Statins and Muscle Pain (Myalgia): What You Should Know When Cholesterol Control Hurts, and What You Can Do About It | Dr Chan Po Fun, Women’s Heart Health & Lipid Specialist, Singapore
- Dr Chan Po Fun
- Oct 7
- 4 min read
Statins remain one of the most effective and economical treatments for lowering cholesterol and reducing heart-attack risk. But for some patients, muscle pain, also known as statin-associated myalgia, can make it difficult to continue therapy.
If you have ever stopped your cholesterol medication because of aches or fatigue, you’re not alone. Let’s explore why statin muscle pain (myalgia) happens, and more importantly, what safe and effective alternatives exist today.
💥 Why Do Statins Cause Muscle Pain (Myalgia)?
Statins work by blocking an enzyme in the liver that helps produce cholesterol. In a small percentage of people (about 5–10 %), this same pathway may slightly reduce co-enzyme Q10 (CoQ10) levels within muscle cells. Low CoQ10 can affect energy metabolism in muscles, leading to:
Aching or heaviness in the thighs or shoulders
Fatigue or weakness, especially after exertion
Discomfort that improves when the medication is stopped
The risk is higher if you:
Are on a higher statin dose
Use interacting medications (certain antibiotics or antifungals)
Have thyroid or kidney issues
Are older or smaller-framed
🧩 Step 1: Confirm the Cause
Not all muscle pain is due to statins.Your doctor will usually:
Check CK (creatine kinase) and liver enzymes
Review all your medications and supplements
Try a short “statin holiday” (stop for 2–4 weeks and reassess symptoms)
If the pain improves and cholesterol rises again, you likely have statin-associated myalgia, and the next step is finding a gentler approach.
💧 Step 2: Switch to a Hydrophilic Statin
Statins differ in how they enter muscle tissue. Hydrophilic statins, such as rosuvastatin and pravastatin, are less likely to cause muscle symptoms than lipophilic ones like simvastatin or atorvastatin.
Your cardiologist may:
Change to a hydrophilic statin
Reduce the dose
⚡ Step 3: Add Co-enzyme Q10
Some studies suggest that supplementing CoQ10 (100–200 mg daily) may reduce muscle pain and improve energy metabolism. Although research results are mixed, many patients find it helps, and it is safe for most people. Always discuss dosage and brand reliability with your physician.
🧠 Step 4: Combine or Substitute with Other Lipid-Lowering Therapies
If symptoms persist despite adjustments, don’t give up. Several non-statin options now exist to help reach LDL targets.
Option | How It Works | Typical LDL Reduction | Notes |
Ezetimibe | Blocks cholesterol absorption in the intestine | 15–25 % | Easy to add to a low-dose statin |
Bempedoic acid | Reduces cholesterol synthesis in the liver, inactive in muscle | 15–25 % | New oral option for statin intolerance |
PCSK9 inhibitors (Repatha, Praluent) | Increases LDL removal from blood | 50–60 % | Injectable every 2–4 weeks; well-tolerated |
Inclisiran (Leqvio) | Silences PCSK9 production in the liver | ~50 % | Injection every 6 months; long-term control |
These therapies can be used alone or in combination, guided by your lipid profile and cardiovascular risk.
🩺 Step 5: Keep the Goal in Sight
The target isn’t just a number. It’s risk reduction. Every 1 mmol/L drop in LDL-C lowers major cardiovascular events by about 20 %. The key is to find a regimen you can stick with long-term, whether that’s a lower statin dose, combination therapy, or PCSK9 injection.
❤️ Takeaway
Statin muscle pain is real but manageable. With the right evaluation and adjustments, most patients can still achieve excellent cholesterol control safely. Don’t stop medication on your own. Speak with a cardiologist experienced in lipid management.
Dr Chan Po Fun tailors lipid therapy using the latest options, from hydrophilic statins and CoQ10 to ezetimibe, bempedoic acid, and PCSK9 inhibitors, ensuring effective and comfortable long-term treatment.
Your heart deserves a treatment you can live with, and live well.
Frequently Asked Questions About Statins and Muscle Pain (Myalgia)
1️⃣ Why do statins cause muscle pain?
Statins lower cholesterol by blocking an enzyme in the liver. In some people, this pathway also reduces a natural energy compound called co-enzyme Q10 (CoQ10) in muscles, which can cause aches, heaviness, or fatigue. The discomfort is usually mild and reversible.
2️⃣ How common is muscle pain from statins?
Mild muscle aches occur in about 5–10 % of people on statins. True statin intolerance is less common, and most patients can tolerate another type of statin or dose adjustment.
3️⃣ What can I do if I get muscle pain from statins?
Never stop medication on your own. Speak to your doctor — often, switching to a hydrophilic statin (like rosuvastatin or pravastatin), lowering the dose, or taking CoQ10 supplements can ease symptoms.
4️⃣ Are there alternatives to statins?
Yes. If you remain symptomatic, your doctor may recommend non-statin cholesterol-lowering treatments such as:
Ezetimibe – reduces cholesterol absorption
Bempedoic acid – acts only in the liver, not in muscle
PCSK9 inhibitors (Repatha, Praluent) – powerful injectable therapy
Inclisiran (Leqvio) – injection every six months for long-term control
5️⃣ What is a PCSK9 inhibitor and how does it work?
PCSK9 inhibitors help your liver remove LDL (“bad”) cholesterol more efficiently. They can lower LDL by up to 60 % and are ideal for people who can’t tolerate statins or have familial high cholesterol.
6️⃣ Are these treatments available in Singapore?
Yes. Ezetimibe, bempedoic acid, Repatha, Praluent, and Inclisiran are available in Singapore through cardiologists experienced in lipid management. Selected treatments may be covered by insurance or residual medical benefits if medically indicated.
7️⃣ When should I see a cardiologist?
You should consult a cardiologist if your cholesterol remains high despite medication, you’ve stopped statins due to muscle pain, or you’re interested in PCSK9 therapy or other advanced lipid-lowering treatments.
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