I enjoyed this episode, but right after I listened I read this article by the respected Paul Ingraham, who mentions a terrible side effect of statins: 3x risk of tendinitis and 4x risk of tendon rupture!
Although he mentions that the numbers met be confounded by the correlation between hypercholesterolemia and tendon trouble, he seems to consider the causal effect relatively likely
He also seems to think that the muscle pain problem may be real and noticeable
Did you mention this in the podcast? I might have zoned out but I don't think so
I would also be interested in whether the new drugs you discuss near the end are likely to have the same effects
Rosuvastatin, which Ingraham thinks caused his tendon rupture, is not a fluoroquinolone (no statins are), an important point which I think Ingraham could have made clearer. Also, if you read his footnote, he says he didn't take it for very long, and not for several weeks before the injury. So, the connection he's trying to play up seems questionable.
Ingraham than trots out a bunch of case studies and case series, which are very questionable forms of evidence. The study on statin induced tendinopathy in rats is more convincing, and the cohort study even more convincing (https://pmc.ncbi.nlm.nih.gov/articles/PMC10350772/). But note the cohort study is showing an association with a 40% increased risk of various tendinopathies, not 3x or 4x. Oddly, the study found the risk decreases with larger statin dose, which is not what you would expect if the statins were causing the risk.
Ingraham also cites three papers all presenting various forms of evidence against the idea that statins increase tendinitis risk.
There's also a lot of important studies Ingraham doesn't mention, even though they are easy to find with a Google search. In particular, "Across over 1 million patients, a large cohort study found no significant increase in the risk of native tendon rupture among statin users (HR 0.95, 95% CI 0.84-1.08). " (https://www.europeanreview.org/wp/wp-content/uploads/457-469.pdf)
Overall, while there a case for being concerned, but it seems murky.
As with many things, risks have to be weighed with benefits, and lowest-effective dose should always be used.
Regarding statin-induced muscle pain, it has been greatly exaggerated in the popular press. It's believed the vast majority of muscle pain complaints are psychosomatic, with the true rate being around 5%, as Ingraham notes.
Definitely do a top 10 drugs episode.
I enjoyed this episode, but right after I listened I read this article by the respected Paul Ingraham, who mentions a terrible side effect of statins: 3x risk of tendinitis and 4x risk of tendon rupture!
https://www.painscience.com/blog/tendon-failure-as-a-drug-side-effect.html
Although he mentions that the numbers met be confounded by the correlation between hypercholesterolemia and tendon trouble, he seems to consider the causal effect relatively likely
He also seems to think that the muscle pain problem may be real and noticeable
Did you mention this in the podcast? I might have zoned out but I don't think so
I would also be interested in whether the new drugs you discuss near the end are likely to have the same effects
Importantly, the 3x and 4x numbers come from a study looking at fluoroquinolones, in particular the antibiotic ones. (https://pubmed.ncbi.nlm.nih.gov/31270563/)
Rosuvastatin, which Ingraham thinks caused his tendon rupture, is not a fluoroquinolone (no statins are), an important point which I think Ingraham could have made clearer. Also, if you read his footnote, he says he didn't take it for very long, and not for several weeks before the injury. So, the connection he's trying to play up seems questionable.
Ingraham than trots out a bunch of case studies and case series, which are very questionable forms of evidence. The study on statin induced tendinopathy in rats is more convincing, and the cohort study even more convincing (https://pmc.ncbi.nlm.nih.gov/articles/PMC10350772/). But note the cohort study is showing an association with a 40% increased risk of various tendinopathies, not 3x or 4x. Oddly, the study found the risk decreases with larger statin dose, which is not what you would expect if the statins were causing the risk.
Ingraham also cites three papers all presenting various forms of evidence against the idea that statins increase tendinitis risk.
There's also a lot of important studies Ingraham doesn't mention, even though they are easy to find with a Google search. In particular, "Across over 1 million patients, a large cohort study found no significant increase in the risk of native tendon rupture among statin users (HR 0.95, 95% CI 0.84-1.08). " (https://www.europeanreview.org/wp/wp-content/uploads/457-469.pdf)
Overall, while there a case for being concerned, but it seems murky.
As with many things, risks have to be weighed with benefits, and lowest-effective dose should always be used.
Regarding statin-induced muscle pain, it has been greatly exaggerated in the popular press. It's believed the vast majority of muscle pain complaints are psychosomatic, with the true rate being around 5%, as Ingraham notes.
I discuss the muscle pain issue in article on statins: https://moreisdifferent.blog/p/four-steps-to-reduce-cardiovascular
nice one.
see my comment above on the putative association between statins and tendinitis.
No, everyone should not be taking statins, especially if you don't need them. Which I don't.
Also, aLL drugs have side effects. Learn how to eat and exercise properly and you won't have to worry about cholesterol levels.
There is also some research that says high cholesterol may not necessarily be bad.