What Should A Heart Patient Do About Joint Pain And Atorvastatin
We agree with the cardiac nurse that the cardiologist might want to reevaluate his prescription for atorvastatin. For one thing, 80 mg is a high dose. Perhaps a different statin at a lower dose would have benefits without side effects.
For those who cannot tolerate any statins, we offer our Guide to Cholesterol Control and Heart Health, in which we discuss other ways to reduce the risk of heart attacks.
Statin Side Effects Risk Factors
Some things can increase your risk of side effects with statins. You may be more likely to have side effects if you:
- Take more than one medication to control your cholesterol
- Are a woman
- Have a small body frame
- Are 80 or older
- Have kidney or liver disease
- Drink a lot of alcohol
- Have some other health conditions, such as hypothyroidism or neuromuscular disorders
The Major Side Effects Of Statin Drugs
Giving a patient a statin means implictly making a trade off beteen cardiovascular benefits and metabolic risk.
While regulatory agencies have deemed statins to be safe to use for their intended purpose, no drug is without side effects in susceptible individuals. As the use of statin drugs continues to increase and people have been taking statins for over a decade – a significantly longer than the time period required for testing drugs – we are learning more about the side effects in large populations.
The drug companies that manufacture statins have added a warning to the medicines’ advertising and labels that was not present when statins first hit the market. The warning tells patients about the possibility of muscle pain and weakness as a rare but serious side effect.
Muscle pain and muscle weakness are two of the main side effects of statin drugs. The scientists who study this put them in a category called muscle-related adverse effects Another common side effect is memory loss. Anyone who is taking statin drugs for any reason should be aware of these side effects and their symptoms. The medical establishment recommends that anyone who suspects they are experiencing any of the possible statin side effects consult with their caregiver.
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Mechanisms And Medical Comorbidity
The classic mechanism of action of statins involves the reduction of endogenous cholesterol biosynthesis via the inhibition of HMG-CoA reductase, a rate limiting enzyme integral to the mevalonate pathway. The corresponding reduction in hepatic cholesterol synthesis instigates translocation of membrane-bound sterol regulatory element-binding proteins to the nucleus, subsequent upregulation of LDL receptors on the surface of hepatocytes, leading to elevated clearance of LDL cholesterol from the blood . These effects make statins effective for treating hypercholesterolemia. However, brain cholesterol metabolism is largely independent of dietary lipid intake because of the BBB. Brain cholesterol is synthesized in the central nervous system , unlike peripheral cholesterol . Not all statins are equally effective in terms of lowering brain cholesterol levels .
Psychiatric disorders are often associated with several somatic consequences, including hypertension, heart disease, stroke, cancer, obesity, diabetes mellitus, and osteoporosis . It is known that individuals with psychiatric disorders tend to have unhealthier lifestyle habits, such as drinking excessive amounts of alcohol, are more likely to smoke, eat an unhealthy diet and be more physically inactive than their peers, be less compliant with medication regimens and have poorer self-care . All these factors significantly contribute to the development and maintenance of the above-mentioned comorbidities.
If Youre Taking Statins Heres What These Findings Mean For You
Its premature for doctors to prescribe statins specifically to treat osteoarthritis symptoms or prevent disease progression.
But if youre taking statins to manage your cholesterol levels, its good to be aware that they could have an impact on the health of your knees and other joints.
If youre concerned about your osteoarthritis risk, ask your doctor about which kind of statins might be best to help improve both your heart and joint health.
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What Other Options Can You Try
Starting drug treatment for RA soon after you’re diagnosed might help. Taking a disease-modifying antirheumatic drug early on helps prevent irreparable joint damage that might occur if DMARD use is delayed. They include hydroxychloroquine sulfasalazine minocycline or methotrexate . Prompt treatment is also associated with lower cardiovascular risk.
Use the lowest possible dose of corticosteroid medications like prednisone for the shortest time possible. Those drugs reduce inflammation in patients with rheumatoid arthritis but might enhance cardiovascular risk.
Ask your doctor to assess your cardiovascular risk each year.
If your risk score is sufficiently high to require statin treatment based on established guidelines, make sure you receive it. A recent study found that the drugs are underprescribed for high-risk RA patients.
Engage in low-impact aerobic exercisesâsuch as walkingâand muscle-strengthening exercises. They lower cardiovascular risk and reduce pressure on the joints. But if a joint is swollen and inflamed, do gentle range-of-motion exercises to keep it flexible, and rest.
Quit smoking. It’s a major cause of heart disease and might increase the severity of RA.
Risks Attenuated After Adjustment For Lipid Levels
byNancy Walsh, Contributing Writer, MedPage Today September 22, 2021
The use of statins did not increase the risk for the development of rheumatoid arthritis after adjustment for the important confounder of hyperlipidemia, a large nationwide U.S. study found.
A modest increased risk for RA was observed among patients taking statins after adjustment for age, sex, index year, region of residence, and race/ethnicity , and also after adjustment for the Charlson comorbidity index , reported Elena Myasoedova, MD, PhD, and colleagues from the Mayo Clinic in Rochester, Minnesota.
However, the association was no longer significant after further adjustment for hyperlipidemia , as shown in the study online in Arthritis Research & Therapy.
Statins are known to have pleiotropic effects and “have been shown to modify a range of non-lipid-related cell signaling pathways, including those involved in eliciting inflammatory responses,” the team wrote.
And while statins have been shown to reduce inflammation among RA patients, an older systematic review of patients with extensive statin exposure suggested that statins might actually induce autoimmunity. But the literature to date includes conflicting results, with some studies finding protective effects against RA, others showing an increased risk for RA, and still others suggesting neutral effects.
A total of 33.7% of RA cases were statin users, as were 31.6% of controls.
Disclosures
Primary Source
Arthritis Research & Therapy
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Do Statins Cause Joint Pain
Overview
If you or someone you know is trying to reduce their cholesterol, youve heard about statins. They are a type of prescription medication that lowers blood cholesterol.
Statins reduce the production of cholesterol by the liver. This can prevent extra cholesterol from building up on the inside of arteries, which could lead to heart attack or stroke. One study that involved three hospitals found that statins seem to work best for people who have a genetic predisposition for heart attacks.
25 million Americans take statins. Between 5 and 18 percent of these people report sore muscles, a common side effect. Statins are more likely to cause muscle pain when taken at high doses or when taken in combination with certain medications.
Other reported side effects of statins include liver or digestive problems, high blood sugar, type 2 diabetes, and memory problems. The Mayo Clinic suggests that some people are more likely than others to suffer from these effects. High-risk groups include women, people over 65, people with liver or kidney disease, and those who drink more than two alcoholic beverages a day.
Joint pain is considered a minor side effect of statin use, though if you suffer from it, it might not seem minor to you.
Common Side Effects Of Lipitor
Most common side effects of Lipitor are minor. But the medication can cause serious side effects, according to the drug label.
Side effects of Lipitor include:
- Cold-like symptoms
- Muscle pain and spasms
- Difficulty falling and staying asleep
Though the reactions occurred less often, people who took the drug during clinical trials also reported nose bleeds, blurred vision and ringing in the ears. Still others reported fever, liver problems, abnormal blood and urine test results, and malaise, which is a general feeling of discomfort or uneasiness.
After the medication became available to the public, people reported additional side effects such as tiredness, tendon problems, memory loss and confusion. Other reported issues included dizziness, depression, peripheral neuropathy, pancreatitis and interstitial lung disease. According to the drug label, the cognitive issues were generally not serious and went away after patients stopped taking the drug.
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The Big Results And Conclusions: Statins Were Not Good Pain Medications
- No matter what statin was used: Statin use was not associated with a lower risk of worsening pain. In other words, statins were not good pain medications.
- Atorvastatin use was associated with a reduced risk of developing pain, whilst rosuvastatin leads to a higher risk of developing pain.
From the researchers: The effect of statins use on knee osteoarthritis outcomes remains unclear, although in our study those using statins for over five years and those using atorvastatin reported a significantly lower risk of developing knee pain.
Confusing right?
- First, the Atorvastatin user was associated with a reduced risk of developing pain AS COMPARED to which lead to a higher risk of developing pain. So the Atorvastatin produced less knee pain risk, but still a risk.
- Either way, if you already have knee pain, cholesterol-lowering medicine will not help make it less painful or from it getting worse.
So again, all these research universities and national resources and a long-term study of over 1000 patients came to this conclusion: The effect of statins use on knee osteoarthritis outcomes remains unclear.
When You Need Themand When You Dont
Your body makes a waxy substance called cholesterol. You also get it from food. Your body needs it, but too much cholesterol in your blood can clog your arteries. This increases your risk of heart disease, heart attack, and death.
Statins are drugs that lower your cholesterol. But if you are age 75 or older and you havent had symptoms of heart disease, statins may be a bad idea. Heres why:
Adults age 75 and older may not need statins.
Many older adults have high cholesterol. Their doctors usually prescribe statins to prevent heart disease.
But for older people, there is no clear evidence that high cholesterol leads to heart disease or death. In fact, some studies show the oppositethat older people with the lowest cholesterol levels actually have the highest risk of death.
Statins have risks.
Compared to younger adults, older adults are more likely to suffer serious side effects from using statins.
Statins can cause muscle problems, such as aches, pains, or weakness. Rarely, there can be a severe form of muscle breakdown.
In older adults, statins can also cause:
- Falls
- Memory loss and confusion
- Nausea, constipation, or diarrhea.
Often, older adults take many drugs. These can interact with statins and lead to serious problems. Side effects, like muscle pain, may increase. Statins can also cause a fatal reaction when taken with heart-rhythm drugs.
Statins may increase the risk of type-2 diabetes and cataracts, as well as damage to the liver, kidneys, and nerves.
04/2014
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What Precautions Should You Take
In addition to the drug interactions described above, tell your doctor if you use or plan to use medications that might increase the side effects of statins, such as antifungals, certain antibiotics, calcium-channel blockers, nefazodone, and warfarin .
Avoid consuming large amounts of grapefruit or grapefruit juice, which has been shown to increase the potential for side effects associated with atorvastatin lovastatin and simvastatin .
Your doctor should test your liver enzyme levels and muscle enzymes before you start statin treatment and again after the first 12 weeks. Liver tests should be repeated annually.
Immediately report any potential sign of liver damage, including fatigue, nausea, vomiting, a markedly reduced appetite, jaundice, or pain in the upper-right portion of your abdomen.
Immediately report possible symptoms of rhabdomyolysis, such as muscle pain, tenderness, soreness, or weakness, or brown, red, or dark-colored urine.
Women of childbearing age should use effective contraception while taking statins, and avoid them altogether if they are pregnant, trying to become pregnant, or breast-feeding.
Statins For Other Psychiatric Disorders
There have been several clinical trials of statins for delirium prevention or treatment in critically ill patients. Based on the neuroinflammatory hypothesis of delirium, which is characterized by acute release of inflammatory mediators during critical illness, the pleiotropic effects of statins may prevent or attenuate delirium due to their effects on neutrophil migration, BBB injury, and inflammation . However, a review of the literature regarding the use of statins for delirium prevention or treatment reveals no clear overall conclusions. Differential effects of statins on neuroinflammation during delirium may be due to treatment with lipophilic vs. hydrophilic statins. The current study demonstrated that the use of a hydrophilic statin was associated with reduced delirium incidence compared with a lipophilic statin , but the reverse has also been found . A recent comprehensive meta-analysis found that statins did not reduce the incidence of delirium in physically ill patients . There are many confounding factors that might account for these inconsistent results, including heterogeneity of study designs, variability of patient populations, the multifactorial nature of delirium, inconsistent delirium assessments, limited study power and lack of information on co-administration of other neuropsychiatric medications. Therefore, well-designed studies on delirium are still needed.
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Soon After Taking These New Cholesterol Medications I Felt A Sharp And Sudden Pain In My Knee
A patient comes in on a recommendation from a friend.
I am here because I have very bad knee pain . . . here is my story:
I went to the doctor for my check-up. My blood work revealed slightly elevated cholesterol and I was advised that I need to take and was given prescriptions for medications that would lower my cholesterol. I also told my doctor that my knee was hurting, could I get something for it? My doctor asked, when and how the knee pain started? I said I aggravated it with a new exercise program, one I would hope that would lower my weight and cholesterol. My doctor said, go easy on my knee.
Soon after taking these new cholesterol medications, I felt a sharp and sudden pain in my knee as my wife and I were walking to our car. My wife drove us home and she got me to the chair and we elevated my leg and got plenty of ice on it.
We made an appointment at the doctors. Here I was given the reason why my knee hurt.
- It must be the exercise program. I should go slower or completely rest.
After a week of not exercising at all, my knee pain, now the pain was in both knees, became so much worse, I could not sleep. My wife began looking up things on the internet. She showed me some articles that said it was the statins, the cholesterol medication causing the knee pain. In fact, she showed me, it is a well-known side-effect.
Joint Pain And Atorvastatin: Really
We are ashamed to admit that we did not consider a relationship between the persons joint pain and atorvastatin . Thats because joint pain is rarely mentioned as a side effect in the clinical trials. Most people complain about muscle pain and weakness while taking drugs like atorvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin.
But when you look carefully in the official prescribing information you will discover a relationship between joint pain and atorvastatin. The same holds true for other statin-type cholesterol-lowering drugs. It may be described as arthralgia rather than arthritis or joint pain, but were basically talking about the same problem.
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Who Should Take Statins
Estimates are that in addition to the people already taking them, another 15 million to 20 million people should be taking statin drugs based on their risk factors for heart disease. Your doctor can do a simple blood test to determine the amount of cholesterol in your blood. If you have high levels of LDL cholesterol, you have a greater chance of heart disease, especially when there are other factors that increase your risk. Based on your overall risk, your doctor may recommend you take statins to help lower your cholesterol by a certain amount.
However, not all cholesterol is bad. It’s good, for instance, to have high levels of HDL cholesterol. HDL cholesterol prevents plaque buildup in the arteries by transporting the bad cholesterol out of the blood to the liver. From there, it is eliminated from the body.
The Danger Of Nsaids For Heart Patients:
Except for aspirin, non steroidal anti-inflammatory drugs like diclofenac , naproxen or ibuprofen can be dangerous for people with heart disease. For one thing, they can raise blood pressure. For another, they can increase the risk of heart attacks and heart failure .
We suggested that NSAIDs might be a bad choice with someone who had diagnosed heart disease and a stent and recommended non-drug approaches for joint pain such as ginger, boswellia, turmeric, cherry and grape juice along with gin-soaked raisins .
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Statin Drug And Food Interactions
Some foods and medications donât mix well with statins and can make side effects worse:
- Grapefruit juice, which has chemical that can change the way your body breaks down statins
- A drug for irregular heart rhythms called amiodarone
- Gemfibrozil , a cholesterol drug
- Protease inhibitors, a type of HIV medication that includes saquinavir and ritonavir
- Some antibiotic and antifungal drugs, such as clarithromycin and itraconazole
- Certain medications, such as cyclosporine, that lower your immune system activity
There are other medications that can cause problems if you take them with statins. You should tell your doctor about all over-the-counter or prescription drugs, herbal supplements, or vitamins that you use.