Statins: How do you wake up in the morning? The ‘feeling’ that’s a common side effect

Statins: How the drug prevents heart attacks and strokes

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Statins have doubtlessly saved millions of lives by helping lower the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol, often referred to as “bad cholesterol”, clings to the inside of your blood vessel walls. Statins intercept this process, thereby reducing your risk of heart disease.

Statins are a vital intervention but taking them does come with some cons, namely side effects.

Like all medicines, statins can cause side effects. But most people tolerate them well and do not have any problems.

According to the NHS, one common side effect of taking statins is “feeling unusually tired or physically weak”.

A helpful way to identify unusual or persistent tiredness, also known as fatigue, is by gauging how you wake up in the morning.

The NHS explains: “We all experience tiredness at times, which can be relieved by sleep and rest. Fatigue is when the tiredness is often overwhelming and isn’t relieved by sleep and rest.”

Research suggests fatigue is a commonly reported side effect among statin users.

A study involving more than 1,000 adults found that individuals taking cholesterol-lowering statin drugs are more likely than non-users to experience decreased energy, fatigue upon exertion, or both.

Researchers at the University of California, San Diego presented randomised trial data which show that these side effects were significantly greater in persons placed on statins than those on a placebo.

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In a randomised trial study, a number of similar people are randomly assigned to two (or more) groups to test a specific drug, treatment or other intervention

More than 1,000 adults from San Diego were randomly allocated to identical capsules with placebo, or one of two statins at relatively low potencies: pravastatin (Pravachol) at 40mg, or simvastatin (Zocor) at 20mg – chosen as the most water-soluble and most fat-soluble of the statins, at doses expected to produce similar LDL reduction.

According to the researchers, the cholesterol reduction would be similar to that expected with atorvastatin (Lipitor) at 10mg, or rosuvastatin (Crestor) at 2.5-5mg.

Persons with heart disease and diabetes were excluded. Neither subjects nor investigators knew which agent the subject had received.

Subjects rated their energy and fatigue with exertion relative to baseline, on a five-point scale, from “much worse” to “much better”.

Those placed on statins were significantly more likely than those on placebo to report worsening in energy, fatigue-with-exertion, or both.

Both statins contributed to the finding, though the effect appeared to be stronger in those on simvastatin.

“Side effects of statins generally rise with increasing dose, and these doses were modest by current standards,” wrote Beatrice Golomb, MD, PhD, associate professor of medicine at UC San Diego School of Medicine, in the study published in the Archives of Internal Medicine.

“Yet occurrence of this problem was not rare – even at these doses, and particularly in women.”

Prof Golomb added: “Exertional fatigue not only predicts actual participation in exercise, but both lower energy and greater exertional fatigue may signal triggering of mechanisms by which statins may adversely affect cell health.”

In light of the findings, the researchers said that decreases in energy, and increases in exertional fatigue on statins represent important findings which should be taken into account in risk-benefit determinations for statins.

Other common side effects include:

  • Headache
  • Dizziness
  • Feeling sick
  • Digestive system problems, such as constipation, diarrhoea, indigestion or farting
  • Muscle pain
  • Sleep problems
  • Low blood platelet count.

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