Are Doctors Minimizing Side Effects of Statins?

San Diego Union writer tells us that a UCSD researcher who helped analyze nearly 900 studies of cholesterol-lowering statins, has indicated that doctors who prescribe an increasingly popular family of drugs to prevent strokes and heart attacks may be downplaying the wide range of side effects.

StatinsPhysicians who fail to recognize those complications – willfully or through ignorance – could put patients at risk of developing more serious health problems, according to the review, published yesterday by the American Journal of Cardiovascular Drugs.

Certaim symptoms that surfaced in the studies are rarely blamed on statins when they occur outside, i.e.:

  • Memory loss,
  • Insomnia,
  • Numbness in the fingers and toes,
  • Sexual dysfunction,
  • Weight gain,
  • Vision impairment
  • Several dozen other conditions

Muscle and liver damage are the best-known side effects. But even then, too many doctors dismiss muscle soreness, pain and weakness as symptoms linked to other factors such as aging, the review concluded.

“Unfortunately, physicians who aren't aware of a problem with a drug often won't consider that drug when the problem arises,” said Dr. Beatrice Golomb, a widely cited statin expert and an associate professor of medicine at the University of California San Diego.
She urges patients and doctors to look more closely at the list of possible side effects for statins, which include Lescol, Pravachol, Zocor and Lipitor.

“They should familiarize themselves with them so they can make appropriate treatment decisions,” she said. Golomb co-wrote the report with UCSD undergraduate student Marcella Evans, who is now enrolled in UC Irvine's Medical Scientist Training Program.

Statins are one of the most well-received groups of drugs in developed countries, with hundreds of millions of prescriptions written annually. Worldwide sales of the medications – the bulk of which occur in the United States – totaled more than $25 billion last year, according to pharmaceutical industry associations.

Researchers consistently have shown that statins can lower levels of LDL cholesterol, which causes plaque buildup in the arteries, by 20 percent to 60 percent while helping to increase levels of beneficial HDL cholesterol.

Formation of plaque can lead to heart attacks and strokes. About 1.3 million Americans will have a heart attack this year, and about 700,000 will suffer a stroke, according to the American Heart Association. More than 450,000 people will die from heart disease in that time, while at least 150,000 will die from stroke.

A major study last year also found that Crestor, a powerful statin, also can significantly reduce the risk of heart attack in people with normal levels of LDL cholesterol but high counts of a protein that causes inflammation.

More doctors have become enthusiastic about statins after seeing overwhelming evidence of their benefits and reading a growing body of research that sets ever-stricter targets for what are considered to be healthy levels of LDL cholesterol. They're prescribing the drugs to a wider range of patients – and in higher doses.

Some doctors worry that if they talk too much about potential side effects, their patients might have second thoughts about the drugs, Bove said. “My statement to my patients is, 'Live until you're 80 and have muscle aches sometimes,' ” he said. “If I were to list all of these things, nobody would want to take a statin.”

Dr. Mark Hlatky, a professor of health research and cardiovascular medicine at Stanford University, said the report should trigger more interest in finding ways to prevent or treat statins' side effects. But he said patients taking the drugs shouldn't let the new concerns become reasons for going off the medication.
“Many people taking statins need to take them. If they give up on them too soon, that's not good either,” Hlatky said. “If they feel like they're having a side effect, they should talk to their doctor.”

The extensive review of research literature by Golomb and Evans turned up a number of characteristics associated with statin complications, including being female, elderly, obese, an alcoholic or a diabetic.
Such risk factors and many of the side effects were tied to a single process triggered by statins, one that damages the body's ability to deliver energy to muscles and the brain, the UCSD report said.
In that process, statins interfere with the production of coenzyme Q10, a compound central to the production of energy within mitochondria, the power plants of cells.

Those findings have prompted some doctors to treat statin complications with Co Enzyme Q 10, Bove said.
Physicians also relieve statin-related muscle aches with tonic water that contains quinine, a naturally occurring substance that has anti-inflammatory properties. He tells patients who are on statins to drink half a cup of tonic water when they experience soreness.

Source: Union-Tribune San Diego,
January 28, 2009
Author: Keith Darce