Millions of people worldwide take statins in an attempt to lower their cholesterol levels and reduce their risk of heart attack. The sad irony is that by blocking endogenous cholesterol production, which is how statin drugs work, these medications also block production of coenzyme Q10, a nutrient needed for the production of energy, especially in muscles and particularly in the heart. As such, statin drugs may cause side effects including fatigue, muscle weakness, and neck pain which clinicians refer to as statin-induced myopathy.
These aches and pains connected to statin use can range from mild muscle cramps, twitches, or fatigue to severe pain and dysfunction. Oftentimes people taking statins don’t realise that the drugs may be causing their neck pain or other aches and pains and so they use NSAIDs, chiropractic treatment, massage, and a range of other conservative treatments to try to resolve the issue.
What’s the Problem with Statins?
Most often people are prescribed statins around the time (50 yrs old or so) that endogenous coQ10 production begins to decline. The use of statins exacerbates this natural decline in coQ10 production meaning that levels of this important nutrient then become insufficient to meed demands. Statin-induced myopathy may be overlooked however as many people simply expect to feel tired and experience muscle aches and pains as they age.
Sometimes otherwise healthy people are prescribed statins as a preventative measure to reduce their risk of elevated cholesterol in the future. This may lead previously active and healthy people to suddenly begin experiencing fatigue, muscle aches, neck pain, and other adverse effects of statins. Many physicians do not have the time, or the knowledge, to give advice on dietary or lifestyle modifications that can help manage cholesterol levels safely without the need for statins and even if they do give such advice many patients don’t have the time or inclination for such things and just want to take a daily pill instead.
This is why statins have become so popular since the first one, Lovastatin, was brought to market in 1987 by Merck & Co. Inc. Statin drugs now include atorvastatin (Lipitor), cerivastatin (Baycol), fluvastatin (Lescol), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor), and used to include Baycol but that was withdrawn from the market in 2001 after being associated with an increased incidence of fatal rhabdomyolysis.
How Do Statins Work?
Statins are HMG-CoA reductase inhibitors, i.e. they decrease the production of cholesterol in the liver by blocking the rate-limiting enzyme HMG-CoA synthase. This means that statins block the formation of mevalonic acid, which is a precursor to all steroids, including cholesterol. As around 10 million Canadians and 107 million Americans have high cholesterol it is easy to see why statins are so commonly prescribed.
Elevated cholesterol (hypercholesterolemia) increases the risk of atherosclerosis, stroke and heart disease and in Canada the use of statins ose from 1.6% in 1994 to 7.8% in 2002, with approximately 24 million Americans thought to be taking statin medications by 2004.
Symptoms of Statin-Induced Myopathy
This means that more and more people are at risk of statin-induced myopathy and the neck pain that comes along with it. Symptoms of statin-induced myopathy may include:
- Leg cramps and other muscle cramps, especially at night
- Morning muscle stiffness
- Muscle pain and difficulty initiating movement
- Disruption of physical activity / reduced mobility and range of motion
- Back pain and neck pain that doesn’t improve with physical therapy
These symptoms are thought to occur in around 1 in every 10 people using statins and in many cases the symptoms can be relieved by switching to an alternative statin medication, by supplementing with coQ10 or by using alternative ways to manage cholesterol levels and avoiding statin use altogether.
As statins can be a key part of preventing or reducing the risk of heart attack, stroke, and also cognitive decline due to cholesterol plaques in the brain it is important that people do not simply cease statin drugs without physician guidance. Many patients manage to use diet and lifestyle modifications to improve cholesterol levels and actually increase their energy and overall wellbeing allowing them to avoid the potential side effects of statin, including neck pain and other aches and pains.
Managing Cholesterol Naturally
One of the most important things for achieving and maintaining healthy cholesterol status is to get regular physical activity as this not only helps lower low density lipoprotein (often referred to as ‘bad cholesterol’) it also helps raise levels of high density lipoprotein (the so-called ‘good cholesterol’ that removes LDL cholesterol from the arteries).
Other lifestyle and dietary interventions that can aid cholesterol management include eating plenty of fiber, whole foods, reducing sugar intake and refined carbohydrates, improving antioxidant status by consuming more plant derived foods and cutting out animal-derived foods as these not only contain cholesterol itself but are also often high in saturated fat which increases endogenous cholesterol production. Animal-derived foods also contain no fiber and can increase inflammation in the body which can then worsen neck pain induced by statins.
Cholesterol-Lowering Supplements and CoQ10
Some people choose to use natural supplements, such as plant sterols, soluble fiber, and niacin (vitamin B3) to help lower cholesterol levels without statins. Supplementing with coQ10 may also help to restore good energy levels and protect the heart even if statins remain necessary, and may be a good option for those with acute neck pain from statin-induced myopathy as they explore alternative ways of lowering cholesterol without these drugs.