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DEAR DR. ROACH: Over the years, I’ve taken a variety of statins. It seems that eventually, I always get bad leg problems with many aches and pains. Various doctors just change the kind of statin I take, but the same things happen. I decided to help myself a little bit and cut the pills in half. For a while, it seemed to work, but then the leg aches eventually returned.
Can you tell us why there are so many different statins and what each one is supposed to do that the others don’t? I know they’re supposed to help my heart, but the leg aches make me want to stop taking them anyway. — V.L.S.
ANSWER: Statin drugs reduce the body’s ability to make cholesterol by blocking an enzyme called HMG-CoA reductase. This lowers blood cholesterol, especially a type of cholesterol called low-density lipoprotein, which is strongly associated with blockages in the blood vessels of the heart and brain. These blockages can lead to heart attacks and strokes.
People who already have blockages, or those who are at a high risk of blockages, benefit from taking statin drugs to lower their risk of having one of these potentially catastrophic events. Guidelines that were released this year are recommending statins for more people than the older guidelines did, recognizing that starting people on medication early may prevent them from getting blockages.
All statins work the same way but have different risks of side effects. Muscle aches are among the most common of side effects; however, even people who take placebo tablets notice muscle aches. Most studies show a 1% to 1.5% risk of muscle aches with statins compared to a placebo.
Sometimes changing to a different statin can relieve the muscle aches. Pitavastatin, pravastatin and fluvastatin have the lowest rates. Sometimes people have muscle aches no matter which statin they take. Some of my colleagues recommend coenzyme Q10 (CoQ10) supplements; although about 30% of people (the results vary in different studies) receive a benefit from CoQ10, almost exactly the same number of people benefitted from a placebo.
When a person really can’t tolerate a statin, there are other options, including ezetimibe (Zetia), bempedoic acid (Nexletol), and PCSK9 inhibitors, which are now available in pill form in addition to the injection. None of these cause increased muscle aches above the rate in people who take placebo tablets.
DR. ROACH WRITES: In a recent column, I identified the location of a pain syndrome at C8-T1. Several people wrote in to note that there are only seven cervical vertebrae and suggested that I open a textbook. One person kindly let me know that even giraffes only have seven cervical vertebrae.
They’re quite right, but C8 in this case refers to the eighth cervical nerve, not a bone. The first cervical spinal nerve (C1) exits above the first cervical vertebra, while the eighth cervical nerve exits below the seventh cervical vertebra and above the first thoracic vertebra (T1).
I always appreciate the letters, and I have made mistakes of course. But in this case, “C8” is due to a quirk in the naming system for spinal nerve roots.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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