What are the risks of tendinitis in patients taking Lipitor (atorvastatin) or other statins?

From the Guidelines

Lipitor (atorvastatin) and other statins do not have a definite association with an increased risk of tendinitis or tendon rupture, according to the 2019 American College of Cardiology/American Heart Association guideline on the management of blood cholesterol 1. The guideline reports that tendon rupture is considered an unfounded risk associated with statin use.

• The evidence suggests that while statin-associated muscle symptoms (SAMS) are common, with myalgias occurring in 1% to 5% of patients in randomized controlled trials (RCTs) and 5% to 10% in observational studies, the risk of tendinitis or tendon rupture is not supported by the data.
• The guideline emphasizes the importance of evaluating musculoskeletal symptoms before initiating statin therapy and monitoring for potential side effects, but it does not specifically recommend increased vigilance for tendinitis or tendon rupture.
• It is essential to note that the benefits of statins in reducing cardiovascular risk typically outweigh the potential risks for most patients, and the decision to prescribe statins should be based on individual patient factors and clinical judgment.
• If patients experience muscle symptoms or other potential side effects while taking statins, they should consult their healthcare provider for proper evaluation and guidance.

From the Research

Risks of Tendinitis with Statins

• The use of statins, including Lipitor (atorvastatin), may be associated with certain tendinopathies and tendon ruptures, especially of the Achilles, quadriceps, and distal biceps tendons 2.
• Tendinopathy usually occurs within the first year of statin use and improves after the drug therapy is stopped 2.
• Systemic conditions with a higher risk of tendon rupture include diabetes, gout, rheumatoid arthritis, and chronic kidney disease, and certain drugs like corticosteroids and fluoroquinolones have also been implicated in tendon ruptures 2.

Statin Therapy and Tendinopathy

• A systematic review found no positive association between statin therapy and tendon rupture for the total study population, but there was evidence that simvastatin reduces the risk of tendinopathy 3.
• The review included four studies with a mean methodological quality score of 67%, and three studies were deemed high quality 3.
• Another study found that statins as a class showed statistically significant risk reductions on non-fatal MI, CVD mortality, all-cause mortality, non-fatal stroke, unstable angina, and composite major cardiovascular events, but increased the risk of myopathy, renal dysfunction, and hepatic dysfunction 4.

Specific Statins and Tendinopathy

• Atorvastatin and rosuvastatin were found to be most effective in reducing CVD events, while atorvastatin appeared to have the best safety profile 4.
• A network meta-analysis found that rosuvastatin, simvastatin, and pravastatin increased the risk of glaucoma onset, but did not specifically examine the risk of tendinitis 5.
• The evidence suggests that while statins may be associated with an increased risk of tendinopathy, the risk is generally low and tends to occur within the first year of use 2, 3.