Which Statin has the Fewest Side Effects?

Statin medications are widely prescribed to lower cholesterol levels and reduce the risk of cardiovascular diseases. While they are generally safe and effective, like any medication, they may cause side effects in some individuals.

The most common reason someone may stop taking their statin is because of statin-associated muscle pain. This risk of statin muscle pain goes up with higher dose statins.

Most people are able to restart a statin on a lower dose without side effects, however, there are a select few who are considered statin intolerant.

What are Common Statin Side Effects?

Statin side effects are the number one reason that patients claim to stop taking their statin. The most common side effects associated with a statin are:

• Headache
• Diarrhea
• Constipation
• Muscle pain
• Weakness

Muscle Pain is the #1 Reason People Stop Taking a Statin

Generally speaking, the higher the dose of statin you take, the higher the chance of statin muscle pain. This is true for all statins. If you experience a statin side effect, be sure to talk to your healthcare provider. More than likely, they will want to lower your dose or switch statins altogether to see how your body responds.

The table below highlights the reported muscle related side effects for each statin based on their FDA-labelling.

Muscle Pain Rate Based on Drug Approval Studies (%)

Which Statin has the Lowest Rate of Muscle Pain?

In most clinical studies which compare one statin to another, the rates of statin side effects are quite similar from statin to statin. However, in clinical practice this may be different. Many healthcare providers will start their patients on high-dose statins and lower the dose, or switch to a different statin, like Zypitamag (pitavastatin), if any issues arise.

Statin Side Effects Appear to be More Common in the Real World

In clinical studies the rates of statin muscle pain is relatively low. This is likely because of the selection criteria used in these studies. But in real-world clinical practice, the data estimates these numbers are much higher, at 11% to 29%.¹

A 2022 meta-analysis looked to answer this question. They looked at 176 studies including over 4 million patients to determine the overall prevalence of statin intolerance to be 9.1%.² In this study they defined statin intolerance as having one or more adverse effect associated with statin therapy.

Interestingly, the rates in this analysis showed that statin intolerance occurred 4.9% of the time in clinical studies and 17% in observational studies.²

Unfortunately, this study did not look at the rates of statin side effects based on the type of statin that was prescribed. There is little comparative evidence to suggest one statin has lower side effects than another. However, switching statins is often an effective strategy for people who are having issues with one statin.

Risk Factors for Statin Intolerance

The 2022 meta-analysis concluded that certain people are at a higher risk of statin intolerance. Some examples include:

• Being Female: 47.9% increased risk
• Increasing Age: 33.1% increased risk
• Black Race: 29.3% increased risk
• Obesity: 30.6% increased risk
• Hypothyroidism: 37.6% increased risk
• Diabetes Mellitus: 26.6% increased risk

See all risk factors for statin intolerance.

A New Proposed Cause of Statin Side Effects

A recent study aimed to understand the underlying cause of statin side effects. It enrolled 60 people who have had issues with statins in the past to better understand what was causing statin side effects. Patients took 4 months of a statin, 4 months of a placebo, and 4 months of no medication.

The study found up to 90% of statin side effects were caused by the nocebo effect.³

A nocebo effect occurs when negative expectations of a treatment cause the treatment to have a more negative effects than it otherwise would have. While this is the case for some people, it doesn't make it any less relevant, as they are real perceived side-effects which your healthcare provider should address. The study later spoke with these patient many were able to restart their statin therapy successfully after proper counselling with their healthcare provider.

What To Do If You Are having Statin Side Effects

If you experience statin side effects, your healthcare provider may employ different strategies: reducing the statin dose, switching to another statin, or non-daily dosing. Most individuals can find an effective treatment to manage cholesterol and reduce the risk of cardiovascular disease, even if they face statin intolerance. Combination therapy might be considered for patients requiring additional cholesterol management beyond a lower statin dose.

It is important to note that the majority of individuals taking statins experience little to no side effects, and the benefits of these medications in reducing the risk of heart disease often outweigh the potential risks. If you are prescribed statins and experience any concerning side effects, it's crucial to inform your healthcare provider promptly to discuss possible adjustments or alternative treatments. Always follow your healthcare provider's advice and have regular check-ups to monitor your health while on statin therapy.