Do statins increase the risk of tendon rupture? A qualitative systematic review

Abstract Introduction: Statins are the first-line treatment for atherosclerotic cardiovascular disease (ASCVD) and act by inhibiting HMG-CoA reductase. Possible but rare adverse effects of statins include tendon disorders such as tendinitis and tendon rupture. The purpose of this systematic review is to summarize current studies relating to statins and tendinopathy. Materials and methods: A search was conducted of studies on the statin-related risk of tendon disorders, published in English until August 2022. It included randomized control trials, experimental studies on human tendon samples and animal tendons, cohort studies, case series, and case reports. The data was then extracted and qualitatively reviewed. The results were tabulated and structured into increased risk, reduced risk, and no effect of statin in tendon disorders. Results: Out of 48 studies, 17 articles indicated an increased risk of tendon disorders, 6 articles found no correlation between statin use and tendinopathy, 7 articles reported decreased risk, and further 6 articles merely mentioned a tendon disorder and statin use without drawing conclusions. The remaining 12 articles were case reports with bilateral quadriceps tendon rupture as the most mentioned tendon disorder. Conclusions: Overall, statins did not seem to increase the risk of tendon disorders in a clinical setting. However, in experimental studies, statins were shown to increase the risk. It is presumed that this is due to prescribing statins in hyperlipidemia, which is a risk factor itself for tendon disorders. Controversially, statins exhibit a tendon healing property in in vitro conducted studies. Further studies are needed to explore the effects of statins on tendons.