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Should you continue taking statins?

Created date

November 23rd, 2015
plaque buildup in an artery
plaque buildup in an artery

The cholesterol-lowering drugs known as statins were hailed as a very effective treatment for high cholesterol when they were first being used. Like most drugs, they were approved by the Food and Drug Administration (FDA) after their safety and efficacy were tested in clinical trials.

But like some other drugs, after years and years of use, problems have arisen that weren’t evident during those clinical trials.

“Statins have become a hot topic,” says Robert Stewart, M.D., medical director at Wind Crest, an Erickson Living community in Highlands Ranch, Colo. “Patients have questions about them.”

Statins work by blocking an enzyme that is necessary for the liver to produce cholesterol. Everyone needs some cholesterol in order for the body to carry out its functions, but some people produce too much low-density lipoprotein (LDL) cholesterol, which is especially damaging to arteries. The ultimate aim of statins is to reduce such damage (plaque buildup in particular) when other, more conservative means such as dietary changes and exercise have failed.

“Research shows that statins are an excellent medication to prevent second heart attacks and certain types of strokes,” says Matt Narrett, M.D., chief medical officer at Erickson Living. “But in people who have not had a heart attack or stroke, the scientific evidence is not as strong in support of their effectiveness.” For example, a 2010 review and analysis of 11 studies revealed that taking statins for high cholesterol did not lower the mortality rate for people who did not have heart disease.

Side effects

Side effects listed on package labels include headache, nausea, vomiting, constipation, diarrhea, skin rashes, weakness, and muscle pains (called statin-induced myopathy).

“Muscle aches and pains are the main side effect I hear about from my patients,” Stewart says. “This discomfort can significantly affect daily functioning in some people. If muscle pains or other side effects become too bothersome, we can consider reducing the dose, switching to a different statin, or adjusting the treatment plan in some other way.”

Some people have reported significant relief from statin-induced myopathy by taking coenzyme Q-10, a vitamin-like compound naturally manufactured by your body that is also available over the counter as a dietary supplement. “The research on this topic has been inconsistent,” Stewart says. “People also need to keep in mind that as a dietary supplement, coenzyme Q-10 is not subject to the same FDA scrutiny as medicine and can thus vary widely in quality and efficacy.”  

Serious medical problems

Questions have arisen about whether statin side effects are merely troublesome or in fact pose real health risks. For example, muscle pain can be an early sign of rhabdomyolysis, a rare but sometimes fatal condition that causes loss of muscle cells and kidney failure. Rhabdomyolysis usually occurs only in people who are on other drugs that can cause the condition, or who are taking drugs that cause statin levels to be too high in the blood. “Liver problems have also been reported with statin use, but serious damage happens infrequently,” Stewart says. “In some instances, statins can cause a temporary elevation of liver enzymes, which usually resolves on its own.”

Recently, in a small number of study participants, researchers identified an association between statin use and the development of signs typical of type 2 diabetes, such as elevated fasting glucose levels. There have also been some reports of memory loss. Research into these and other problems associated with statins continues.

“As is the case with any drug, all side effects, no matter how insignificant they seem, should be brought to the attention of your doctor,” Stewart advises.

Making a decision

If you are on a statin, or you’ve been prescribed one, you need to cover all the bases with your doctor. “There are so many factors to consider,” Narrett says. “In the case of two people of the same age and who have the same medical problems, one may benefit from a statin and one may not. That’s where the art of medicine comes into play.”

“Ultimately, the decision whether or not to take a statin is up to you,” Stewart says. “Talk with your doctor about the specific benefits and risks.”