Achilles tendon and cholesterol lowering statin drugs

[injuryupdate]

Interesting link from:

http://www.medsafe.govt.nz/profs/adverse/Minutes114.htm

Suggests a possible case report correlation between use of statin drugs and Achilles tendon problems, but could be coincidental. There is a proven link between quinolone antibiotics (e.g. ciprafloxacin) and Achilles problems. May be a reason for further study:

3.2.2 Statins and tendonopathy

Issue Although a number of diverse adverse events are reported in association with statin therapy, tendon disorders have not been recognised. CARM has received five reports of tendon disorders with statin therapy - four of tendonitis (two each with atorvastatin and simvastatin) and one of tendon rupture with simvastatin.
The five CARM case reports (affecting four men and one woman) reflect a consistent pattern of tendonopathy occurring within six-months of initiation of statin therapy. Two of the reports provide rechallenge evidence of tendonopathy with atorvastatin.

A search of the WHO database revealed 205 reports of tendonitis, tendon disorder or tendon rupture associated with statins. These occurred predominantly with simvastatin (n=71) and atorvastatin (n=58), although this may reflect the wider use of these agents.

A search of the literature revealed four cases of tendonopathy in patients on statin therapy (both atorvastatin and simvastatin). The events occurred within two-months of treatment initiation and resolved within a similar period.

Discussion Members noted that CARM intends to submit this signal for publication, and no further action was recommended.

[injuryupdate]

There is also a possible link posted with risk of muscle strains - interesting!

http://www.ptjournal.org/cgi/content/full/85/5/459

Many people have high blood cholesterol that may lead to coronary heart disease (CHD). A multifaceted approach consisting of diet, exercise, and pharmacological management is recommended to lower the risk of CHD.1 Elevated low-density lipoprotein-cholesterol (LDL-C) has been established as a major cause of CHD.1 The group of cholesterol-lowering drugs known as statins (3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors) are widely and successfully used in the management of atherosclerotic disease processes that include CHD, myocardial infarction, stroke, and peripheral vascular disease.2 Statins inhibit the formation of HMG-CoA reductase, which is essential in forming mevalonate, a precursor to cholesterol and other compounds. Lowering LDL-C is the goal of statin therapy, and multiple studies indicate that lowering LDL-C decreases the risk for CHD in people without a history of CHD and decreases the risk for cardiovascular events in people with a history of CHD.1

Six statins are currently available, and they are known by a variety of brand names: atorvastatin (Lipitor*), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), pravastatin (Pravachol||), rosuvastatin (Crestor#), and simvastatin (Zocor)2–4 (Table). Although these drugs have been very successful in managing the cardiovascular health of many patients, there are also potential adverse effects that have been identified. The most common adverse effects reported include muscle pain or weakness that can progress to rhabdomyolysis and mortality.5 If detected early, statin-related symptoms are reversible after withdrawal of the statin.6,7 Early identification of these potentially serious adverse effects makes the information in this update critical for physical therapists, because they frequently screen patients with musculoskeletal complaints.

Considering that more than 76 million prescriptions for statins were filled in 2000,8 there was increased concern in the medical and lay communities about the safety of statins. One statin, cerivastatin (Baycol**), was voluntarily withdrawn from the market by the manufacturer in 2001, following its implication in severe adverse muscle reactions and death.9 In 2002, the American College of Cardiology, the American Heart Association, and the National Heart, Lung and Blood Institute (ACC/AHA/NHLBI) issued a clinical advisory about the use of statins.2 Although the pathophysiology of these adverse effects is not clearly understood, the advisory lists factors associated with an increased risk. The purpose of this article is to describe the adverse effects of statins on muscle so that physical therapists will be better prepared to recognize possible statin-induced myopathy.

etc.

[rumki8]

Last year at this time I was 200 pounds and cholesterol was 222. I am now 125 pounds. I eat very healthy, low fat, rarely eat more than 40 grams a fat per day, I do at least 30 minutes or more of cardio everyday, I eat a lot of soluble fiber foods daily, apples, grapes, oatmeal, wholegrain etc. I never eat fast food or fried food. Never eat chips or other salty snacks. I went for cholesterol test yesterday and it was 246! I fasted for 15 hours! The how can this is possible? What do you think?

[matt182]

Maybe theres something in your diet that you dont know ?

May be genetic and that you dont have a balance of HDL AND LDL. I think you should buy some products that have HDL to improven your ratio.

[leah]

Last year at this time I was 200 pounds and cholesterol was 222. I am now 125 pounds. I eat very healthy, low fat, rarely eat more than 40 grams a fat per day, I do at least 30 minutes or more of cardio everyday, I eat a lot of soluble fiber foods daily, apples, grapes, oatmeal, wholegrain etc. I never eat fast food or fried food. Never eat chips or other salty snacks. I went for cholesterol test yesterday and it was 246! I fasted for 15 hours! The how can this is possible? What do you think?
My doctor told me increased cholesterol levels in my case are genetic. I don't eat red meat, any dairy or much fat. Am interested in the links to muscle spasms and weakness though. I did go off my simvastatin (zocor) to try out any change to osteitis pubis and fibromyalgia - didn't notice any relief. Dr told me off as cholestrol levels rose and then doubled the dose! What do others think, is it worth the risk going off the medication and trying some natural alternatives. Dr told me i'd have to eat bucklet loads of those margarine type alternatives to have any impression on cholestrol levels.

[Ports]

There is also a possible link posted with risk of muscle strains - interesting!

http://www.ptjournal.org/cgi/content/full/85/5/459

Many people have high blood cholesterol that may lead to coronary heart disease (CHD). A multifaceted approach consisting of diet, exercise, and pharmacological management is recommended to lower the risk of CHD.1 Elevated low-density lipoprotein-cholesterol (LDL-C) has been established as a major cause of CHD.1 The group of cholesterol-lowering drugs known as statins (3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors) are widely and successfully used in the management of atherosclerotic disease processes that include CHD, myocardial infarction, stroke, and peripheral vascular disease.2 Statins inhibit the formation of HMG-CoA reductase, which is essential in forming mevalonate, a precursor to cholesterol and other compounds. Lowering LDL-C is the goal of statin therapy, and multiple studies indicate that lowering LDL-C decreases the risk for CHD in people without a history of CHD and decreases the risk for cardiovascular events in people with a history of CHD.1

Six statins are currently available, and they are known by a variety of brand names: atorvastatin (Lipitor*), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), pravastatin (Pravachol||), rosuvastatin (Crestor#), and simvastatin (Zocor)2–4 (Table). Although these drugs have been very successful in managing the cardiovascular health of many patients, there are also potential adverse effects that have been identified. The most common adverse effects reported include muscle pain or weakness that can progress to rhabdomyolysis and mortality.5 If detected early, statin-related symptoms are reversible after withdrawal of the statin.6,7 Early identification of these potentially serious adverse effects makes the information in this update critical for physical therapists, because they frequently screen patients with musculoskeletal complaints.

Considering that more than 76 million prescriptions for statins were filled in 2000,8 there was increased concern in the medical and lay communities about the safety of statins. One statin, cerivastatin (Baycol**), was voluntarily withdrawn from the market by the manufacturer in 2001, following its implication in severe adverse muscle reactions and death.9 In 2002, the American College of Cardiology, the American Heart Association, and the National Heart, Lung and Blood Institute (ACC/AHA/NHLBI) issued a clinical advisory about the use of statins.2 Although the pathophysiology of these adverse effects is not clearly understood, the advisory lists factors associated with an increased risk. The purpose of this article is to describe the adverse effects of statins on muscle so that physical therapists will be better prepared to recognize possible statin-induced myopathy.

etc.

Hi there, Have just read this post and am sitting here stunned! Complete ATR on OCT 13 and had been prescribed Lipitor for cholesterol and have taken daily 6 months prior to my injury. Now you have me thinking??? Not sure what to do but will be speaking to my GP for some other options.......may be a coincidence but I am surprised. Do not want to continue this drug if it has this effect....DO NOT WANT THIS TO HAPPEN AGAIN. Thanks for the post.....at least I can investigate further. Please reply any more info down the track
Cheers Andrew

[Lana1951]

I took Lipitor for years and noticed increased symptoms of sudden changes in skin quality, urine odor, anxiety, etc. Accidentally found on line that Lipitor and statins suck the Co !Q 10 out of you which maintains collagen, evidence of reduction of heart muscle leading to heart issues {failure etc}, it goes on and on. Major class action suits as long ago as 2003 due to statins. I quit immediately, have genetically high cholesterol over 300 with excellent HDL balance, no diet or exercise has ever altered my numbers and my weight varied from lean to ok, maybe up 10 lbs. I take live niacin,,, ie the kind that does make you flush, daily, lots of C... keep looking for other things to supplement. Between the Fosamax that can give you jaw death and rot your teeth and the lipitor and its side effects Ill never take another prescription drug regularly.....!!!! NO ONE informed me of the life threatening side effects, let alone tendon problems. Also have diminshed cartilage in shoulder now probably due to that lack of Co Q10 for years.

[Tudor Redmond]

Hi,

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