Statin induced muscle pain mostly isn't a thing ....

[Eddy Edson]

The human body is an amazing machine and it produces cholesterol for a purpose, we know so little about interfering with chemicals and I feel we should not "blanket" prescribe any drugs whatsoever. The cognitive function interference is well documented, after all cholesterol is a building block for every cell in the body, in particular brain cells. So I regret @Eddy Edson I must disagree with you that these drugs should be distributed like sweeties.

I don't think that statins should be distributed like sweeties. Actually, I don't think that sweeties should be distributed like sweeties.

Also, you are wrong about cognitive function intereference being "well documented"; the opposite is true. And serum cholesterol isn't necessary for cell activity.

 

[Eddy Edson]

Or to increase placebo effects. It is known that placebos can work (to some extent) even when people know that they're taking a placebo. So just knowing that what you're feeling is likely (or certainly) nocebo probably isn't sufficient.

This page suggests "There has been little work published on examining how the nocebo effect can be reduced." but continues to offer some suggestions.

The nocebo effect: what is it, why is it important and how can it be reduced? - bpacnz

bpac.org.nz

There's quite a bit published but FWIW from what I've seen it mainly comes down to common sense of the type nicely summarised in that NZ piece. Plus some IMO dubious-looking psychology pieces.

I really think that practitioners taking more care and probably being better educated is a good place to attack the problem, but that's just another comon sense-type view.

 

[void]

I took statins for years AIUI because it's standard treatment for all diabetics. No attributable ill effects for a long time. I got muscle aches all right but attributed that to just getting old. I was put on muscle relaxants for the pain because I'd really tense up when falling asleep and I couldn't really sleep. Bought a memory foam matress, too. It was only after not taking them for a week or so for some reason, then taking them again that I noticed the causal relationship. Stopped taking the statin, no more need for said muscle relaxants.

I'm a bit worried not taking them because the baseline CVD risk factor for diabetics is it's as if they've already had a heart attack. I've been reading up on the flushing version of niacin as an alternative but now see that it's not recommended on the NICE website so not sure what to do. My chol/trig readings are ok but they could be better.

 

[Eddy Edson]

I took statins for years AIUI because it's standard treatment for all diabetics. No attributable ill effects for a long time. I got muscle aches all right but attributed that to just getting old. I was put on muscle relaxants for the pain because I'd really tense up when falling asleep and I couldn't really sleep. Bought a memory foam matress, too. It was only after not taking them for a week or so for some reason, then taking them again that I noticed the causal relationship. Stopped taking the statin, no more need for said muscle relaxants.

I'm a bit worried not taking them because the baseline CVD risk factor for diabetics is it's as if they've already had a heart attack. I've been reading up on the flushing version of niacin as an alternative but now see that it's not recommended on the NICE website so not sure what to do. My chol/trig readings are ok but they could be better.

For reference, this summarises NHS' lipid management guidance: https://www.england.nhs.uk/aac/wp-c...ondary-prevention-of-cardiovascular-disea.pdf

For management of statin intolerance, it refers to this: https://www.england.nhs.uk/aac/wp-c...8/Statin-intolerance-pathway-January-2022.pdf

My guess is that this may be too labour intensive & complicated for over-stretched GP settings, but I'd suggest that getting yr head around it might be worthwhile prep for getting your doc to take appropriate action.

FWIW, I follow a bunch of lipid experts (real ones, not Internet experts) on twitter etc and the consensus these days appears to be that people should be started on ezetimibe plus a statin at a lower dosage than if you're taking just the statin. This has similar lipid effects with generally fewer statin side effect risks. You'll see in the NHS guidance that this approach is recommended there only after jumping through multiple other hoops, so maybe a difficult outcome to achieve, but perhaps worth pushing for.

On the other hand, if the problem is actually a nocebo effect then the statin dosage might not matter, because in that case simply taking a pill you think is a statin causes the problems, regardless of what the pill actually is. That the problem goes away when you stop taking the pill and returns when you take it again, doesn't rule out nocebo effects: in high quality studies, the same thing occurs when the patients are given placebos they think are statins.

In any case, whether nocebo or not, yr doc should be taking it seriously and working on strategies to achieve good lipid outcomes regardless. Getting yr head around the guidance etc might be useful to induce and help yr doc to do that.

 

[void]

For reference, this summarises NHS' lipid management guidance: https://www.england.nhs.uk/aac/wp-c...ondary-prevention-of-cardiovascular-disea.pdf

For management of statin intolerance, it refers to this: https://www.england.nhs.uk/aac/wp-c...8/Statin-intolerance-pathway-January-2022.pdf

My guess is that this may be too labour intensive & complicated for over-stretched GP settings, but I'd suggest that getting yr head around it might be worthwhile prep for getting your doc to take appropriate action.

My GP tried with an alternative, at lower dose. The problem took 3 days to re-manifest itself. I think they'll have something to say about it when my next review happens in a few weeks.

FWIW, I follow a bunch of lipid experts (real ones, not Internet experts) on twitter etc and the consensus these days appears to be that people should be started on ezetimibe plus a statin at a lower dosage than if you're taking just the statin. This has similar lipid effects with generally fewer statin side effect risks.

please can you share their @ ? i do use twitter, like an RSS though. I don't participate in it.

 

[Eddy Edson]

My GP tried with an alternative, at lower dose. The problem took 3 days to re-manifest itself. I think they'll have something to say about it when my next review happens in a few weeks.

please can you share their @ ? i do use twitter, like an RSS though. I don't participate in it.

Same here, mainly.

Some lipidology types plus metabolism, nutrition, cardio people I've found interesting on lipds:

Thomas Dayspring @drlipid
Danielle Belardo @DBelardoMD
Spencer Nadolsky @DrNadolsky
Gil Carvalho @NutritionMadeS3
Ethan Weiss @ethanjweiss
Daniel Drucker @DanielJDrucker

 

[Eddy Edson]

My GP tried with an alternative, at lower dose. The problem took 3 days to re-manifest itself. I think they'll have something to say about it when my next review happens in a few weeks.

Cool, sounds like they have you well on the path to consider statin alternatives. If they don't raise it I can guess you can quizz them about why not following the NHS guidance: ezetimibe or inclisiran or bempedoic acid or a PCSK9 inhibitor. Lots of options ...

 

[void]

thanks

 

[void]

Cool, sounds like they have you well on the path to consider statin alternatives. If they don't raise it I can guess you can quizz them about why not following the NHS guidance: ezetimibe or inclisiran or bempedoic acid or a PCSK9 inhibitor. Lots of options ...

Very late following up, sorry, but in case you're interested, I was put on bempedoic acid plus ezetimibe. No detectable ill effects 3 months in.