Statins and tendinopathy: a systematic review

Andrew J Teichtahl, Sharmayne RE Brady, Donna M Urquhart, Anita E Wluka, Yuanyuan Wang, Jonathan E Shaw and Flavia M Cicuttini
Med J Aust 2016; 204 (3): 115-121. || doi: 10.5694/mja15.00806


Objectives: To systematically review the evidence on whether statin therapy, commonly used in clinical practice to treat hypercholesterolaemia for primary and secondary prevention of cardiovascular disease, contributes to tendinopathy; and to examine causality according to the Bradford Hill criteria.

Study design: A systematic review of studies examining the relationship between statin therapy and tendinopathy. Included studies were rated based on their methodological quality. A best evidence synthesis was used to summarise the results, and Bradford Hill criteria were used to assess causation.

Data sources: Ovid MEDLINE, CINAHL Plus, PubMed and Embase databases.

Study selection: We included adult human studies published in the English language between January 1966 and October 2015. Study designs eligible for inclusion were randomised controlled trials and cross-sectional, cohort or case–control studies.

Data synthesis: Four studies (three cohort studies and one case–control study) were included, with a mean methodological quality score of 67%. Three studies were deemed high quality. Tendon rupture was the primary outcome in three studies, and rotator cuff disease in the other. All studies found no positive association between statin therapy and tendon rupture for the total study population. There was evidence that simvastatin reduces the risk of tendinopathy.

Conclusion: To date, there is a paucity of evidence to implicate statin therapy as a well established risk factor or causal mechanism for tendon rupture in the general population. There is strong evidence that simvastatin reduces the risk of tendinopathy.

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  • Andrew J Teichtahl1,2
  • Sharmayne RE Brady3
  • Donna M Urquhart3
  • Anita E Wluka3
  • Yuanyuan Wang3
  • Jonathan E Shaw1
  • Flavia M Cicuttini3

  • 1 Baker IDI Heart and Diabetes Institute, Melbourne, VIC
  • 2 The Alfred Hospital, Melbourne, VIC
  • 3 Monash University, Melbourne, VIC


Andrew Teichtahl is the recipient of a National Health and Medical Research Council (NHMRC) Early Career Fellowship (#1073284). Sharmayne Brady is supported by an NHMRC Clinical Postgraduate Research scholarship (#1074979). Donna Urquhart is the recipient of an NHMRC Career Development Fellowship (Clinical Level 1, #1011975). Anita Wluka is the recipient of an NHMRC Career Development Fellowship (Clinical Level 2, #1063574). Yuanyuan Wang is the recipient of an NHMRC Career Development Fellowship (Clinical Level 1, #1065464). Jonathan Shaw is supported by an NHMRC Senior Research Fellowship (#1079438).

Competing interests:

No relevant disclosures.

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