Many people take statins without experiencing any side effects. However, some develop muscle pain, soreness, or weakness after starting cholesterol-lowering medication. These symptoms, often referred to as statin-associated muscle symptoms (SAMS), are among the most reported side effects of statins. While these medicines play an important role in managing cholesterol and reducing cardiovascular risk, muscle pain remains a frequent concern. For some, the discomfort is mild. For others, muscle aches, cramps, or weakness can interfere with daily activities. This can leave people unsure whether to continue treatment or look for ways to manage muscle pain without compromising heart health.
Why Some People Develop Muscle Pain When Taking Statins
For many years, muscle pain and weakness have been among the most common reasons people stop taking cholesterol-lowering statins. Despite their well-established benefits for heart health, some patients experience ongoing muscle discomfort, fatigue, or a noticeable loss of strength after starting treatment. Until recently, the biological explanation behind these side effects was not fully understood.
New research from Columbia University may offer part of the answer. Scientists found that certain statins can interact with a specific protein inside muscle cells, leading to a small but persistent leak of calcium. Over time, this disruption may interfere with normal muscle function and contribute to muscle pain or weakness.
The researchers suggest that this calcium leak does not cause immediate damage. Instead, it may gradually weaken muscle fibres or activate processes that slowly break muscle tissue down. This could help explain why statin-related muscle symptoms often develop over time rather than appearing suddenly.
According to Andrew Marks, Chair of the Department of Physiology and Cellular Biophysics at Columbia University, this mechanism may not account for every case of statin-associated muscle symptoms. Even so, understanding one possible cause could make a meaningful difference for a large number of patients who struggle to tolerate statin therapy.
Statins remain among the most widely prescribed cholesterol-lowering medicines worldwide. Around 40 million adults in the United States and more than 50 million people across the European Union take statins regularly. Current estimates suggest that approximately 10 percent of users experience muscle-related side effects, underlining the importance of understanding why these symptoms occur.
A Longstanding Puzzle Around Statin Muscle Pain
Scientists have been trying to understand statin-related muscle problems since the drugs first became available in the late 1980s. Statins work by binding to an enzyme involved in cholesterol production, but they can also attach to other unintended targets in the body.
Earlier research hinted that muscle side effects might occur when statins interact with a specific protein in muscle tissue. Until now, the details of that interaction were unclear.
Using cryo-electron microscopy, a powerful imaging method that allows researchers to see structures down to individual atoms, the Columbia team was able to directly observe how a statin interacts with muscle cells.
Calcium Leaks Inside Muscle Cells
The images showed that a commonly prescribed statin, simvastatin, binds to two specific sites on a muscle protein known as the ryanodine receptor. This binding opens a channel in the protein, allowing calcium to leak into areas of the cell where it does not normally flow.
According to Marks, this calcium leak may explain muscle pain and weakness linked to statins. The excess calcium can weaken muscle fibres directly or activate enzymes that gradually break down muscle tissue. (While for this study, only simvastatin was studied, many patients on other types of statins (Atorvastatin, rosuvastatin, pravastatin, fluvastatin, lovastatin and pitavastatin – have also complained of ‘muscle pain’. Ed.)
Toward Safer Cholesterol Drugs
The findings point to new possibilities for reducing statin-related side effects. One approach under discussion is the development of cholesterol-lowering options that maintain effectiveness while minimising unwanted interactions within muscle cells, such as binding to the ryanodine receptor.
In this context, naturally derived compounds that contain statin-like substances have also attracted scientific interest. Red yeast rice is known to provide a standardised source of naturally occurring monacolins, including monacolin K, which shares structural similarities with certain statins. Sona Red Yeast Rice provides monacolins in a full-spectrum formulation, with each capsule containing 2.95 mg of total monacolins, including monacolin K.
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Source: Columbia University Irving Medical Center. "Scientists finally uncover why statins cause muscle pain." ScienceDaily, 14 January 2026.