Itâs likely not the lipid lowering per se. Itâs more likely connected with the mechanism behind myalgia symptoms in some users, which has been put down to statins affecting calcium channels (essentially they keep them open in muscles constantly which has deleterious effects). All statins do that, but some individuals are more susceptible to perceptible side effects. As other LLT agents donât have this effect, itâs likely not an issue, i.e. just lowering ApoB/LDL by itself is not the problem.
The decision as to whether taking statins makes sense must be individualized. You have to look carefully at your specific situation. You may reach the conclusion that even with muscle deterioration or some other side effects, itâs still worth taking statins, not just because on balance they allow you better healthspan and prevent CVD related problems. Thatâs the âeasyâ part. The more difficult problem complicating the decision is the larger context. For example, what if you have drug X, which makes your muscles somewhat weaker, but adds 10 years to your lifespan? As long as the muscle weakening is not debilitating, and as long as big muscles are not your life goal in and of itself, then Iâd take the extra 10 years. We often keep failing to tackle antagonistic pleiotropy in our decision making.
What if - as happens not infrequently - you are trading some fitness for a longer lifespan. What if great fitness is incompatible with a long lifespan? You may still opt for a shorter lifespan because as I mentioned, the cost is unacceptable. Example: thereâs a whole thread here positing how castration can be lifespan prolonging at the cost of loss of strength and all the other things that go with castration. Many of us (myself included) would not trade an extra 3-5 years for lifelong castration. Of course, give me a 200 year advantage and Iâd likely ask for some dull scissors. Now, trading off procreation for longevity is as old as the hills - CR is a prime example (for both males and females, amenorrhea for the latter). But this extends to tons of other tradeoffs. Going in the other direction - GIGANTIC muscles a la bodybuilders may result in a shortened lifespan. Then what if at the other end is âmediocreâ muscles, but 10 extra years? A bodybuilder would not agree. I would, as I donât care if my muscles are not tip top - as long as it doesnât impact my ADL, I donât care if the day before I die I can lift 150lbs vs 200lbs. For muscles, I say, Iâm OK with âgood enoughâ. Btw. even here it might not be so clear cut. For example, with CR you definitely have lower muscle mass and bone density and fertility. BUT. It transpires that the muscle tissue is preserved for longer than the âburn bright but burn shortâ big muscles (as well as things like hormones - testosterone is lowered on CR, but then ends up at a higher level than the sharp drop with age experienced by ad-lib folks), and the bone has superior architecture and fertility can be restored much later in life compared to the faster burning non-CR candle. Again, trade offs.
Bottom line, to me, itâs not so simple as to say âstatins are bad for musclesâ I quit. Way, way too simplistic. Itâs actually very complicated. Statins do much more for the health than lower lipids and ameliorate CVD. There are pleiotropic benefits which might be enough to push me to take them even if I do not need them to lower my lipids or affect my CVD. Iâm playing a much longer game. And in that game, it might make sense to sacrifice a degree of muscle fitness for those benefits, exactly as in CR. To me, as long as my ADL is not affected, I donât care. But if you have different goals and values, that might be a bridge too far. In essence, what I am saying is: this is complicated. How much worse do the muscles get - wheelchair level? What are the compensating benefits, if any? Do I have CVD and atherosclerosis already? And so on. Some of this data we donât actually have at present, which makes all this even more fraught. But thatâs true of almost all the pharmaceuticals we take - we trade off risks vs benefits and operate in an environment of incomplete information (so brush up on mathematical game theory!).
