How much do you know about side effects of statins?

Created date

May 15th, 2019
A box of generic statin medication sits next to a stethoscope on top of a piece of paper that says "Cholesterol Test"

Examples of statins prescribed in the U.S.

Atorvastatin (Lipitor)

Fluvastatin (Lescol)

Lovastatin (Altoprev, Mevacor)

Pitavastatin (Livalo)

Pravastatin (Pravachol)

Rosuvastatin (Crestor)

Simvastatin (Zocor)

A class of cholesterol-lowering drugs called statins have been widely prescribed for several years. Statins decrease harmful fats in the blood (low-density lipoprotein (LDL) cholesterol and triglycerides), while increasing beneficial cholesterol called high-density lipoprotein (HDL).

For many years, research has shown that statins can safely prevent heart disease in many adults. Increasingly, however, side effects have been causing some people to question their safety.

True or false: Statins are very toxic to your liver.

Like many drugs, statins are primarily metabolized in the liver. but research shows they are no more toxic to the liver than other drugs metabolized the same way.

According to the prescribing information for atorvastatin (Lipitor), one of the most commonly prescribed statins, signs of liver injury (persistent elevation of liver enzymes) occurred in 0.7% of patients who received the drug in clinical trials. In other studies, people taking a placebo had a similar rate of liver enzyme elevation as people taking statins. A systematic review and meta-analysis of other statins, including pravastatin, lovastatin, and simvastatin, also showed no increased risk.

“People tend to overstate the negative effects of statins on the liver,” says Allen Taylor, M.D., chairman of cardiology at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center and MedStar Georgetown University Hospital in Washington, D.C. “If patients are prescribed the proper dose and have been thoroughly screened for drug interactions and other risk factors, statins are unlikely to be toxic to the liver.”

True or false: Statins cause forgetfulness and dementia.

When use of statins began, scientists hoped the drugs would have a similar protective effect on the brain as they did on the heart. But that has not been supported by subsequent research. In fact, some patients say the opposite is true—that they have experienced forgetfulness or other cognitive problems with statin use.

“It is not known for sure whether statins cause memory loss,” Taylor says. “For now, most studies show that they do not cause forgetfulness or dementia.”

Regardless, when a patient says they’ve developed memory problems after starting a statin, Taylor takes it very seriously. “Everyone metabolizes drugs differently, and various statins work in slightly different ways,” he says. “When there is a cognitive problem, we investigate other possible causes, and patients can decide whether they wish to try a dose adjustment, a different drug, or stop statins altogether.”

A review study published in 2015 found that the results of most studies on this topic did not find a statistically significant link between statin use and cognitive decline, including temporary cognitive problems. Nevertheless, the number of patients reporting this side effect was sufficient for the Food and Drug Administration (FDA) to mandate in 2016 that statin manufacturers include a warning about a risk of memory loss on warning labels.

True or false: Statins cause painful muscles.

According to prescribing information for atorvastatin, the most frequently reported adverse effects were nasopharyngitis; arthralgia; diarrhea; pain in extremities; urinary tract infection; and muscle weakness, spasms, and pain.

“It’s true that muscle weakness and pain have been reported by people taking statins,” Taylor says. “When this occurs, we need to determine if something else is going on or if it is in fact the statins causing the muscle problems.”

Muscle pain was also part of the 2016 FDA mandate for statin labeling.

Aside from general pain and weakness, some statins, especially in high doses, have been associated with severe muscular conditions, so it is vital that you report any muscle weakness or aches, no matter how minor, to your doctor.

True or false: Statins cause diabetes.

According to a review and meta-analysis of 13 studies published in The Lancet, there is a slightly increased risk for diabetes, but it is very low. For example, in one study of 255 people taking statins over a period of four years, one person developed diabetes. “The likelihood of developing diabetes tends to be higher among people who were already at a high risk for the disease,” Taylor says.

Again, however, it is enough of a concern to the FDA that elevated blood sugar and diabetes risks have also been added to the warning labels.

Many experts point out that there is already a significant association between heart disease and diabetes, and that people with high cholesterol often have other risk factors for developing diabetes, such as excess weight.

The wrap-up

Statins are not the only, or necessarily the best, treatment to lower cholesterol for everyone. Lifestyle modifications such as dietary changes and exercise should always be mainstays of your treatment plan, and sometimes those modifications alone can significantly lower your cholesterol. There are also nonstatin medications available.

Ultimately, treatment decisions should be personalized—especially if you are over age 75. “All older adults, including those over age 75, need to have a conversation with their doctors about using statins,” Taylor says. “Many factors need to be taken into consideration, and not enough studies have been conducted on this group to give us clear guidelines about the risks and benefits.”