DEAR DR. ROACH: I am a 75-year-old woman who is active in many ways. I did the swim leg for a women’s triathlon relay team, which was 2-3 miles in the open ocean. So I’m baffled by my recent diagnosis of myasthenia gravis (MG)! Reading as much as I could for a clue, I found an (invalid) study stating that older people who started taking statins mysteriously got MG. I started Crestor in April 2022.
Older people in the study started taking cholesterol medications other than statins and their symptoms decreased. MG is not listed as a “risk factor” for any statin. What does your research say? —NC
ANSWER: Hundreds of thousands of people start taking statins each year and, coincidentally, they may also get illnesses that might lead them to think statins might be the cause. This can make it difficult to determine whether the statin is actually causing the problem.
I have read a few case reports of older people developing MG (an autoimmune disease of the nerve and muscle junction, leading to muscle weakness) within a few weeks of starting a statin. The fact that your association began two years after you created Crestor makes the association seem more serendipitous than Crestor.
I’ve read that up to 10% of people experience a worsening of the disease if they start taking a statin. If this is the case, statin therapy should be stopped. I also read that a drug that shouldn’t affect muscles at all – ezetimibe (Zetia), which works by reducing the absorption of cholesterol from food – was also associated with worsening MG. in one case. The situation improved when the treatment was stopped.
Statins slightly reduce the risk of complications from vascular disease, including stroke, heart attack, and death, when given to people at higher risk. The higher the risk of heart attack or stroke, the more beneficial taking a statin will be. The data on heart disease prevention in 75-year-old women who do not have known heart disease is not strong, but most experts in the field believe there are some benefits to statins.
However, the potential benefits must be weighed against the possible risks. The risk of developing MG is not great enough to be a significant factor when starting a statin, but in people who already have MG, it would be wise to monitor for worsening MG symptoms, such as double vision or muscle weakness.
Other options for lowering cholesterol with less risk to muscles include bile acid sequestrants, which are very safe but do little to reduce heart risks. In one study, PCSK-9 inhibitors, such as evolocumab (Rapatha), were shown to not have an increased risk of muscle damage, despite case reports of worsening of the disease. Bempedoic acid (Nexlotol) is a newer cholesterol medication with much less risk of muscle damage, but I haven’t found any data for people with MG.
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Dr. Roach regrets not being able to respond to individual letters, but he will incorporate them into the column as much as possible. Readers can email questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.
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