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Statins: Are these cholesterol-lowering drugs right for you?

The side effects of statins

Although statins are well tolerated by most people, they do have side effects, some of which may go away as your body adjusts to the medication. Side effects include:

  • Muscle and joint aches (most common)
  • Nausea
  • Diarrhea
  • Constipation

There are two potentially serious side effects of statins of which you need to be aware:

  • Liver damage. Occasionally, statin use causes an increase in liver enzymes. If the increase is only mild, you can continue to take the drug. If the increase is severe, you may need to stop taking it, which usually reverses the problem. If left unchecked, increased liver enzymes can lead to permanent liver damage. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin, increase the risk of liver problems even more in people who take statins. Because liver problems may develop without symptoms, people who take statins have their liver function tested periodically.
  • Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). The higher the dose of statin you take, the more likely you are to have muscle pains. In severe cases, muscle cells can break down (rhabdomyolysis) and release a protein called myoglobin into the bloodstream. Myoglobin can damage your kidneys. Certain drugs when taken with statins can increase the risk of rhabdomyolysis. These include gemfibrozil, erythromycin (Erythrocin), antifungal medications, nefazodone (Serzone), cyclosporine and niacin. If you take statins and have new muscle aching or tenderness, check with your doctor.

It's important to consider the effects of statins on other organs in your body, especially if you have health problems such as liver or kidney disease. Also, check out whether statins interact with any other prescription or over-the-counter drugs or supplements you take.

Keep in mind that when you begin to take a statin, you'll most likely be on it for the rest of your life. Side effects are often minor, but if you experience them, you may want to talk to your doctor about decreasing your dose or trying a different statin. Don't stop taking a statin without talking to your doctor first.

Are there other options?

Statins effectively reduce bad cholesterol (LDL). But, because of genetic differences, the type or dose of statin each person takes can vary. For example:

  • If you are not able to lower your LDL to the desired goal using statin medication, your doctor may add ezetimibe (Zetia) to your treatment plan or switch to a combination ezetimibe and simvastatin medication (Vytorin). This combination will help drop your LDL level further, perhaps even another 15 percent to 20 percent. You may have heard reports that the combination medication of ezetimibe and simvastatin (together, these two medications are called Vytorin) is no more effective than taking simvastatin by itself. But, this small study didn't find any differences in death, hospitalization or heart attacks between the two medications. If you are on this combination medication, you should continue to take it unless your doctor tells you otherwise.
  • If you have both high LDL and high triglycerides, you may benefit from combining the statin with niacin (Niaspan) or combining the statin with a fibric acid drug such as fenofibrate (TriCor) or gemfibrozil (Lopid). The risk of muscle problems is higher when these medications are paired, so to combat that risk, your dose of statins may be lowered to less than 20 mg.
  • If you have just high triglycerides, use of niacin (Niaspan) is very effective. Fibric acid agents (TriCor and Lopid) are another option. Fish oil (omega-3 fatty acid) supplements (Lovaza) in 2- to 4-gram doses also can help.
  • If your high-density lipoprotein (HDL) cholesterol is low, niacin might be the best choice to raise it. Fibric acids also are useful but less effective than niacin. Exercise and weight loss may help, as well.
  • If your doctor recommends niacin in addition to a statin, you might want to discuss taking a medication that combines both niacin and a statin, such as Simcor or Advicor. These medications can reduce the number of pills you have to take. However, that may be the only benefit. Research studies haven't yet shown that the combination drugs lower cholesterol more than does taking niacin and a statin separately.

In some cases, one medication may simply not be effective and a different drug must be substituted. For other people, lifestyle changes may be all that are needed to lower cholesterol.

What else can statins do?

High cholesterol affects all arteries, not just those in the heart. Its negative effects permeate the body, so it's likely that the benefits of lowering cholesterol might have widespread health benefits as well.

One promising benefit of statins appears to be their anti-inflammatory properties, which help stabilize the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart, to blood vessels and organs throughout the body.

In the heart, stabilizing the blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack. Statins also help relax blood vessels, lowering blood pressure. In addition, statins have blood-thinning effects, reducing the risk of blood clots. For these reasons, doctors are now beginning to prescribe statins before and after coronary artery bypass surgery or angioplasty, and following certain types of strokes.

Other benefits of statins could include:

  • Prevention of arthritis and bone fractures. Statins might help protect against osteoporosis, arthritis and bone fractures, but more research is needed to confirm this benefit.
  • Prevention of cancer. It's unclear whether statins might reduce your cancer risk. While some studies have suggested statins could reduce cancer risk, later studies haven't found a connection between statin use and reducing risk for breast, colon, prostate, respiratory, skin, or gastrointestinal cancers.
  • Reduction in the risk of dementia and Alzheimer's disease. Statins might help keep your brain healthy, but more research is needed.
  • Protection of the kidneys. Statins may help protect kidneys, through their effects on cholesterol and blood pressure and perhaps their ability to reduce inflammation.

Statins may also be helpful in controlling the body's immune system response after an organ transplant.

Weighing the risks and benefits of statins

When thinking about whether you should take statins for high cholesterol, ask yourself these questions:

  • Do I have other risk factors for cardiovascular disease?
  • Am I willing and able to make lifestyle changes to improve my health?
  • Am I concerned about taking a pill everyday, perhaps for the rest of my life?
  • Am I concerned about statins' side effects or interactions with other drugs?

It's important to take into account not only your medical reasons for a decision, but also your personal values and concerns. Talk to your doctor about your total risk of cardiovascular disease and discuss how your lifestyle and preferences play a role in your decision about taking medication for high cholesterol.

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March 28, 2008

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