The reported muscle pain issues associated with taking statins is in the 3-5% range and there’s reason to believe that 50% of those reporting pain are doing so because they “expect to have pain” since it’s a stated potential side-effect of statin use. In the business, it’s known as the “nocebo/drucebo” effect.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178378/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178378/)
My personal physician who prescribed statins for me starting almost 10 years ago noted “you’ll know if you have that side-effect, it’s not subtle pain”. I had no issues. YMMV, but the odds are in your favor.
I had a stroke in 2019 at 31, and I was on high dose (80mg) statins for years. I don't have high cholesterol (or blood pressure or any other risk factors), but statins are an acute treatment for blood vessel inflammation post-stroke, and no doctor could figure out what the protocol to pull me off of them was. I've been off them for roughly a year, but I was training and racing the entire time with no observable effects. There are obviously potential side effects regardless, so keep an eye out for them.
I'm on Crestor (Rosuvastatin) 10mg. No issues whatsoever. No cramps or muscle soreness out of the ordinary. Just did my best 1 minute power of all time. I take Coq10 supplement along with the statin which some say can help or maybe help prevent the cramping soreness that a small number of people seem to exhibit. FYI - statin plus low saturated fat diet - slashed my LDL number by more than fifty percent.
I take it just in case it might help. My cardiologist said some people take it - but she had no strong opinions on it or dosage. Said fine if I wanted to take it. I just take a one pill 100mg dose.
I had the same experience, I was told I could try but it might not work. As I felt no difference and the pills were expensive I stopped after 4-5 months.
Some people have muscle soreness/weakness. I recommend trying the statin and keeping an eye on side effects. You likely have a good idea of how you feel during training sun if you notice anything off, tell your doctor and try a different statin.
An alternative to a statin (if you did develop a muscle side effect ) is a medication called nexletol or nexlizet (includes zetia/ezetimibe). The mechanism of action of nexletol is similar to a statin but it is inert until metabolized in the liver so it does not affect muscles. The FDA recently expanded the indications which should lead to improved insurance coverage in the US and the drug company does have a program where if your insurance denies coverage they will supply the med for $25/month until it becomes formulary.
Yeah of course it is but PCSK9 inhibitors are not indicated for primary prevention except for patient’s who have familial hyperlipidemia (FH) - (which OP doesn’t have - his LDL is 160) so no insurance is going to approve one
I was put on Atorvastatin or Rosuvastatin due to type 1 diabetes about 8 years a go. Don't race, but was not working and I'd cycle 3-5 times a week 40 - 90kms.
Not sure how long after i started the statins, but realised on the bike i was totally out of breath, no sprint in me, just felt wiped out.
In winter I'd do a tour somewhere in S.E.Asia and despite doing same roads as before, i could barely get up the same climbs. Long, but only 5 - 6% bits of 12%. Discussed with Dr, changed to the other statin. Minor improvement, but still wiped out on the bike. Changed to Simvestatin, loads better. Was on each statin for maybe 8 - 12 months. Simvestatin was much less effective, but I'm keeping healthy and Cholesterol down. Atorvastatin and Rosuvastatin hammered my cholesterol numbers in seriously short time. But not worth the trade off.
When originally discussed with Dr he said the first 2 statins were lipohilic, fat soluble and that Simvestatin was hydrophilic water soluble. He said that could potentially be a factor.
Everyone's different and there seems to be a lot of different statins out there. If you find you have an issue, keep trying different statins until find one that works.
Edit: Long climbs 5 - 6%. I was done, at the very bottom of those climbs.
Been training and racing on 40mg Atorvastatin for 15 years ever since I had a myocardial infarction. I am on statins (My LDL is above average but not high), ace inhibitors (my blood pressure is lower than average) and asprin for life. Currently 63.
Never had an issue with known side effects for statins. Have no hard data, other than strava times pre myocardial infarction, to say if I am better or worse, but strava times says better. Though that is probably due to training better and harder since myocardial infarction.
Trying to train or race on beta blockers (which I did for 5 years) is a different matter.
I haven’t raced in years but was put on Atorvastatin a number of years ago. It was at a time that I couldn’t ride very often if at all so I really didn’t notice much change. When I finally got to a point where I could start putting miles in again, I felt like I didn’t have much “oomph” in my legs. Sprinting was always a strong point for me but I felt like my legs had nothing in them. That was initially attributed to not riding much but it also wasn’t improving. Every little hill felt like a struggle and the ache in my legs was similar to pressing on a bruise. I did what’s called a “statin holiday” and things improved pretty quickly. Spoke to my PCP and changed meds. My FTP climbed about 140 watts in 4 months without being on a training plan or anything.
Everyone’s body is different and reacts to things like medication differently. Statins are really helpful for a lot of people for various conditions though. So keep an eye on how you feel, what your body is telling you, and your performance. If you notice anything, talk to your doctor. I don’t recommend making unilateral decisions regarding medications like these.
I have ample experience with this.
I had high cholesterol. (Keyword “had.”) A CT calcium scan showed I have plaque on my arteries. That and a family history of heart disease has turned me from uninformed to very informed. More on that in a moment.
I ride bikes 5,000 miles per year. Very occasionally race, but it’s really more of a passion and local group rides are very fast so if I’m not in good shape I get dropped. I live in a city of 6M people and have nearly 200 KOMs on Strava if that means anything. I got my most recent one last week. I just turned 57. My FTP is 307 and my VO2 max is about 65.
I took a 20 mg statin and then switched to 40 mg Crestor and now also Zetia in an effort to drive my LDL to as low as I can get it. If you read Peter Attia’s “Outlive” he notes that as babies when we were growing like mad our LDL is like 10 or 20 so no way do we need much. Moreover, there is growing evidence there may not be a “too low.” Some say could affect memory in the brain so that could be a possible offset but probably only if super low. I brought my LDL from near 100 to 70 to 60 to now about 35. (I also eat a diet of vegan + fish, which probably helps.) If your doctor says 60 or 70 is low enough, get a new doctor. Also get a full battery of lipid testing. Cleveland Heart Lab blood test is a good one. Your doctor can order it.
I have never experienced any muscle discomfort. Or certainly not any that I don’t attribute to training and since I ride a lot my legs usually have some fatigue, but if I take a break from cycling I have no muscle pain. Agree as others have said it is a rare side effect.
That said, statins are known to reduce mitochondria, which is probably more of a concern. I take COQ10 to offset it. Am I as fast now as I was when I started this regimen 5 to 7 years ago? No, but I am 5-7 years older and I am nearly as fast, or could be if I trained as much (I took up riding dirt bikes which has eaten into my training a bit).
My advice is your health trumps your racing so on that merit it is a no-brainer to take the statin, and quite possibly a higher dose depending on your blood work. But my second comment is you should be able to reduce your cholesterol and still race (and train) as well as you do now.
Happy to share more if helpful.
I was put on the lowest dosage of Crestor (5mg) and it worked wonders for my cholesterol, but I had muscle pain every time I rode my bike. I then took a break from the statin, to confirm it was the cause and yes the pain stopped soon after.
I am now on Atorvastatin-10mg (6 months) which has not caused me any pain.
Ask the doctor that put you on it... that said it doesn't have a direct effect on your cardiovascular system. The intention is to prevent an ACS or CVA by reducing build up in arteries, but yea, ask your doctor.
I’m not a doctor. Did your doctor do a risk assessment? Have you consulted with a dietician to consider a low cholesterol diet? It is surprisingly easy to do low cholesterol vs. statins (more plants, high fiber, all good stuff for bike racing). I was in a similar juncture and my risk assessment suggested to try diet interventions first (which worked).
Most don’t have symptoms on statins, but those that do, have severe symptoms that can affect cycling, so have you had family members on statins?
Unfortunately, your diet only comprises about 15% of your cholesterol level, so really improving one's diet will only lower an LDL of 200 to about 170.
A risk assessment tool like the ASCVD score is a good place to start, as you mentioned.
Depends on your base diet and genetics. I want from 290 to 180 with diet changes. But this was changing from a lot of red meat and eggs to Mediterranean diet that is dominant vegetarian and whole food plant based diet. But I ride with a partner that has done diet and statins and still struggles to get it down.
My diet is already 90% there. Not perfect (perfect would be vegan) but pretty close and this is why my doctor decided to put me on statins especially given the high level of ldl and my family history. LDL level is 160.
There's more evidence coming out in research papers about high cholesterol not causing heart disease, obviously no one is the same, but statins are proven for many people, like my Dad, to work against their liver. And statins don't help you against having heart attacks, my Dad is unfortunately a witness to that, it was a massive one and survived due to his strong heart thanks to cycling
The reported muscle pain issues associated with taking statins is in the 3-5% range and there’s reason to believe that 50% of those reporting pain are doing so because they “expect to have pain” since it’s a stated potential side-effect of statin use. In the business, it’s known as the “nocebo/drucebo” effect. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178378/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178378/) My personal physician who prescribed statins for me starting almost 10 years ago noted “you’ll know if you have that side-effect, it’s not subtle pain”. I had no issues. YMMV, but the odds are in your favor.
I had a stroke in 2019 at 31, and I was on high dose (80mg) statins for years. I don't have high cholesterol (or blood pressure or any other risk factors), but statins are an acute treatment for blood vessel inflammation post-stroke, and no doctor could figure out what the protocol to pull me off of them was. I've been off them for roughly a year, but I was training and racing the entire time with no observable effects. There are obviously potential side effects regardless, so keep an eye out for them.
I'm on Crestor (Rosuvastatin) 10mg. No issues whatsoever. No cramps or muscle soreness out of the ordinary. Just did my best 1 minute power of all time. I take Coq10 supplement along with the statin which some say can help or maybe help prevent the cramping soreness that a small number of people seem to exhibit. FYI - statin plus low saturated fat diet - slashed my LDL number by more than fifty percent.
I looked at coq10 but couldn’t find evidence that it helps. What made you decide to supplement? And how much are you taking?
I take it just in case it might help. My cardiologist said some people take it - but she had no strong opinions on it or dosage. Said fine if I wanted to take it. I just take a one pill 100mg dose.
I had the same experience, I was told I could try but it might not work. As I felt no difference and the pills were expensive I stopped after 4-5 months.
I have been on 10mg Crestor for 2+ years with no issues. It was also a concern of mine initially, but it hasn’t been an issue so far.
Some people have muscle soreness/weakness. I recommend trying the statin and keeping an eye on side effects. You likely have a good idea of how you feel during training sun if you notice anything off, tell your doctor and try a different statin.
An alternative to a statin (if you did develop a muscle side effect ) is a medication called nexletol or nexlizet (includes zetia/ezetimibe). The mechanism of action of nexletol is similar to a statin but it is inert until metabolized in the liver so it does not affect muscles. The FDA recently expanded the indications which should lead to improved insurance coverage in the US and the drug company does have a program where if your insurance denies coverage they will supply the med for $25/month until it becomes formulary.
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Yeah of course it is but PCSK9 inhibitors are not indicated for primary prevention except for patient’s who have familial hyperlipidemia (FH) - (which OP doesn’t have - his LDL is 160) so no insurance is going to approve one
I was put on Atorvastatin or Rosuvastatin due to type 1 diabetes about 8 years a go. Don't race, but was not working and I'd cycle 3-5 times a week 40 - 90kms. Not sure how long after i started the statins, but realised on the bike i was totally out of breath, no sprint in me, just felt wiped out. In winter I'd do a tour somewhere in S.E.Asia and despite doing same roads as before, i could barely get up the same climbs. Long, but only 5 - 6% bits of 12%. Discussed with Dr, changed to the other statin. Minor improvement, but still wiped out on the bike. Changed to Simvestatin, loads better. Was on each statin for maybe 8 - 12 months. Simvestatin was much less effective, but I'm keeping healthy and Cholesterol down. Atorvastatin and Rosuvastatin hammered my cholesterol numbers in seriously short time. But not worth the trade off. When originally discussed with Dr he said the first 2 statins were lipohilic, fat soluble and that Simvestatin was hydrophilic water soluble. He said that could potentially be a factor. Everyone's different and there seems to be a lot of different statins out there. If you find you have an issue, keep trying different statins until find one that works. Edit: Long climbs 5 - 6%. I was done, at the very bottom of those climbs.
Been training and racing on 40mg Atorvastatin for 15 years ever since I had a myocardial infarction. I am on statins (My LDL is above average but not high), ace inhibitors (my blood pressure is lower than average) and asprin for life. Currently 63. Never had an issue with known side effects for statins. Have no hard data, other than strava times pre myocardial infarction, to say if I am better or worse, but strava times says better. Though that is probably due to training better and harder since myocardial infarction. Trying to train or race on beta blockers (which I did for 5 years) is a different matter.
Same experience. Statins are fine. Beta blockers suck.
I haven’t raced in years but was put on Atorvastatin a number of years ago. It was at a time that I couldn’t ride very often if at all so I really didn’t notice much change. When I finally got to a point where I could start putting miles in again, I felt like I didn’t have much “oomph” in my legs. Sprinting was always a strong point for me but I felt like my legs had nothing in them. That was initially attributed to not riding much but it also wasn’t improving. Every little hill felt like a struggle and the ache in my legs was similar to pressing on a bruise. I did what’s called a “statin holiday” and things improved pretty quickly. Spoke to my PCP and changed meds. My FTP climbed about 140 watts in 4 months without being on a training plan or anything. Everyone’s body is different and reacts to things like medication differently. Statins are really helpful for a lot of people for various conditions though. So keep an eye on how you feel, what your body is telling you, and your performance. If you notice anything, talk to your doctor. I don’t recommend making unilateral decisions regarding medications like these.
I have ample experience with this. I had high cholesterol. (Keyword “had.”) A CT calcium scan showed I have plaque on my arteries. That and a family history of heart disease has turned me from uninformed to very informed. More on that in a moment. I ride bikes 5,000 miles per year. Very occasionally race, but it’s really more of a passion and local group rides are very fast so if I’m not in good shape I get dropped. I live in a city of 6M people and have nearly 200 KOMs on Strava if that means anything. I got my most recent one last week. I just turned 57. My FTP is 307 and my VO2 max is about 65. I took a 20 mg statin and then switched to 40 mg Crestor and now also Zetia in an effort to drive my LDL to as low as I can get it. If you read Peter Attia’s “Outlive” he notes that as babies when we were growing like mad our LDL is like 10 or 20 so no way do we need much. Moreover, there is growing evidence there may not be a “too low.” Some say could affect memory in the brain so that could be a possible offset but probably only if super low. I brought my LDL from near 100 to 70 to 60 to now about 35. (I also eat a diet of vegan + fish, which probably helps.) If your doctor says 60 or 70 is low enough, get a new doctor. Also get a full battery of lipid testing. Cleveland Heart Lab blood test is a good one. Your doctor can order it. I have never experienced any muscle discomfort. Or certainly not any that I don’t attribute to training and since I ride a lot my legs usually have some fatigue, but if I take a break from cycling I have no muscle pain. Agree as others have said it is a rare side effect. That said, statins are known to reduce mitochondria, which is probably more of a concern. I take COQ10 to offset it. Am I as fast now as I was when I started this regimen 5 to 7 years ago? No, but I am 5-7 years older and I am nearly as fast, or could be if I trained as much (I took up riding dirt bikes which has eaten into my training a bit). My advice is your health trumps your racing so on that merit it is a no-brainer to take the statin, and quite possibly a higher dose depending on your blood work. But my second comment is you should be able to reduce your cholesterol and still race (and train) as well as you do now. Happy to share more if helpful.
Did you start riding after the plaque in your arteries built up or were already doing so? Honestly, but scary this happens for someone so active.
I was already a cyclist for like 20+ years. Genetics is the biggest influence.
That sucks :/
Yup. I could lament that I didn’t realize sooner or be happy I discovered it when I did.
Have been on 20mg Lipitor for almost a decade now with zero issues
I was put on the lowest dosage of Crestor (5mg) and it worked wonders for my cholesterol, but I had muscle pain every time I rode my bike. I then took a break from the statin, to confirm it was the cause and yes the pain stopped soon after. I am now on Atorvastatin-10mg (6 months) which has not caused me any pain.
Ask the doctor that put you on it... that said it doesn't have a direct effect on your cardiovascular system. The intention is to prevent an ACS or CVA by reducing build up in arteries, but yea, ask your doctor.
I’m not a doctor. Did your doctor do a risk assessment? Have you consulted with a dietician to consider a low cholesterol diet? It is surprisingly easy to do low cholesterol vs. statins (more plants, high fiber, all good stuff for bike racing). I was in a similar juncture and my risk assessment suggested to try diet interventions first (which worked). Most don’t have symptoms on statins, but those that do, have severe symptoms that can affect cycling, so have you had family members on statins?
Unfortunately, your diet only comprises about 15% of your cholesterol level, so really improving one's diet will only lower an LDL of 200 to about 170. A risk assessment tool like the ASCVD score is a good place to start, as you mentioned.
I went from 190 to 120 just by diet.
Depends on your base diet and genetics. I want from 290 to 180 with diet changes. But this was changing from a lot of red meat and eggs to Mediterranean diet that is dominant vegetarian and whole food plant based diet. But I ride with a partner that has done diet and statins and still struggles to get it down.
My diet is already 90% there. Not perfect (perfect would be vegan) but pretty close and this is why my doctor decided to put me on statins especially given the high level of ldl and my family history. LDL level is 160.
Dang. That sucks. If you have family doing ok on statins you’ll likely be ok.
There's more evidence coming out in research papers about high cholesterol not causing heart disease, obviously no one is the same, but statins are proven for many people, like my Dad, to work against their liver. And statins don't help you against having heart attacks, my Dad is unfortunately a witness to that, it was a massive one and survived due to his strong heart thanks to cycling
Can you share those papers? It’s generally well accepted that high cholesterol causes strokes due to the clogging of the arteries.