TO ALL ATHLETES - THIS IS A WARNING F... - British Heart Fou...

British Heart Foundation

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Hi All

Climbing a steep hill in May 2016, with my 17 AV Speed Group, I 'felt strange and weak' - never felt like this before - so straight to A+E.

Not much found, but a CT Angiogram in July 16 revealed severe cardiac atherosclerosis, with a calcium Agatston score of 1315 - super high!

At this stage, I was under the Nurse Led Cardiac Team at my hospital - and after taking a Full History and Lipid Profiles etc said I probably had Familial Cardiac Atherosclerosis.

And since my Total Cholesterol was only 3.0 (on a Vegan diet) statins were deemed as not needed. I was started on Diltiazem, Clopidrogel and GTN spray (prn)

In November 16, I had the final test - the Coronary Angiogram and 3 cardiac vessels were found to be severely blocked at between 74-94% and I was referred for a Bypass.

The specialist there, without asking for or reading my history, put me on Simvastatin 10 mgs. I asked why, as my total cholesterol was only 3.0? But, no answer, he just walked away!

Just before the Bypass I took just 3 doses of 5 mgs and straightaway my Av Speed dropped from 17 to 12 AV. I told my GP about this and he changed it to Rosuvastatin.

I had the Triple Bypass In February 17 and it was a great success - thanks NHS!

However, the aches continued and I told my GP about this many a time, but he didn't stop them.

So, I stopped them myself in April 17.

However, the muscle aches have continued and progressed.

90 % of the aches are in the Vastus Medialii - the cycling muscles!

Looking 'everywhere' for the reasons why, last week I FINALLY came across something that might explain why - this Study from 2004.

It describes an 8 year Study of 22 professional athletes who had Familial Hypercholesterolaemia, with total cholesterol of between 8-10, and they agreed to try statins, after being told about the potential muscle aches and being carefully monitored throughout.

And the result was that only 6 of the 22 (about 25%) could tolerate any statin, without muscle aches. Any athlete who complained about muscle aches, was immediately taken off them. ( WHY wasn't I?)

Compared to about 80% of the general population.

So, the remaining 16, who had muscle aches, even after a change in statin, were advised to try a non-statin remedy, such as Ezetimibe.

Now, I am not a professional athlete, but I have been a lifelong 'competitive' cyclist, from the age of 14 - 71 now.

I was able to ride at 25 Av till the age of 45. Then, of course, slightly slower each year.

So, at age 50 I could ride at 23 AV - age 60 at 20 AV.

At age 66, pre-statin, I was able to ride with my 17 AV group.

Then, after just 3 doses of 5 mgs simvastatin, my AV speed straightaway dropped to 12AV.

And, it has remained there all these 4 years, with the very occasional ride at 13-14-15 AV.

So, my question is this - Why was I not warned about this by the prescriber - that most Athletes do not tolerate statins, because of muscle aches?

If I was told, I certainly would have refused them.

After all, this Study was already out there, and should not the prescriber have known about it?

I've now seen many other similar studies.

My other Query is this?

What tests should be done, prior to taking statins?

I did not have any.

And finally, why did my GP, a fellow cyclist, not take me off them?

Here is the Study I am referring to.

Subject: Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems

Thank you for reading!


60 Replies

The reason is simply that their job is to give you the best chance of survival, not to maximise your athletic potential.

Statins aren't just about cholesterol. They've been clearly shown to have a useful role in stabilising plaque and preventing that sudden heart attack when a piece of unstable plaque breaks off and blocks something important.

Which is why they're now a virtually automatic part of care after a cardiac event / procedure. They're there to help keep you alive, not to keep you fast.


I don't agree with anything you have said


That's entirely your prerogative.

But, what I've said is where medical knowledge stands at the moment. You asked why they did what they did, I explained why.

If you wish to disagree then something more substantial to back that disagreement would be helpful.

Because what you WON'T get on this site is people nodding along with unsubstantiated opinions that aren't backed by the state of current medical best practice. There's Facebook for that.

MilkfairyHeart Star in reply to Thatwasunexpected

We do love a robust up to date peer reviewed, double blinded, large, long term, randomised trial, all under the gaze of a medical statistician to interpret. 😉

I totally agree with you, I have never had any issues with cholesterol but after my transplant my cardiac team put me on statins, the reason being they feel all cardiac patients should be on them to prevent any of the issues you mentioned, I feel I am better safe than sorry and I will continue to take them char

Well I do. Everything thatwas unexpected says is correct. The doctors are trying to save your life which they have done by giving you a successful bypass operation.You could try and be grateful for that instead of complaining about status

Love that answer!! 😊😊

Been on statins for nearly ten years no probs at all. In fact my last angio showed evidence that my atherosclerosis had not progressed.

Which was your score calcium and which is your score calcium now please

MichaelJHHeart Star

"These findings indicate that in top sports performers only about 20% tolerate statin treatment without side-effects. Clinical decision making as to lipid lowering therapy thus becomes a critical issue in this small subgroup of patients."

The above quote is from the paper you reference. To me this suggests that the medical profession need to take into account the person's lifestyle, etc. Both the cardiologist I saw privately and my surgeon actually discussed jobs, hobbies, activity levels in detail. We cannot withdraw a drug based on a small minority that have an issue. Whilst much has been written about blood clots and the Astra-Zeneca vaccine people are at a far greater risk of fatal clots from CovID. Unfortunately nothing is perfect!

Also, at that "top sports" level:

(a) The doctors ARE employed to maximise potential while managing risks. It's not practical or reasonable to expect that approach from a "free at delivery" health service, and (more importantly)

(b) At that level, any use of statins is a precautionary measure for lipid control rather than a response to confirmed severe coronary artery disease and bypass. The situations are entirely different!

MichaelJHHeart Star in reply to Thatwasunexpected

Many sports doctors do not have the best of reputations. I have seen the result of someoneusing steroids to enhance performance. Severe hypertension and kidney failure at 40. Fortunately he got a transplant but has a lifelong cocktail of drugs.

As I said, they're employed to maximise performance at an "acceptable" level of risk. Some do seem to put that second part a very distant second!

Whereas, the NHS has a remit to minimise risk at an acceptable level of performance.

Thank you Michael

And how is your health now?

Absolutely agreed that I'm not saying statins should be withdrawn.

My point is this

The prescriber first should have noted if the total cholesterol was over 5.2 - Mine was 3.0

Then factor in Lifestyle

Then do various tests to check liver, kidneys, CK levels

Then, and only then,after telling the patient about likely side effects, should alow dose statin be started.

My prescriber didn't do any of the above - just told me I was on them and walked away

All the best Michael!


It’s about time The medics explained what they are doing and why.

Yes agreed statins are Poison for a very, very few, like me My plan is to run all this by my current GP and take it from there



When you look at all the possible side effects of many drugs, sometime the ailment is less bother.

Everyone has their free will choices.

After all the run ins with different areas of the medical profession to my detriment, I want answers, I want to know why what for. We have the right to know but there are many Drs who think we should just do as your told.

Recently got told by an under qualified Dr to up my Bisoprolol and take an anticoagulant, my Consultant said I don’t need one, I’m at more risk from it. Said Dr had failed to tell me the cardiologist he spoke to said they’d book me for a cardioversion 👀 Turns out I didn’t need that either, consultant virtually shouted in the email.

MilkfairyHeart Star

'Statins have been shown to reduce the progression of native artery atherosclerosis, slow the process of vein graft disease, and reduce adverse cardiovascular events following surgical revascularization.'

Hello AlpsLike yourself I love my cycling having raced into my 50s, indeed I was a civil service national and regional champion at one time.

However for myself at 59 I am content to just amble around my local area for 30/40 mins, my heavy days are over and I have to accept that.

As for the meds, we'll we are all different and have different responses, maybe you might have to accept you can't do what you once did, like myself.

I sincerely hope you enjoy your cycling.

Good luck.

Alpsholiday in reply to pjw17

Hi pjw

You sound like you were a speedy chap!

I absolutely can NOT accept that a medication, that I shouldn't have been given in the first place, has given me long term muscle aches.

I was doing fine before statins came along, just slowing down by about 1 AV every 3 years or so

All the best!


What you are now discovering with statins is not new. If people really did their research they would see the corruption of the studies including the statin companies paying for the studies, paying their researchers, bribing the universities with $. Re drafting the results before they are published and not publishing the extreme side effects. For crying out loud doctors are supposed to report their patients bad side effects and they don't bother. People who do exercise and challenge their bodies are the first to notice the side effects especially women who incidentally , very little research and studies with statins included women, that being said some people choose to lead a lazier life style that will suffer the side effects it will just take longer. I'd be happy to send you some well documented and respected links but start with Duane Graveline, The Statin Damage Crisis and The Great Cholesterol Myth by Jonny Bowden and Stephen Sinatra.

Read the book The great cholesterol con - by Malcolm Kendrick. He will explain all about the evil statins and the damage they do to our body AND brain.

Whats AV ?

Fazerboy in reply to SPV123

I think it is average as in average speed for rides. I ride at around 14 to 15.

SPV123 in reply to Fazerboy

Ah ok thanks for the info, that makes me on 13 then, i used to use strava for my rides and had a few sections near the top of the leaderboard, that was before heart attack, now i dont bother with it, just ride for the scenery and exercise.

Alison_L in reply to Fazerboy

Thanks for translating, Fazerboy. I was thinking it must be a niche cycling club for people with atrioventricular repairs! I'm happy pootling around on my hybrid at 8-10 :)

Alison_L in reply to Alison_L

PS I have been known to get up to 22 mph... going downhill!

Fazerboy in reply to Alison_L

I must admit I spent a while thinking up possible heart related terms first (I had svt) but finally decided it was probably average.

MichaelJHHeart Star in reply to SPV123

It's just a bad abbreviation for *average". Overuse of abbreviations can make people lose interest particularly with scientific papers.

What does AV mean?

MichaelJHHeart Star in reply to Ecki

It's just a bad abbreviation for *average". Overuse of abbreviations can make people lose interest particularly with scientific papers.

Statins do more than simply lower cholesterol. They are anti inflammatory and protect the vessels of the heart - this is exactly what I was told by my consultant when my cholesterol dropped from 6.9 to 2.35 (I too was a very activeperson - I ran a sub-20min 5k shortly before my cardiac arrest).

Now, I’ve been recently taken off Statins due to it affecting my liver, but I suffered no external side effects from the drug. All the side effects are listed in the pamphlet that comes with the drugs so all the information you needed should have been there for you to read - if the doctors stood round to told you about every person who had a side effect, they’d be there all’s up to all of us to make sure we read up and recognise symptoms that may be caused by drugs we’re prescribed.

Telling someone about the possible side effects caused by a drug can create a “nocebo” effect - if you tell a patient they may suffer in a certain way, they end up pushing these symptoms upon themselves. Now I’m not saying this has happened in your case, I’m sure the pain you endured is real, it’s just something to bear in mind in future.

Hope this helps.

Hi curlyman

Good they spotted the liver issue and pulled you off them.

Also, seems like you are one of the 80% who have no muscle probs with statins

Re the muscle aches, I told my GP (a cyclist himself) many times that my Vastus Medialii were achy - but he didn't pull me off them

In the end, I pulled myself off them

Keep running!

All the best!


There is truth to the anti inflamatory results of statins but not much else has been proven. There are plenty of anti inflamatory foods and natural remedies.

Can't comment on the cycling aspect but can confirm that the NHS 'way' is to put you on a large cocktail of pills to cover all eventualities in the hope that they don't see you again.

And then you have chip away at them to get off the pills that you never needed. Painful process.

I had the same problem o take Rosuvastaton after changing from Simvastatin. Muscle pain in my legs. However I stopped for one month and there was no change. Can’t find the reason.


Are your muscle aches still there, despite stopping statins?


I feel your pain. I was diagnosed at 59 with a totally unexpected condition (an ascending aortic aneurysm) by a sports cardiologist when I volunteered for a research project as an older amateur endurance athlete. For the next year, I had 10 major multisport competitions lined up, including my first World Triathlon Championships as a member of the GB team.

I was told to get referred to a specialist cardiologist, advised not to do any competitive sport, to avoid any heavy lifting (not my thing anyway) and any high intensity training (which was). I had to cancel all my events. 2.5 years later, I am now with a specialist cardiologist at a leading NHS centre and, at the moment, with a stable aneurysm that is still too large for high intensity exercise but not large enough to justify an operation, I'm in a bind which has echoes of your own.

To speak up for sports cardiologists, I'm immensely glad I was diagnosed by one, because she did put the emphasis on staying physically active and I am in no doubt that her priority (and that of her professor, with whom she discussed my case before advising me) is to prevent the tragedies - which I have seen the effects of, at races I've taken part in - where fit and healthy athletes drop dead in the course of their efforts.

The sports cardiology literature, by the way, says that sudden death in older marathon runners is massively more likely with high Agatston scores: with yours, it looks to me that you had a very lucky escape.

I have very mixed feelings about statins and about the 'nocebo' effect, which is real but very peculiar.

I am the person who reads every detail of every side effect in a patient information leaflet before taking a medicine or receiving a vaccine - and almost always experiences none of them.

Fundamentally, I believe in full patient information, informed consent, co-decision between patients and doctors in matters of health.

Yes, there is compelling evidence from double-blind trials that 'nocebo' effects are real and that muscle pains from statins are often related to patient beliefs rather than the medication itself and more or less equally present when people are taking statins or placebos.

However, these trials may not be completely relevant for very particular populations, as suggested in the paper you cite.

For the time being, my personal choice (with an Agatston score of 6 and a low Q score) is not to take statins, though the sports cardiologist who diagnosed me did recommend one. I've agreed with subsequent cardiologists not to go on any medication, though the choice is open to me. I'm open to evidence in all directions.

It feels to me that the real challenge you're facing, and it's a very big one, is coming to terms with the fact that the things we love doing and which can give a great deal of meaning in our lives aren't always possible at the level we want and feel we need. It's tough: talk about it with the people close to you.

Alpsholiday in reply to JulianM

Hi Julian

Sorry to hear about your ascending aorta enlargement.

Were you having any symptoms at all?

The reason I ask, is because in 2008, during a chest scan for asthma, it was also noted that I too had an enlarged ascending aorta - at 4.2

This has been monitored every 3 years since then, and no change

And, it has never given me any symptoms at all

So, I figure it is because I have been cycling all my life?

But, as you know, the statins have given me long standing aches

And all this because I was started on statins, when I shouldn't have been.

Old age and riding slightly slower each year by about 0.3 AV I was EXTREMELY happy about!

After all, how many can ride at 17 AV at age 66?

All the best!


JulianM in reply to Alpsholiday

The aortic dilation might indeed be related to your training, going by a very interesting recent paper from Massachusetts looking at and comparing older competitive marathon runners and rowers - these links give you an abstract and it's worth downloading the paper, from JAMA, which is free to access.


Your own level of dilation would place you inside this population of older endurance athletes and, as the authors say, it's an open question whether this level of dilation should be regarded as any kind of sign of disease, or more as a normal response to relatively extreme exercise. But they might still caution against heavy weightlifting.

As a general rule, dilation over 40mm should be monitored, and it sounds like you're being properly taken care of.

In my own case, I was diagnosed at 4.5 or 4.6cm by CT scan and am now at 4.7cm (by MRI with contrast). I have absolutely no symptoms relating to this. On close examination, I have some other, minor, signs of connective tissue disorder, so my consultant cardiologist is convinced there's a genetic vulnerability and it's on that basis, as well as the level of dilation, that I'm advised to avoid competitive sport.

Alpsholiday in reply to JulianM

Thanks Julian for the articles that found that 21% of older endurance athletes have ascending aortas of over 4.0.Nobody has pointed this out to me before.

And yes, it's reassuring that they do 3 yearly scans.

All the best with getting all the exercise you need.

Thanks again


JulianM in reply to Alpsholiday

Hi Alps -

Please don't get me started on the lack of patient information about ascending aortic dilation and aneurysms! It's something I am trying to change, but it's not easy.

To be fair to doctors, the paper was in JAMA Cardiology rather than JAMA (my mistake), these are emerging findings in a select group of relatively elite older exercisers, and more research is needed.

At the same time, this is one of the strongest research groups in the field and Dr Aaron Baggish (one of the authors, at Harvard) is as eminent a sports cardiologist as you can find. There's a chance this will be picked up in the current revision of the 2010 Hiratzka et al guidelines on managing thoracic aortic aneurysms and dissections, and if that happens it should become much more widely known.

Regards - Julian

Also, as someone who has often experienced leg muscle cramps, usually towards the end of a long bike ride, occasionally mid-race when transitioning from bike to run, it may be worth re-framing your issue as a pain management one. Let the statins go: focus on when cramps happen and what you might be able to do to control them.

As you'll know, there are two schools of thought about cramps. One focusses on electrolytes and is popular with sales people for salt supplements. I had my worst ever cramps after racing on a very hot day, so I don't totally dismiss this but it doesn't really explain why cramps hit in specific muscles.

The other school is that cramps are triggered by the (perhaps inappropriate) triggering through neuromuscular fatigue of a protective mechanism that has evolved to prevent over-stretching and damage to muscles. This does explain why cramps hit those muscles that you tend to work the hardest and through the biggest range. I find that they come on more, when I haven't been training so hard and step up my efforts, hence the impact in races. In swimming, they happen in the calves when we push off the wall at the end of a session, in cycling I get them in big muscles when I climb out of the saddle and - when I was competing - I sometimes got them in transition just after dismounting from the bike. However, they rarely stopped me completing the event (once in 91 events, to be exact), even if I had to stop and stretch a while.

Coaching advice on preventing cramps includes emphasis on doing race-intensity training before racing, and progressive training especially when returning to sport after a layoff.

I find I can avoid cramps by taking hills much more gently in low gear to stay in the saddle and, in the last resort, walking the steepest ones.

One possible explanation for the 'nocebo' findings may be that they are very specific to muscle cramps and don't apply to other side effects of medication because muscle cramps have a very specific cause which involves an 'action threshold' for cramping that can be trained and reset through neuromuscular feedback mechanisms (not yet fully understood). What you expect to happen could therefore influence what actually happens. Either way, the pain is very real.

If this is the case, finding a safe way to change your personal settings, possibly through stretching routines developed with a sports physiotherapist, possibly by doing some training on static bikes set up to mimic your road bikes (spinning bikes are good for this) to see what brings on your cramping and how to manage it might help. Another thought might be to look carefully at e-bike options to take the strain off climbing and give you a bit of safety around being able to get home even if you do cramp up badly at some point in a ride.

(I work in a gym and am qualified as a personal trainer, but obviously I can't give you personal advice as I've not seen you; these thoughts are offered as pointers to how you might look for help.)

Alpsholiday in reply to JulianM

Hi Julian

No cramps at all.

Had them once only, many years ago, after a very long ride, with not enough drink



JulianM in reply to Alpsholiday

I stand corrected on that - sorry for the misunderstanding. I still think that with muscle aches there may be value in consulting an experienced sports physiotherapist, preferably one who works with cyclists, to see if there are any rehab techniques that might help.

Statins don’t suit everyone, I was on them for years and getting weaker by the day so my doc stopped them. I’m still aching so the damage is done. I’m on a non statin med now, ezetimibe so see how this goes.Being hypothyroid causes high cholesterol despite a healthy lifestyle so I understand completely.

Everyone is entitled to their opinion but you should respect someone else’s opinion on their experience with these drugs, I support you.

The problem isn't the OP's opinion.

The problem is shouting it, in all caps, as a "warning to others" on a site where people new to heart issues come for advice.

When the opinion files in the face of overwhelming current medical knowledge, and justifies itself with reference to literature that doesn't relate to even his own situation, let alone others, that has the potential to scare people into rejecting treatment that genuinely saves lives.

And THAT is a problem.

I didn’t see any caps in the message, I didn’t find his message alarming either and I’m also new to this. Statins have had a bad wrap for a long time and doctors have written books about the problem with statins for many people. Maybe he shouldn’t have written to this forum as people seem to be over sensitive. It’s up to each individual to decide for themselves how drugs effect them and the side effects they are left with From taking them.

The caps are right across the title.

And you may not have found it alarming but a lot of people do. We regularly get posts from people worried about what they've been prescribed - without having experienced side effects themselves - because they've "read somewhere that..."

In this case, the fact the OP can no longer maintain a pace in his 70s that many 50 year olds would struggle with is, in any normal sense, a pretty fair trade-off for not being in a box because of a heart attack.

Keep in mind, the fact of his difficulties may well NOT be down to the statins in any case. He's suffered severe arterial disease and a bypass. It's entirely possible (likely, even) that his aches are because of impaired cardiac capacity from that reducing the oxygen available to muscles he's trying to work like someone 20 years younger.

Whether he's willing to face that or not is up to him, but adding to the already problematic reputation of statins - which DO, without question, save lives - is poor form.

The question i am forever asking is if Statins are meant to be anti inflammatory why are so many people who take them are in fact on anti inflammatory medication to address the side effects. Although I was fit like you and played a lot of tennis and all my tests and weight were fine also cholesterol I had to have a bypass , They discovered I could not tolerate statins so I am only on an aspirin. My sister was on Statins for years and suffered physically - and mentally. I sometimes think it is better to actually have side effects because you are at least are aware of the damage they may be doing

Their anti-inflammatory effect is specific to the walls of blood vessels and inflammation of vessel walls is a serious driver of vascular disease. Preventing it helps to reduce / stop the progression of plaque and also helps stabilise existing plaque, which reduces the risk of sudden events caused by plaque rupture.

The "other anti-inflammatories" are used to reduce possible (but by no means universal, or even common) side effects in other tissue. But inflammation in that other tissue isn't going to make you suddenly drop dead, so it's usually a reasonable trade-off.

Trade off maybe but the side effects of statins could be contributing to other questionable problems. Why for instance did my body reject all the ones tried by my cardiologist.. My older sister has been off Statins for a few years now after her minor heart attack and her muscular problems disappeared. Her blood pressure also is now normal ..very odd

Valdan58 in reply to Pollypuss

My sisters fingers curled up so she could no longer type after being on statins for a short while, she had to stop them or be unemployed and unable to look after herself. Statins do not suit everyone and that goes for me too.

Hi Alps, Try this facebook group, 'stopped our statins', which you might find helpful.

My opinion is, you have by pass, the effect of taking statins in less harmful than do not taking it.Statins helps reduce CPR (C protein reactive) and reduce cholesterol.

I use rusovastatin 10mg and do not fell any side affect. I just fell aches in my chest and will find s doctor the male some exams , my score calcium is 24, I’m 34 year old

Hi Edson

The bypass op was great - thanks NHS!

However, as you know, the statins I took just for 12 weeks have left me with long term muscle damage.

You're one of the 80% who can tolerate statins.

My cholesterol was only 3.0, so why was I put on them?

Taking them was THE biggest mistake of my life



Send him your information and ask why.

Well known the older generation are over medicated. Give you pills that cause a problem, then give you another to counter act it.

Hi Alps, I read your post a couple of days ago and was interested in what you said. I suffered cardiac issues about 4 years ago in my mid 40s despite competitive swimming. As a result I was prescribed 80mg atorvastatin and noticed a profound increase in fatigue. After several months and a drop to 40mg I was back to normal but did start taking 100mg coQ10 daily. It may just be a coincidence but I believe statins cut the synthesis of coQ10 by the liver. Also I believe coQ10 is routinely prescribed in the US to people on statins.

Finally just wanted to say if 12 mph is your AV at 73 this is pretty amazing! I’m 50 now and doing cycling at 12 - 14mph AV for 50mins (fastest today) and feel like I’m flying along at this speed so try not to be so hard on yourself. All the best!

Alpsholiday in reply to Stu888

Thank you Stu88

Yes in Canada they advise taking Co Q10 with statins

I never took any for the 12 weeks that I was on statins,

But, in summer 18, I tried 200 mcg Ubiquinol for 8 weeks, to see if it would help the aches - to no avail

Re the AV Speeds of competitive cyclists!

25AV is actually just Average for a fit young athlete

And Pros can ride 'easily' at 30AV

And the Tour de France is ridden at 25AV - including those high cols and mountains!

Some time back, I met an 81 year old who was able to ride at 16 AV

This is because, like me, he had been 'competitive' all his life

Keep cycling!


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