A new study now confirms what many patients have been telling their doctors for years. There is a clear link between statins and tendon problems, which includes both tendonitis and tendinopathies.
So what does this mean for you? Are there certain statins that don’t have this effect? And what if you’ve been on statins for a long time? Are you at even higher risk for tendonitis? Let’s take a closer look at the study results to see what we can learn. I’m also going to give you some other options to improve your metabolic health without the use of medications.
Statin medications are used to reduce cholesterol levels and improve cardiovascular health. They reduce the risk of heart attacks and strokes and decrease the need for angioplasty and open heart surgery. Statins are widely prescribed to individuals with risk factors for heart disease. These include high cholesterol, diabetes, and hypertension.
But with all of their reported benefits, there are still concerns about their side effects. Chief among these are their effects on the musculoskeletal system. Many studies have confirmed that statins can cause serious side effects to muscles. But less is known about their effects on tendons.
Several studies have found that statins increase the risk of developing tendinopathies. Some even suggest that statins are linked to tendon ruptures. But other studies show the opposite, that statins reduce the risk of tendon related pathology. So what we really need is more data to help answer this question.
This new cohort study analyzed over 84,000 people taking statins and matched them to 168,000 controls. They wanted to know if the statin group would have higher rates of tendon problems. These included trigger finger, De Quervain’s tenosynovitis, tennis elbow and golfer’s elbow, rotator cuff tendinopathy, and achilles tendinopathy.
The researchers found that statin users had 43.5% higher risk of developing tendinopathy when compared to non statin users. This number sounds high. But to keep things in context, let’s look at the absolute difference in the number of events. The study found that there was a difference of only about 10 events among statin users for every 10,000 person years. So depending on how you look at things, the numbers could seem alarmingly high (43.5% higher risk of developing tendinopathy). Or it could be seen as tolerable (only 10 extra cases per 10,000 person years) if it means preventing death from cardiovascular disease.
Now let’s ask the question, is any one statin better than the others? Or put in another way, is there a statin that has less risk for developing tendinopathies? The authors specifically looked at atorvastatin, rosuvastatin, and simvastatin. They found that atorvastatin and simvastatin had the highest rates of tendinopathy across all types. Rosuvastatin had higher rates of trigger finger, elbow tendinopathies, and shoulder tendinopathies but NOT de Quervain’s tenosynovitis or achilles tendinopathy.
All the other statins were lumped together in a single group called “other statins”. This group also was found to have significantly higher rates of tendinopathy across all types. So what this means is that it really doesn’t matter what type of statin you are on. All of them increase your risk of developing tendinopathy.
So, knowing this, does that also mean the longer that you’ve been on a statin, the higher your risk of developing tendinopathy? The authors looked at a measurement called the cumulative defined daily dose. This just refers to the total amount of a medication that has been consumed over time. So the longer that you’ve been taking a medication, the higher your cumulative defined daily dose.
The authors found that statin users had greater rates of tendinopathy compared with nonusers regardless of cumulative dosage. Interestingly though, they found that the risk of developing tendinopathies actually became lower with more doses of statin. Meaning, the risk is highest in the first 3 months after starting a statin. Specifically, it’s 134% higher. Between 3 months and 6 months, it’s 121% higher.
But after 6 months on the medication, the risk is much lower at only 12% high. In fact, when we break it down by tendinopathy type, the rates of de Quervain’s tenosynovitis, tennis elbow and golfer’s elbow, and achilles tendinopathy were no longer different when compared to non-statin users.
Ok so let me summarize what all of this means. The first takeaway is that this study confirms that statin use increases the risk of developing tendinopathies, regardless of the type of statin used. We’re still unsure of the exact mechanism for how and why this happens. One hypothesis involves statins inducing the release of matrix metalloproteinases which results in weakening of the tendon matrix. Interestingly, rosuvastatin did not significantly increase the risk of certain tendinopathies suggesting that there may be variations on the effects of different statins on specific tendons.
The second takeaway is that the risk of tendinopathy is the highest in the initial 3 months of statin use. The negative impact of statins on tendons seems to decrease as the cumulative dose increases. We’re still unsure why this is but current evidence suggests that individuals who have been on a statin for six months without experiencing any issues likely do not have THAT much more of an increased risk of developing tendon disorders.
So I think it’s always important to highlight that everything we do in medicine involves a risk benefit analysis. Medications that have been shown to save lives still have side effects and it’s important that we learn about them. That’s the only way we can have a true risk benefit discussion. This of course includes statins.
The benefits of statins vary depending on an individual’s specific risk factors and medical history. Those who have already suffered a heart attack or a stroke are at incredibly high risk for repeat events. These patients will benefit tremendously from a statin. Similarly, those with risk factors such as diabetes are at high risk for future cardiovascular events and may benefit from statin medications.
But the decision to take a statin medication becomes much more murky when it comes to everyone else who doesn’t have risk factors. For many of these people, statins are only one of many options to try to improve overall health. And that’s the key thing here. What many people don’t realize is that poor metabolic health increases the risk for tendon problems, just as much, if not more so, than taking statins.
This study found that people with metabolic syndrome are also at high risk of tendon issues. Metabolic syndrome is defined as having three of the following: 1) excessive abdominal fat 2) insulin resistance or impaired glucose tolerance 3) high blood pressure 4) abnormal lipid or fat levels and 5) elevated fasting blood sugar.
The authors report that those with metabolic syndrome had about 2.5 times higher risk of tendon injury. Those with elevated hemoglobin a1c, which is a marker for prediabetes and diabetes, had a 3 times higher risk. And those with high cholesterol had a 1.5 times higher risk.
So the reality is that many people are at high risk of developing tendon problems regardless of whether or not they are on a statin. We are realizing that tendinopathies are as much a metabolic disease as it is an overuse or wear and tear problem. And what we really need to do is to make better choices when it comes to nutrition and physical activity.
So that’s what I want to talk about next. How can you take back control of your metabolic health? First, focus on your diet. Minimize the consumption of processed and fried foods. These types of foods have been associated with triggering inflammation and increasing oxidative stress. These foods skyrocket your risk for metabolic disorders, insulin resistance, and cardiovascular disease. The same is true of refined carbohydrates and sugary foods. These too are notorious for contributing to overall inflammation and destroying your metabolic health.
Instead, focus on eating an anti-inflammatory diet. This means filling your plate with foods that have been shown to reduce inflammation and improve your metabolism. Fruits and vegetables are packed with antioxidants, vitamins, and minerals that can help combat inflammation and improve insulin sensitivity.
Lean proteins such as chicken and fish or plant based proteins such as nuts, seeds, legumes, and soy are excellent choices. Healthy fats such as those found in avocados, olive oil, and fatty fish are also beneficial. These contain omega-3 fatty acids which have anti-inflammatory properties and improve your metabolic health.
And don’t forget about exercise. Exercise comes in two flavors. The first is aerobic exercise such as daily walking. Walking has benefits to all cause mortality, cardiovascular disease, mental health, cognitive function, immune function, weight loss, and more. Other excellent forms of low impact aerobic exercise include cycling, swimming, elliptical training, and rowing. Aim for at least 30 minutes every day of aerobic exercise.
The second flavor of exercise is strength training. This helps increase muscle mass, improve insulin sensitivity, enhance resting energy expenditure, promote fat loss, and induce positive metabolic adaptations. Aim to do strength training at least three times a week and include both upper and lower body training.
Ultimately, I believe there are a lot of things you can control to improve your metabolic health without the need for medication. Ultimately, the decision to start or continue a statin will vary depending on you as an individual, your specific risk factors, your medical history, and even your family history. All of this should be discussed with your trusted health care provider.