Dr. Keith Roach
October 30, 2026, 5:06 a.m. ET
Dear Dr. Roach: Over the years I have taken various statins. It seems that in the end I still have bad leg problems with lots of pain. Different doctors just change the type of statin I take, but the same things happen. I decided to help myself a little and cut the pills in half. For a while it seemed to work, but eventually the leg pain returned.
Can you explain why there are so many different statins and what each one is supposed to do and what the others don’t? I know they are supposed to help my heart, but the leg pain still makes me want to stop taking them.
— VLS
Dear VLS: Statins reduce the body’s ability to produce cholesterol by blocking an enzyme called HMG-CoA reductase. This reduces blood cholesterol, particularly a type of cholesterol called low-density lipoprotein, which is strongly associated with blockages in blood vessels in the heart and brain. These blockages can lead to heart attacks and strokes.
People who already have blockages, or those who are at high risk of blockages, benefit from taking statins to reduce their risk of experiencing one of these potentially catastrophic events. Guidelines released this year recommend statins for more people than older guidelines, recognizing that starting medications early can prevent them from getting blockages.
All statins work the same but have different risks of side effects. Muscle pain is one of the most common side effects; However, even people who take placebo tablets notice muscle pain. Most studies show a 1 to 1.5% risk of muscle pain with statins compared to a placebo.
Sometimes switching to another statin can relieve muscle pain. Pitavastatin, pravastatin and fluvastatin have the lowest levels. Sometimes people experience muscle pain regardless of which statin they are taking. Some of my colleagues recommend coenzyme Q10 (CoQ10) supplements; Although about 30% of people (results vary between studies) benefited from CoQ10, almost exactly the same number of people benefited from a placebo.
When a person truly cannot 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 injection. None of these drugs cause an increase in muscle pain greater than that seen in people taking placebo tablets.
Clarification: In a recent column, I identified the location of a pain syndrome in C8-T1. Several people wrote to me to point out that there were only seven cervical vertebrae and suggested that I open a textbook. One person kindly pointed out to me that even giraffes only have seven cervical vertebrae.
They are absolutely right, but C8 in this case refers to the eighth cervical nerve and 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 still enjoy the letters and have made mistakes, of course. But in this case, “C8” is due to a quirk in the spinal nerve root naming system.Readers can email questions to ToYourGoodHealth@med.cornell.edu.
Gn Health
