The Pros And Cons Of Taking Statin Drugs

Many people over the age of 50 and some over 40 years of age will take a type of drug called a statin - a group of cholesterol lowering drugs, especially if they have risk factors for diabetes or heart disease.  Some experts believe that their benefit is so universal that everyone over the age of 40 should take one daily to prevent heart disease. But the list of side effects being reported by patients and in studies is growing, and even led to the current restriction of the 80mg dose of simvastatin in the US.

What side effects have been reported?

Since the 1990s it has been known that statin drugs are associated with causing muscle pain, weakness and inflammation and the leaflet in all packs of these drugs carries a warning (amongst others) about this effect. 

There was also an increased risk of developed osteoarthritis and other joint conditions in those taking statins.

Reduced energy and tiredness on exertion

Low energy and tiredness has been reported by people taking statins, and a randomized study of over 1,000 men and women showed a definite link between taking the drugs and this side effect. The study authors estimate that 20 to 40% of people taking statins will experience low energy or tiredness on exertion when taking statins.  This is somewhat paradoxical as these drugs are prescribed to patients who will mostly be advised to exercise to keep their heart healthy! 

Many people prescribed statins do not have heart disease or diabetes (they take the drugs to try and help prevent these diseases).  If these drugs prevent the taker from being active and exercising, they are more likely to contribute towards heart disease, obesity and diabetes, than prevent them.

Dr Beatrice Golomb of University of California, San Diego, who led the research group commented:

(A mortality benefit is one which prevents deaths and CRP is C-reactive protein and can indicate increased risk of heart disease).

She added that the side effects seemed linked to the potency of the statin, so that the most potent in the study (rosuvastatin) was the most likely to cause these effects.

Cataracts

This eye condition causes progressive clouding of the eye lens, reducing vision.  Virtually everyone over the age of 70 is affected by it to some degree, but a study found that people taking statins were 50% more likely to develop cataracts and the risk was even higher in people with type 2 diabetes.

Why are so many people prescribed statins?

As well as obtaining cholesterol from food we also constantly manufacture it in the liver.  Most people should be able to reduce their blood cholesterol to healthy levels (160mg/dL or less) by reducing their intake of fat and cholesterol-rich foods. 

But some people have an inherited metabolic fault which causes them to have high levels of cholesterol in the blood.  Modifying diet alone may not lower cholesterol levels enough in these people or in those with type 2 diabetes, which is also a metabolic disease. Statins work by blocking the process of cholesterol production in the liver.

What is so bad about high cholesterol?

Cholesterol is an essential constituent of many parts of our bodies, including the membranes surrounding each cell, the crystalline lens in our eye, and hormones such as estrogen and testosterone.  But an excessive level of cholesterol in the blood is associated with blockage of arteries – such as those supplying the brain, heart and legs.  In these diseases, cholesterol forms solid slabs (‘plaques’) on the internal walls of our blood vessels – in those supplying the heart muscle in the case of coronary heart disease. 

The plaques lead to progressive narrowing of the blood vessels until blood can no longer pass through it.  The muscle or tissue dependent on that blood supply will be damaged, and if the supply is not quickly restored, will die. This is what happens in a heart attack or stroke – part of the heart muscle or brain is starved of blood and oxygen and may be left permanently damaged.

So should everyone take a statin?

These are all aimed at reducing the risk of coronary heart disease which is predicted to become the world’s leading cause of death and disability by 2020. But this would mean exposing people to the side effects of drugs like statins, when their risk of heart disease may be very small.

Dr Golomb commented that people without risk factors for coronary heart disease are more likely to experience a side effect from taking a statin than they are to have a coronary event.

Who should be taking a statin?

There is clear evidence that people with multiple risk factors for heart disease (including type 2 diabetes) or who already have heart disease, could benefit substantially from taking a statin as part of treatment to modify their risk.

In such cases it is likely that the potential benefits will outweigh the risks of side effects. Not everyone experiences the side effects mentioned and it may be possible to modify them by changing the statin, or its dose or combining it with a different class of lipid (fat) lowering drug.