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ScienceDaily are reporting: Tendon Complications, Though Rare, Linked To Statins, Study Shows
Quote:
Statins, the most effective treatment for lowering cholesterol, are widely used and have been demonstrated to be safe in large clinical trials. Although side effects are usually mild, more severe side effects, especially musculoskeletal complications, have been reported. Tendon impairment has been reported anecdotally but has not been included in large-scale studies. A new study published in the March issue of Arthritis Care & Research found that, although rare, tendon complications are linked to the use of statins.
Led by Catherine Noblet, of Rouen University Hospital in Rouen Cedex, France, researchers identified 96 cases of tendon complications from the French Pharmacovigilance database between 1990 and 2005 that were attributed to statins. Tendon conditions included tendonitis and tendon rupture. Patient data retrieved from computer database were as follows: medical history, other medications they were taking (especially those known to increase statin concentrations), information about the onset, pattern and severity of their condition, and the dosage and type of statin they took.
The results showed that of the 4,597 side effects associated with statins, about two percent were attributed to tendon complications. Symptoms usually occurred within 8 months of beginning statin therapy. Most patients had tendonitis, but some also suffered ruptured tendons. The most common tendon affected was the Achilles tendon, with pain, swelling, warmth, and stiffness as the most common symptoms. Seventeen of the patients had symptoms severe enough to warrant hospitalization. The researchers were able to link the tendon problems to statin use based on the fact that the symptoms appeared after the statins were started, they improved when the statins were stopped and they recurred in all of the patients who restarted the therapy.....
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.
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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September 29, 2008 (Salt Lake City, Utah) — A new study has shown that a high proportion of patients with sporadic amyotrophic lateral sclerosis (ALS) who were exposed to statin therapy before their diagnosis reported muscle weakness and pain associated with statin treatment.
The finding builds on evidence from previous studies suggesting that statin treatment is associated with more rapid progression of the disease. The association in this study was limited to patients with sporadic ALS.
"We're not saying that statins cause ALS, but they may accelerate the course leading to diagnosis in some patients," Benjamin R. Brooks, MD, director of the Carolinas Neuromuscular/ALS-MDA Center, in Charlotte, North Carolina, told Medscape Neurology & Neurosurgery in an interview.
The results were presented here at the American Neurological Association 133rd Annual Meeting.
It is well known that patients receiving statins to treat hypercholesterolemia and hypertriglyceridemia may have pain, cramps, or weakness in muscle that resolves when the statin is withdrawn, Dr. Brooks said. In rare instances, treatment is associated with myopathy or rhabdomyolysis.
In the setting of ALS, a recent study by researchers at the University of Toronto suggested that patients with ALS who were exposed to statins had more rapid functional decline than patients with ALS who were not exposed to statin therapy (Zinman L et al. Amyotroph Lateral Scler. 2008;4:223-228).
Similar findings from French researchers have led these groups to recommend that statins should not be used in patients with ALS, Dr. Brooks said. "I think that's a standard that is slowly being adopted by all neuromuscular practitioners."
If statin use can accelerate disease progression, the researchers tested the hypothesis that patients with ALS might have experienced reactions to statin therapy before their diagnosis. To examine this question, Dr. Brooks reviewed statin use before diagnosis in 240 patients with sporadic or familial motor neuron diseases, including ALS, primary lateral sclerosis, disimmune motor neuropathies, and atypical motor neuron diseases.
They report that of 164 patients with sporadic ALS, 31 were exposed to statins before their diagnosis. Of 28 of these patients who had received a single statin, 11 had reported treatment-associated muscle pain and increased weakness before their diagnosis. The 3 remaining patients had each been treated with 3 statins and had reported pain and weakness with each one. In all patients, diagnosis occurred within 12 months of these complaints related to statin treatment.
Of the 18 familial patients with ALS, neither of 2 statin-treated patients showed this phenomenon, Dr. Brooks noted. Of 20 patients with primary lateral sclerosis, 1 of 2 patients who had received a single statin and 1 patient who had received treatment with multiple statins had symptoms. There was no statin use in 14 patients with disimmune motor neuropathies or atypical motor neuron disease before diagnosis.
They examined comorbidities to ALS that appeared to increase the risk for this phenomenon and found that, in patients with sporadic ALS and diabetes or ALS and hypothyroidism, 2 of 8 patients who had received a single statin and 4 of 6 patients who had received multiple statins had muscle symptoms before the diagnosis of ALS.
One possible explanation for this finding is the genetic background of patients with ALS in the face of an environmental challenge such as statin therapy, Dr. Brooks noted. However, they do not have the genetic background of these particular patients.
"So this is just an epidemiological statement saying that in those patients who were exposed to statins who eventually developed a diagnosis of ALS, half of them will have pain and weakness associated with the first exposure to the statin, and that very often leads to a diagnosis of ALS. It may not be a cause, but it may be a trigger of the disease process that leads them to go to a neurologist and get diagnosed."
"I think that more and more people are concerned about potential side effects of statins," he added, with a growing literature on muscle-specific and some cognitive issues related to treatment. "Statins are a double-edged sword. They may be good for some diseases and not other diseases, they may be good in some people and not in other people, and one has to be very careful when initiating them."
Doctors prescribing statins should pay close attention to adverse effects, he said. "Overall, the use of statins is very good and has excellent effects on a large number of people," he concluded. "We're talking about a subgroup of people who may be at risk for a relatively rare statin complication."
The study was funded in part by the Muscular Dystrophy Association and Department of Veterans Affairs. Dr. Brooks has disclosed no relevant financial relationships.
American Neurological Association 133rd Annual Meeting: Abstract M-9. Presented on September 22, 2008.
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.
Quote:
INTRODUCTION: Ruptures of the Achilles tendon are common however simultaneous ruptures occur less frequently. Eccentric loading exercise programmes have been used to successfully treat Achilles tendinopathy.
CASE REPORT: We report a case of simultaneous bilateral Achilles tendon rupture in a patient predisposed to rupture due to longstanding raised serum lipoprotein and recently introduced therapeutic statin medication. The patient was also a keen rock climber and had regularly undertaken loading exercise.
CONCLUSION: This case illustrates that the therapeutic effect of mixed loading exercises for the Achilles tendon may not be adequate to overcome the predisposition to rupture caused by hyperlipidaemia and statin medication.
Statins and tendon complications
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