Study Links Statin Use to Tendon Injury
Tendinitis, Tendon Rupture Reported but Considered Rare
Feb. 28, 2008 -- New research suggests a link between the use of cholesterol-lowering statin drugs and tendon injury, but the study falls short of
proving an association, a cholesterol expert tells WebMD.
Millions of people worldwide use medications like Lipitor, Zocor, Crestor, and other statins to lower their cholesterol,
and they are among the most widely studied drugs ever.
Tendon ruptures and other tendon injuries have not been reported as a side
effect of statin use in previous studies, but there have been anecdotal reports
of a link over the years, appearing mostly in French medical journals.
Statin Use and Tendon Injury
These reports led researchers from France's Rouen University Hospital, Rouen
Cedex, to conduct a look-back study using a database of patients who reported
adverse side effects associated with statin use between 1990 and 2005.
Of the 4,597 side effects reported, 96, or about 2%, involved tendinitis or tendon
The Achilles tendon was the most common site of injury, with pain, swelling, warmth, and
stiffness being the most common complaints.
According to the researchers, tendon problems began in 59% of patients
within a year of starting statin treatment, and the problems went away in many
patients after they stopped taking the drugs.
"(Tendon complications) recurred in the seven patients (100% of cases)
in whom statin therapy was reinstituted, which strongly supports a relationship
with the use of these drugs," researcher Isabelle Marie, MD, PhD, and
colleagues write in the March issue of the journal Arthritis and
Cholesterol Expert Unconvinced
But heart surgeon Michael Richman, MD, is unconvinced. He tells WebMD that
there is no way to know from the study design if the tendon problems reported
by the patients had anything to do with their statin use.
He points out that none of the pre- and post-marketing statin studies,
involving around 45,000 patients, ever identified tendon injury as a
complication of statin use.
Richman is president of the Center for Cholesterol Management in Los
"Statins are among the most studied and the safest drugs we have,"
he says. "They save lives every day, and they have changed the face of
cardiovascular medicine. As far as I'm concerned, doctors should be looking for
reasons to put more people on them rather than looking for reasons not
Tendon Injuries Rare
If statin use is associated with an increased risk for tendon injury, all
agree that the complication is rare.
But Marie and colleagues conclude that the evidence is strong enough to
recommend closer monitoring of statin users.
"Our study suggests that regular (tendon-related) clinical examination
may be required in statin-treated patients, particularly during the first year
following statin therapy initiation," they write. "They also suggest
that it is worth considering interrupting statin therapy before strenuous physical activity such as marathon
Calls for comment to media representatives of Pfizer Inc., maker of Lipitor,
and Merck & Co., maker of Zocor, were not returned in time for