Dear Readers,

A puzzling case has emerged involving a 75-year-old woman who recently received a diagnosis of myasthenia gravis (MG), a rare autoimmune disorder affecting the connection between nerves and muscles, leading to significant muscle weakness. Active and athletic, she previously participated in triathlons, which makes this diagnosis particularly bewildering for her.

The woman in question began taking Crestor, a popular statin medication, in April 2022. After diving into research, she stumbled upon a questionable study suggesting that seniors who start taking statins may coincidentally develop MG symptoms soon after. This study reported that upon switching to alternative cholesterol medications, patients experienced a reduction in symptoms. However, it’s crucial to note that MG is not listed as a known risk factor associated with statin use.

In her letter to Dr. Roach, our correspondent expresses her confusion over any potential linkage between her statin use and her recent diagnosis. It’s important to clarify that while hundreds of thousands start statin therapy annually, other health issues may arise around the same time, leading to misconceptions regarding causality.

Notably, there have been some case reports of patients developing MG shortly after beginning statin treatments. Yet, since this woman's symptoms appeared two years after starting Crestor, it seems more plausible that her diagnosis resulted from an unrelated cause rather than a direct effect of the statin.

Interestingly, it is estimated that 10% of individuals with MG might see a worsening of their symptoms upon starting a statin. Should this occur, discontinuing the medication is often recommended. Moreover, even ezetimibe (Zetia), a cholesterol absorption inhibitor known for its minimal muscle impact, was associated with worsening MG symptoms in one case but showed improvement upon withdrawal of the medication.

On the subject of statins, they have been shown to remarkably reduce the risk of cardiovascular diseases, such as strokes and heart attacks, particularly in individuals identified as high-risk. However, data supporting statin use in 75-year-old women without pre-existing heart conditions remains insufficient. Most experts still concur that statins can provide some benefits to this demographic.

As we consider using statins, it’s imperative to balance possible benefits against potential risks. While the likelihood of developing MG due to statin use is relatively low, those already diagnosed with MG should monitor for symptom exacerbation, including issues like double vision or increased muscle weakness.

For those seeking alternatives to statins for cholesterol management with reduced muscle risks, bile acid sequestrants and newer medications such as PCSK-9 inhibitors and bempedoic acid offer promise. PCSK-9 inhibitors like evolocumab (Rapatha) have an excellent safety profile with no significant risk of causing muscle damage, even in reported cases of MG worsening. Meanwhile, bempedoic acid (Nexlotol) stands out as a newer cholesterol-lowering agent, boasting minimal muscle-related side effects. However, current research does not provide strong data on its impact on individuals with MG.

In conclusion, while some studies might hint at a connection between statin use and myasthenia gravis, it appears the evidence remains inconclusive. Anyone facing similar health concerns is encouraged to consult their healthcare provider to assess the best course of action tailored to their individual risks and health profile. Stay informed and take charge of your health!