Statins and side effects

I often have patients who stop taking their statins or refuse to take them because of “side effects”. This can range from muscle aches to memory loss (the latter side effect of which there is conflicting data for).

One option would be to switch to a more hydrophilic statin – like pravastatin (now generic) – which have been shown in studies to decrease the incidence of muscle aches and cognitive deficits.

There is a subset of patients who refuse any treatment, despite a markedly elevated LDL. To these patients who fear the side effects of statins I ask: “Are you aware of the side effects of an LDL above 200?”.

How about heart disease (about 30 percent risk reduction in the primary prevention of cardiovascular deaths with LDL lowering) and stroke (about a 21 to 29 percent risk reduction in the primary prevention of stroke with LDL lowering).

The “side effects” of markedly high cholesterol dwarf those of statin therapy. Once patients realize this, they often agree to treatment.

Comments

diora
How about heart disease (about 30 percent risk reduction in the primary prevention of cardiovascular deaths with LDL lowering) and stroke (about a 21 to 29 percent risk reduction in the primary prevention of stroke with LDL lowering).
Would you care to show evidence for primary prevention in women? Because this letter mentions that this evidence is lacking, there was also a meta-analysis in JAMA 2004 April issue that seemed to point to lack of benefit, not sure if it was ever disproven. I also saw some papers that for women HDL and triglicerides seem more important than LDL (don’t have time to look for it now. So, when you talk to women, do you also mention 30% reduction of heart attack risk?
Also, I just love it when doctors use relative numbers instead of absolute numbers or NNT to describe the benefits. If someone’s chance of having a heart attack within next 10 years is 100% than 30% is huge, if someone’s risk is 1% you should look for the benefit under the microscope. If somebody’s risk of a heart attack within next 10 years is 10%, 30% reduction is .3*.1 = 3% chance that the person’s will avoid a heart attack and , since many heart attacks are non-fatal, the chance that somebody’s life will be saved is less. Surely when you are talking of side effects NOW, people should know the real chance of benefit for them personally?
Trent
Three words: Absolute. Risk. Reduction.
Learn them, use them, love them.
As I proceed through my medical training, I have become more astute in my understanding of how relative risk reductions are abused. A statistical purist would argue, probably correctly, that RRR’s are useless. We should really make a concerted effort to stop using them in lieu of a superior statistic, ARR.
Trent
Oops, should have read the first comment before I wrote.
Here, here, diora.
Anonymous
I do not believe that using cholesterol lowering drugs is the right thing to do. Instead, I chew 2 to 3 garlic cloves daily and cut the fat out of my steaks and I am fine.
Thanks
Henrymoran@gmail.com
Anonymous
My total cholesterol ran at about 230 before I started a statin. I developed severe muscle problems on the statin and was partially disabled by it for almost a year and a half. I will probably be taking meds for mitochondrial cytopathy for the rest of my life. I now understand that taking the statin reduced my heart attack risk from about 5%/year to 3%/year. If I knew then what I know now, I would have never taken any statin at any dose. — Darrell
Anonymous
How about Dr Uffe Ravenskov’s book The Cholesterol Myths, which shows how little trust can be placed on the whole saturated fat, cholesterol lowering and statins theories, I have examined 2 large trial reports myself and science and logic are replaced by statistical sleight of hand. Except for familial hypercholesterolemia, it appears that statins only save lives by their side effect of reducing homocysteine, the cause of artery inflammation to which cholesterol, whether high or low, adheres. Homocysteine is a part made substance, needing cheap Folic acid and vits B6 and B12 to turn it into something useful. Who is going to take on further research into this harmless treatment and consign statins to outer darkness before the world population is damaged by irresponsible “preventive” medication,urged on us by flashing the spectre of heart attack before healthy people.
Anonymous
I had high cholestoral, and had a mild heart event. I would rather have a full blown heart attack, than have the problems I currently have which were caused by statin injury from Crestor. Just 30 days of taking Crestor caused me to lose 50% of my strenght and abilities (2yrs later now). I have lowered my cholestoral with fish oil and other natural supplements which cause no ill effects and have lowered my cholestoral and blood pressure too. There are cures and alternatives to high cholestoral, but there are not cures to stain myopathy, and mitochondrial tissue damage.
Anonymous
Diet and whatever is fine for your elevated cholesterol but some people have elevations into the 600-700 range. over 70% of our Cholesterol is made in our liver. Sometimes when you take these natural steps to lowere, it the liver then assumes something must be wrong and just produces a little more. If there were no statins to take, these people would surely be in a crisis very quickly.
I love how people can only see what effects themselves. “My cholesterol was 205 and I watched my diet and now it is 195 so everyone else can do the same.” Sorry, that just isn’t the way it works!
Anonymous
Re “I love how people…”:
Oh yeah, well I love how some doctors, including Kevin, can condescendingly put the words side effects in quotes and be dismissive of muscle aches. Before I stopped taking Zocor, it had me so fatigued I thought I was getting the flu and so weak in my right leg that I couldn’t get up steps. I almost couldn’t get to my doctor’s office. What some doctors don’t understand is that when they are dismissive the conversation is over and they end up not learning things they really ought to learn about the side effects of what they prescribe regularly.
Greg P
I just saw a patient today, on a statin for several years, and at least possibly having problems with it.
One thing about her is that she is 85 years old — is it really worth putting people at this age on a statin?
Anonymous
..and how many docs. run TFT’s- hypothyroidism being a known cause of elevated cholesterol -and more so in women?
Anonymous
There are also some drugs that are known to decrease HDL, increase LDL – norithendrone acetate, for example, although it also lowers triglicerides. It is part of some forms of HRT – e.g. FemHRT where this type of progestin reduces estrogen’s effect on LDL and decreases HDL below what it would’ve been without HRT; it can also be prescribed to women for endometriosis. Most doctors are clueless about this side effect, so when a woman taking it comes with LDL just barely fall into the statin guidelines for this woman’s risk profile the doctors is all to ready to prescribe it. Even if these levels changed drastically in exactly the period of time the woman was on this drug in spite of the fact she had lost weight during this time from BMI of about 27 to the BMI of 22.
Anonymous
I’m with the garlic guy. I also choose (for myself – I can’t speak for anyone else) to dismiss the conventional wisdom of cholesterol. Perhaps this is a glib statement, but we are all going to die eventually, and I think how well you live counts for a lot. I’d rather die of a heart attack than liver failure from taking a million unnecesssary prescription drugs.
Anonymous
Just been diagnosed with a constantly increasing high cholestorol. Was on statins previously. Pure misery with muscle pain – Don’t know why doctor prescribed them as I have Guillaine Barre Syndrome which affects the peripheral nerve endings and I cannot walk and have severe muscle pain.
He says there is other treatment I can have but I have just commenced a herbal remedy . Hopefully will be able to reduce level myself. Don’t want to live in more misery. By the way I eat all the right things ? What is going on?
Anonymous
It maybe great but Doctors need to be aware of its rare devestating side effects to protect their patients.
I was on 80mg of Zocor for several years, yes it got my colesterol down (diet barely altered my level).
But I would prefer to die earlier (there are other options ie. Ezertrol) than end up barely functional for years, fatigue, memory lose, pain in hands and feet, barely able to stand on bad days due to weakness, had trouble walking, and a dry cough.
Coming off Statins would show an improvement upto to the above level and that is where it left me for years, any dose level of any brand made the symptoms worse.
In my case there was a magic bullet that was found by accident Prednisolone, in a matter of days I became my old self, I have managed to lower the dose to 15 mg a day, I am better on a slightly higher dose but I am trying to avoid the side effects of this drug and playing around with supplements to try and get the Prednilone lower still, so far no luck but I will keep searching.
I am even back cycling again, I dont know if I will regain my previous fitness level but it is great to be living again.

Statins and side effects

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