Statin use may result in a subjective feeling of lack of energy and fatigue with exertion, a randomised controlled trial has found. The effects were more common in women than men.

A total of 1,016 patients (692 men) with LDL cholesterol levels of 115 to 190 mg/dl and no cardiovascular disease or diabetes were randomised to simvastatin 20 mg, pravastatin 40 mg, or placebo for six months. Patients rated their own changes from baseline in energy and fatigue with exertion assessed at six-month follow-up. The changes were scored on a five-point scale from much less (-2) to much more (+2) compared with baseline.

A significant adverse effect on energy and fatigue with exertion associated with statin use was found which was more common in women than men. Both simvastatin and pravastatin contributed to this effect. There was an average reduction of 0.25 points with simvastatin and 0.17 points with pravastatin.

Furthermore, there was a significant relation between the reduced energy reported and actual activity. This last point could lead to an increase in cardiovascular clinical events through a reduction in aerobic activity.

The authors of this study state that fatigue has been described by patients receiving statins in observational studies but no randomised trial had previously been undertaken to investigate this.

Statins are among the most widely used drugs in primary care and are generally well tolerated. However, the ‘tired all the time’ presentation will be one that is very familiar to GPs and because of the ubiquity of statins it follows that many such patients could also be taking these drugs.

The findings from this study become even more relevant when considering statin use for primary prevention particularly at the lower end of the risk spectrum when patients may be least willing to tolerate such negative effects on their quality of life.

I will certainly be more likely to think of statins as a potential cause for fatigue after reading this study.

Dr Peter Savill

• Golomb BA, Evans MA, Dimsdale JE and White HL. Effects of statins on energy and fatigue with exertion: Results from a randomized controlled trial. Arch Intern Med 2012; DOI:10.1001/ archinternmed. 2012.2171