Will statins give you muscle pain? What your genes can tell you.

Statins are used by tens of millions of people worldwide for lowering cholesterol levels.[ref] This type of medication is nearly always top the list of most prescribed in the US, with Lipitor (a type of statin) as the most prescribed drug in the US as of July 2019.[article] Genetic variants combine with statin usage to cause muscle pain for some individuals. Learn how to check your genes and what you can do about statin muscle pain.

Statins and myopathy

One side effect of statins is myopathy, or muscle pain and weakness.  Myopathy can be severe, leading to the breakdown of muscles and the risk of renal failure. The risk of severe myopathy with statins is small, but milder myotoxicity is found in 7 to 29% of patients. Essentially, this means that less severe, yet still painful, muscle-related symptoms are present in quite a few patients who take statins.[ref]

Why do statins cause muscle pain?

Statins lower cholesterol levels by inhibiting the hydroxymethylglutaryl-coenzyme A reductase enzyme, which is part of the pathway through which the body synthesizes cholesterol. Blocking this enzyme reduces cholesterol synthesis, leading to an increase in LDL receptor expression. More LDL receptors cause more LDL cholesterol to be removed from the bloodstream. Before statins can act within the liver cells, though, they have to be transported into the cell via a transport protein... The SLCO1B1 gene codes for the organic anion transporting polypeptide 1B1 (OATP1B1) protein. Genetic variants can cause this transport protein not to function as well, impairing the uptake of the statin. When the transport protein doesn't work well, the statin remains longer in circulation in the bloodstream. This causes side effects such as myopathy.[ref]

Genetic Variant:

The main genetic variant (SNP) that impacts statin side effects is known as SLCO1B1*5 or OATP1B1 -388G>A. You can check your genetic data to see if you carry this variant.

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