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Tendon Complications, Though Rare, Linked To Statins, Study Shows
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This is a helpfull research paper. I know it's rare, however something that all of us should be aware of. I have plenty of patients on lipid modifying medication, some of which are still quite young and active. It seems this may put them in a higher risk category for tendon complications.
My Father in-law has extremely high cholesterol and has been a marathon runner most of his life (he is a butcher though, loves a snag) and recently had a tripple bi-pass. He has always been plagued by achilles problems, not that he lets me have a look, you know the son-in-law thing. I'm not sure of his medication, I'm keen to have a look now though.
Trent -
Medscape Medical News are reporting:
Muscle Pain and Weakness With Statin Treatment May Herald ALS
From American Neurological Association (ANA) 133rd Annual Meeting
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Simultaneous bilateral Achilles tendon ruptures associated with statin medication despite regular rock climbing exercise.
Carmont MR, Highland AM, Blundell CM, Davies MB.
Phys Ther Sport. 2009 Nov;10(4):150-2.
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Effects of Statins on Skeletal Muscle: A Perspective for Physical Therapists
Stephanie L. Di Stasi, Toran D. MacLeod, Joshua D. Winters and Stuart A. Binder-Macleod
Physical Therapy October 2010 vol. 90
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THE LINK BETWEEN DYSLIPIDEMIA AND TENDON PATHOLOGY
N Grewal, D Granville, D Reid, A Scott
2nd International Scientific Tendinopathy Symposium; Vancouver Sept 27-29 2012
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Press Release:
Musculoskeletal Conditions, Injuries May Be Associated with Statin Use
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Ishak Mansi, MD; Christopher R. Frei, PharmD, MSc; Mary Jo Pugh, PhD; Una Makris, MD; Eric M. Mortensen, MD, MSc
JAMA Intern Med. 2013;():1-9.
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How about this one!
A patent was granted to treat this:
HYPERCHOLESTEROLEMIA AND TENDINOUS INJURIES
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Statins induce biochemical changes in the Achilles tendon after chronic treatment
Letícia Prado de Oliveira, Cristiano Pedrozo Vieira, Flávia Da Ré Guerra, Marcos dos Santos Almeida, Edson Rosa Pimentel
Toxicology; Available online 4 July 2013
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Simvastatin-lnduced nocturnal leg pain disappears with pravastatin substitution.
Stojaković N, Igić R.
Srp Arh Celok Lek. 2013 May-Jun;141(5-6):387-9.
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Structural and biomechanical changes in the achilles tendon after chronic treatment with statins
L.P. Oliveiraa, C.P. Vieiraa, F.D. Guerraa, M.S. Almeidaa, E.R. Pimentela
Food and Chemical Toxicology; Available online
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Statin-induced bilateral foot drop in a case of hypothyroidism.
Chaudhary N et al
Ann Indian Acad Neurol. 2015 Jul-Sep;18(3):331-4
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Prevention of simvastatin-induced inhibition of tendon cell proliferation and cell cycle progression by geranylgeranyl pyrophosphate
Wen-Chung Tsai et al
Toxicol. Sci. (2015) doi: 10.1093/toxsci/kfv239
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Statins and tendinopathy: a systematic review
Andrew J Teichtahl, Sharmayne RE Brady, Donna M Urquhart, Anita E Wluka, Yuanyuan Wang, Jonathan E Shaw and Flavia M Cicuttini
Med J Aust 2016; 204 (3): 115-121.
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Do different tendons exhibit the same response following chronic exposure to statins?
Letícia Oliveira, Cristiano Vieira, Petrus Marques, Edson Pimentel
Canadian Journal of Physiology and Pharmacology, 10.1139/cjpp-2016-0133
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Association Between Statin Use and Prevalence of Exercise-Related Injuries: A Cross-Sectional Survey of Amateur Runners in the Netherlands
Authors
Bakker, E.A., Timmers, S., Hopman, M.T.E. et al.
Sports Med (2017). doi:10.1007/s40279-017-0681-7
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A CROSS-SECTIONAL STUDY TO EVALUATE THE EFFECT OF STATINS ON
ACHILLES TENDON MORPHOLOGY USING ULTRASOUND TISSUE
CHARACTERIZATION.
Agnetha de Sá
Thesis, The University of British Columbia
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No increase in muscle pain:
Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase.
Gupta A, et al.
Lancet. 2017.
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Correlation of some predisposing intrinsic conditions with the morphological integrity of the Achilles tendon.
Fakoya AOJ et al
Ann Afr Med. 2018 Apr-Jun;17(2):58-63. doi: 10.4103/aam.aam_49_17.
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Achilles tendon structure is negatively correlated with body mass index, but not influenced by statin use: A cross-sectional study using ultrasound tissue characterization.
de Sá A et al
PLoS One. 2018 Jun 21;13(6):e0199645. doi: 10.1371/journal.pone.0199645. eCollection 2018.
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Full text letter to editor:
Statin-Associated Achilles Tendon Rupture and Reproducible Bilateral Tendinopathy on Repeated Exposure -
PUBLIC RELEASE: 7-NOV-2018
Study explores timing of muscle-related problems of statin use
Statins have been linked with muscle pain and other musculoskeletal adverse events (MAEs) in some patients. A new Pharmacology Research & Perspectives study has examined the timing of MAEs that develop during statin therapy and determined whether concomitant drugs used concurrently with statin therapy shifts the timing of MAEs.
For the study, cases in which statins (atorvastatin, rosuvastatin, simvastatin, lovastatin, fluvastatin, pitavastatin, and pravastatin) were prescribed were extracted from the US Food and Drug Administration Adverse Event Reporting System Data Files.
The onset timing of statin-induced musculoskeletal adverse events (MAEs) differed with each statin. For example, the onset of MAEs was significantly faster with high-intensity statins including atorvastatin and rosuvastatin than with simvastatin. Concomitant use of drugs--even those that may increase the risk of MAEs--did not cause changes in the onset timing of MAEs associated with statins.
"Passive surveillance of adverse events has played a major role in securing drug safety as a system to detect unknown adverse events. Data mining using Food and Drug Administration Adverse Event Reporting System, which is a large-scale database, will be an aid to enhance drug safety," said senior author Dr. Daiuke Kobayashi, of Josai University, in Japan. -
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Statin treatment increases the clinical risk of tendinopathy through matrix metalloproteinase release – a cohort study design combined with an experimental study
Pernilla Eliasson, Franciele Dietrich-Zagonel, Anna-Carin Lundin, Per Aspenberg, Alicja Wolk & Karl Michaëlsson
Scientific Reports volume 9, Article number: 17958 (2019)
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News Release 3-Apr-2023
Moderate exercise safe for people with muscle pain from statins
Statins do not increase muscle injury after prolonged walking, important for heart health in statin users
Statin therapy does not exacerbate muscle injury, pain or fatigue in people engaging in moderate-intensity exercise, such as walking, according to a study published today in the Journal of the American College of Cardiology. The findings are reassuring for people who experience muscle pain or fatigue from statins but need to engage in physical activity to keep their cholesterol levels low and their hearts healthy.
Statins have long been the gold standard for lowering LDL or “bad” cholesterol and preventing cardiovascular disease (CVD) events, but while generally well-tolerated, they can cause muscle pain and weakness in some. Physical activity is also a cornerstone of CVD prevention, especially when combined with statins; however, studies have shown vigorous exercise can increase muscle damage in some statin users, which can lead to decreased physical activity or cause people to stop taking their medication. Less is known about the impact of moderate exercise.
Researchers sought to compare the impact of moderate-intensity exercise on muscle injury in symptomatic and asymptomatic statin users, plus nonstatin using controls. Symptomatic vs. asymptomatic was determined by the presence, localization and onset of muscle cramps, pain and/or weakness using the statin myalgia clinical index score. Researchers also examined the association between leukocyte CoQ10 levels on muscle injury and muscle complaints, since statins may lower CoQ10 levels and reduced levels can predispose people to muscle injury.
All study participants walked 30, 40 or 50 km (18.6, 24.8 or 31 miles, respectively) per day at a self-selected pace for four consecutive days. Statin users had all been on the medication for at least three months. The researchers excluded those with diabetes, hypo- or hyperthyroidism, known hereditary skeletal muscle defects, other diseases known to cause muscle symptoms or those using CoQ10 supplementation. There were no differences in body mass index, waist circumference, physical activity levels or vitamin D3 levels (low vitamin D3 levels have been associated with statin-induced myopathy and therefore may be a risk-factor for statin-associated muscle symptoms) among the three groups at baseline.
Researchers found that statins did not exacerbate muscle injury or muscle symptoms after moderate-intensity exercise.
“Even though muscle pain and fatigue scores were higher in symptomatic statin users at baseline, the increase in muscle symptoms after exercise was similar among the groups,” said Neeltje Allard, MD, first author of the study and researcher at the Department of integrative physiology, Radboud University Medical Center in Nijmegen, Netherlands. “These results demonstrate that prolonged moderate-intensity exercise is safe for statin users and can be performed by statin users to maintain a physically active lifestyle and to derive its cardiovascular health benefits.”
Researchers did not find a correlation between leukocyte CoQ10 levels and muscle injury markers at baseline or after exercise nor was there a correlation between CoQ10 levels and muscle fatigue resistance or muscle pain scores.
In an accompanying editorial comment, Robert Rosenson, MD, Director of Metabolism and Lipids for the Mount Sinai Health System in New York, said patients experiencing statin associated muscle symptoms will often avoid exercise because of muscle pain and weakness and concerns of making the pain worse; however, exercise is essential for restoring and maintaining fitness in people at increased risk for cardiovascular disease or who have had a cardiovascular event.
“[Based on the study], many patients who develop statin associated muscle symptoms may engage in a moderately intensive walking program without concern for worsened muscle biomarkers or performance,” he said. -
Effects of Statin Treatment
on the Development of Tendinopathy
A Nationwide Population-Based Cohort Study
Donghee Kwak et al
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