrote:
| Quote: | A blood test is unlikely to be of help since people can have
high muscle enzyme values without injury and normal values
despite injury
|
However, depending on how we are defining "injury", is it not
fair to say that if (1) there is no enzyme elevation, and (2)
there are no symptoms, then there is no injury? Or in other
words, no need to worry?
A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
B. Some people** have chosen to identify high levels of
prostaglandin F as indicating statin-induced "oxidative injury",
which may therefore be a marker of a concealed form of muscle or
other damage. The evidence for this seems to me weak,
circumstantial and lacking clinical relevance, but it's an area
that needs more work.
David Rollo
** Sinzinger H et al (2002) Drug Safety 25:877-883 |
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
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| Posted: Sun May 28, 2006 1:44 pm Post subject:
Re: Statins and muscle damage
|
|
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David Rollo wrote:
| Quote: | David Rind wrote:
A blood test is unlikely to be of help since people can have
high muscle enzyme values without injury and normal values
despite injury
However, depending on how we are defining "injury", is it not
fair to say that if (1) there is no enzyme elevation, and (2)
there are no symptoms, then there is no injury? Or in other
words, no need to worry?
|
Well, it seemed to me that that was the crux of what the OP was really
asking.
In general, I think the assumption is as you imply: if there are no
symptoms and no enzyme elevation than everything is fine.
I think that assumption is probably correct for the vast majority of
people who take statins (maybe for all of them), but I'm not sure we
really have solid evidence to back it up. It seems conceivable that
someone without obvious symptoms could still lose muscle strength over
years of taking statins.
For someone taking a statin for a reasonable indication (such as an
actually elevated risk of cardiovascular disease that could be lowered
to a significant degree by a statin) it's unlikely that an unproven risk
of long-term muscle weakness is worth worrying about at this point.
But I have seen a lot of people given statins for remarkably weak
indications -- for instance, women in their 20's with no CHD risk
factors who have LDL's in the 150-160 range and are placed on statins.
We don't really know what statins might do to their muscle over the next
40 years, and it's likely to be many decades before they develop CHD
even without a statin.
--
David Rind
drind@caregroup.harvard.edu |
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Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
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| Posted: Sun May 28, 2006 4:15 pm Post subject:
Re: Statins and muscle damage
|
|
|
In article <e5c9dn$i7i$1@reader1.panix.com>, David Rind
<drind@caregroup.harvard.edu> wrote:
David Rollo wrote:
| Quote: | David Rind wrote:
A blood test is unlikely to be of help since people can have
high muscle enzyme values without injury and normal values
despite injury
However, depending on how we are defining "injury", is it not
fair to say that if (1) there is no enzyme elevation, and (2)
there are no symptoms, then there is no injury? Or in other
words, no need to worry?
|
Well, it seemed to me that that was the crux of what the OP was really
asking.
In general, I think the assumption is as you imply: if there are no
symptoms and no enzyme elevation than everything is fine.
I think that assumption is probably correct for the vast majority of
people who take statins (maybe for all of them), but I'm not sure we
really have solid evidence to back it up. It seems conceivable that
someone without obvious symptoms could still lose muscle strength over
years of taking statins.
For someone taking a statin for a reasonable indication (such as an
actually elevated risk of cardiovascular disease that could be lowered
to a significant degree by a statin) it's unlikely that an unproven risk
of long-term muscle weakness is worth worrying about at this point.
But I have seen a lot of people given statins for remarkably weak
indications -- for instance, women in their 20's with no CHD risk
factors who have LDL's in the 150-160 range and are placed on statins.
We don't really know what statins might do to their muscle over the next
40 years, and it's likely to be many decades before they develop CHD
even without a statin.
I done some research on this subject last year when I developed muscle
problems as a result of taking statins. I found out (at that time) that
checking the blood levels of creatine kinase (CK) was the best method
of finding out if a patient is experiencing muscle wasting or rhabdomyolysis.
There now may be newer and better tests that I am not aware of. I doubt
that most doctors would do a muscle biopsy since insurance programs would
probably not approve it. There are more blood tests and urine tests mentioned
at this web site:
http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm |
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
|
| Posted: Sun May 28, 2006 5:00 pm Post subject:
Re: Statins and muscle damage
|
|
|
Jason Johnson wrote:
| Quote: | I done some research on this subject last year when I developed muscle
problems as a result of taking statins. I found out (at that time) that
checking the blood levels of creatine kinase (CK) was the best method
of finding out if a patient is experiencing muscle wasting or rhabdomyolysis.
|
There is no evidence that I know of that checking a CK tells anything at
all about "muscle wasting" in patients on statins. It's not even known
if statins cause "muscle wasting". Feel free to post a citation to a
primary study if you think otherwise.
CK is commonly elevated in people who have muscle symptoms (pain,
weakness, decreased exercise tolerance) on statins, but there is good
evidence that not everyone has an elevated CK even when a statin is
responsible for such symptoms.
As for rhabdomyolysis, a CK would certainly answer that question, but
rhabdo is a rare problem and is not asymptomatic. It has nothing to do
with the OP's question.
--
David Rind
drind@caregroup.harvard.edu |
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Andrew B. Chung, MD/PhD
medicine forum Guru
Joined: 25 Mar 2005
Posts: 8540
|
| Posted: Sun May 28, 2006 5:02 pm Post subject:
Re: Statins and muscle damage
|
|
|
David Rollo wrote:
| Quote: | David Rind wrote:
A blood test is unlikely to be of help since people can have
high muscle enzyme values without injury and normal values
despite injury
However, depending on how we are defining "injury", is it not
fair to say that if (1) there is no enzyme elevation, and (2)
there are no symptoms, then there is no injury? Or in other
words, no need to worry?
|
That is the best we can do at the moment.
| Quote: | A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
|
For us non-prophets, correct :-)
| Quote: | B. Some people** have chosen to identify high levels of
prostaglandin F as indicating statin-induced "oxidative injury",
which may therefore be a marker of a concealed form of muscle or
other damage. The evidence for this seems to me weak,
circumstantial and lacking clinical relevance, but it's an area
that needs more work.
|
Would concur.
In my cardiology practice, the concerns about long-term adverse effects
on muscle and brain have actually turned out to be a blessing because
it serves as an extra motivation for my patients to follow the
recommendations that I give that ultimately get most of them off
statins.
Again, welcome back :-)
Prayerfully in Christ's amazing love,
Andrew
http://tinyurl.com/jjl29 |
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eml
medicine forum Guru Wannabe
Joined: 12 Jun 2005
Posts: 135
|
| Posted: Sun May 28, 2006 9:14 pm Post subject:
Re: Statins and muscle damage
|
|
|
| Quote: | David Rind wrote:
A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
|
the following may interest those responding to this OP:
"Statins may alter the response of muscle to exercise stress by
altering the action of the UPP, protein folding, and catabolism,
disrupting the balance between protein degradation and repair. "
Atherosclerosis and Lipoproteins
Changes in Ubiquitin Proteasome Pathway Gene Expression in Skeletal
Muscle With Exercise and Statins
Maria L. Urso; Priscilla M. Clarkson; Dustin Hittel; Eric P. Hoffman;
Paul D. Thompson
| Quote: | From the Department of Exercise Science (M.L.U., P.M.C.), University of
|
Massachusetts, Amherst, Mass; the Division of Cardiology (P.D.T.),
Henry Low Heart Center, Hartford Hospital, Hartford, Conn; and the
Research Center for Genetic Medicine (D.H., E.P.H.), Children's
National Medical Center, Washington DC.
Objective- Statins are safe medications but have side effects
including myalgia and rhabdomyolysis. How statins provoke muscle damage
is not known, but this effect is exacerbated by exercise.
Methods and Results- Healthy subjects took Atorvastatin (80 mg/daily)
or placebo for 4 weeks. Biopsies of both vastus lateralis muscles were
performed 8 hours after eccentric exercise (known to result in muscle
soreness and damage) of the left leg at baseline and the right leg
after statin/placebo treatment. Gene expression was determined using
Affymetrix GeneChips, and selected genes confirmed by polymerase chain
reaction (qRT-PCR). Atorvastatin had little effect on gene expression
at rest. When combined with exercise, 56 genes were differentially
expressed with 18% involved in the ubiquitin proteasome pathway (UPP)
and 20% involved in protein folding and catabolism, and apoptosis.
Conclusion- This is the first investigation to our knowledge to
implicate involvement of the UPP in skeletal muscle in response to
combined exercise and statin treatment, possibly explaining the onset
of myalgia with exertion. Statins may alter the response of muscle to
exercise stress by altering the action of the UPP, protein folding, and
catabolism, disrupting the balance between protein degradation and
repair.
Statins are safe medications but have side effects including myalgia
and rhabdomyolysis. How statins provoke muscle damage is not known, but
this effect is exacerbated by exercise. This is the first investigation
to our knowledge to implicate involvement of the UPP in skeletal muscle
in response to combined exercise and statin treatment, possibly
explaining the onset of myalgia with exertion. Statins may alter the
response of muscle to exercise stress by altering the action of the
UPP, protein folding, and catabolism, disrupting the balance between
protein degradation and repair.
Key Words: gene expression · exercise · cardiovascular pharmacology
Related Article:
Mechanisms of Statin-Induced Myopathy: A Role for the
Ubiquitin-Proteasome Pathway?
M. John Chapman and Alain Carrie
Arterioscler. Thromb. Vasc. Biol. 2005 25: 2441-2444. [Full Text |
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Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
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| Posted: Sun May 28, 2006 10:07 pm Post subject:
Re: Statins and muscle damage
|
|
|
In article <e5ckqr$6n5$1@reader1.panix.com>, David Rind
<drind@caregroup.harvard.edu> wrote:
Jason Johnson wrote:
| Quote: | I done some research on this subject last year when I developed muscle
problems as a result of taking statins. I found out (at that time) that
checking the blood levels of creatine kinase (CK) was the best method
of finding out if a patient is experiencing muscle wasting or rhabdomyolysis.
|
There is no evidence that I know of that checking a CK tells anything at
all about "muscle wasting" in patients on statins. It's not even known
if statins cause "muscle wasting". Feel free to post a citation to a
primary study if you think otherwise.
CK is commonly elevated in people who have muscle symptoms (pain,
weakness, decreased exercise tolerance) on statins, but there is good
evidence that not everyone has an elevated CK even when a statin is
responsible for such symptoms.
One CK blood tests means nothing. However, if statin patient takes a CK
blood test every two months and the CK levels keeps going higher and
higher--that is evidence that the statins are the source of the problem
and symptoms. That's the reason that doctors conduct blood and urine tests
on statins patients on a regular basis to keep track of their Creatinine,
CK levels. They may also check other items on the blood and urine kidney
and liver function tests.
As for rhabdomyolysis, a CK would certainly answer that question, but
rhabdo is a rare problem and is not asymptomatic. It has nothing to do
with the OP's question.
I agree--but any patient that takes statins should be aware of the
symptoms of Rhaddomyolysis. That's my opinion. They symptoms are mentioned
in this report:
http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm
Just because it is a rare problem does not mean that it never happens.
Some statin patients may have it and not even be aware of it. They may
blame the symptoms on other things such as the regular pains assoiciated
with some types of exercises such as weight lifting or jogging.
Jason |
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