Is the Statin Making the Patient Tired?

Abstract & Commentary

By Joseph E. Scherger, MD, MPH, Vice President, Primary Care, Eisenhower Medical Center; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Scherger reports no financial relationships relevant to this field of study.

Synopsis: A randomized, controlled trial showed that moderate doses of simvastatin or pravastatin resulted in reduced energy or exertional fatigue in up to 40% of patients, especially in women.

Source: Golomb BA, et al. Effect of statins on energy and fatigue with exertion: Results from a randomized controlled trial. Arch Intern Med 2012;172:1180-1182.

A longitudinal randomized, controlled trial at the University of California, San Diego, looked at multiple effects of statins, focusing on the non-cardiovascular effects. A total of 1016 patients over age 20 were followed for 6 months taking 20 mg of simvastatin or 40 mg of pravastatin or placebo for modest elevations of LDL cholesterol. Two-thirds of the patients were male. Interestingly, the simvastatin was more effective in lowering the LDL cholesterol than pravastatin even at the lower dose. This report focused on perceived energy and exertional fatigue over the 6 months.

Compared with placebo, up to 40% of the patients reported either reduced energy or exertional fatigue while using the statin. Twenty percent reported both symptoms and 10% reported these symptoms as “much worse.” There was a slight increase in these complaints in the patients taking the simvastatin over the pravastatin but these differences were not statistically significant. Women reported greater reduced energy and exertional fatigue than the men, but these may be more perception than real objective change. The energy level and exertional fatigue were reported using a standardized instrument called the EnergyFatigEx.

Commentary

Statins have many beneficial effects, including more than the reduction of cardiovascular risk. They are, however, not without adverse effects.1,2 We recently learned that they cause a modest increase risk in blood sugar, but not enough to offset the cardiovascular benefit. They may cause short-term memory loss. Muscle aches have also been known since the beginning of their use. Anecdotal reports of fatigue and reduced energy have been common but this is the first reported randomized, controlled trial showing these effects.

Statins may be the most life-saving medications invented since antibiotics. Like most medications, there is always a downside. It is important to remember that in patients other than those with a major genetic hyperlipidemia, intense lifestyle modification confers all the benefits of a statin without the adverse effects. Optimal nutrition and regular physical activity — becoming lean and fit with low body fat — is the best pathway to reduced cardiovascular risk and the other benefits. All patients should be offered this option with motivational counseling toward it.

I use statins whenever necessary. But recently, I do find that I am reducing them or not needing to start them more often by taking an aggressive wellness approach in my own clinical practice.

References

1. Golumb BA, Evans MA. Statin adverse effects: A review of the literature and evidence for a mitochondrial mechanism. Am J Cardiovasc Drugs 2008;8:373-418.

2. Cham S, et al. Statin-associated muscle-related adverse effects: A case series of 354 patients. Pharmacotherapy 2010;30:541-553.