Dr. Patricia Yarberry Allen is a collaborative physician. Last week, she asked cardiologist Timothy C. Dutta to advise a 51-year-old who is highly wary of taking a statin drug, although her family doctor believes she needs to do so. Dr. Dutta’s response, “Do I Need to Take a Statin?” laid out in considerable detail the benefits that taking a statin can provide to a patient who needs this medication.
In this week’s article, Dr. Dutta, a member of Women’s Voices for Change’s Medical Advisory Board, takes up the matter of the side effects of taking a statin—the issue that troubles Peggy in her letter, below.
Dear Dr. Pat:
“I am a 51-year-old woman with great health habits. I exercise almost every day. I am 5-foot-6 and weigh what I weighed in college: 130 pounds. I eat lots of salads, fish, vegetables, and some fruit. I avoid processed foods and red meat. No one in my family had any early heart disease or strokes. But everyone in my father’s large family had elevated cholesterol. My last period was two years ago, and my cholesterol shot up! My total cholesterol is 264, with bad cholesterol of 120 and good cholesterol of 144. My triglycerides are normal. My family doctor is pushing me to take a statin, but so many of my friends have had bad experiences with these drugs, I really don’t want to start on this drug path. I don’t take any prescription medications. I take Vitamin D and a multi-vitamin for women that has no iron. Do women with my history have to take a statin? What about the side effects?
Dr. Dutta Responds
I have noticed that patients seem to worry more about a statin’s side effects than they consider its benefits. Many patients wonder if taking a daily medicine, potentially for the rest of their life, is going to cause problems. Like all medications, statins have a long list of possible side effects. The three following side effects are asked about commonly: (a) muscle damage, (b) increased risk of diabetes, and (c) memory loss. Do statins put people at risk for these side effects?
It has long been recognized that statins cause muscle aches, and this is probably the most common reported side effect of the medication. Somewhere in the range of 5% of patients will get some degree of muscle aches, but only 0.1% of patients will have a serious event. Muscle aches occur, but this is almost always a reversible symptom that goes away promptly after stopping the medication. Should aches occur, most patients will notice a resolution within days to weeks, though occasionally it can take months. There is interest in whether the statins can cause permanent muscle damage, but the clinical significance of this is uncertain. Drug interactions are common with statins, and raise the risk; even an interaction with grapefruit juice can raise the risk.
In the past five years, large statin studies have been analyzed and found to show that high doses of statins raise blood sugar slightly. The magnitude of this effect is small, and it affected patients who were already close to being diabetic before taking a statin. The effect has been shown only with high doses of the drugs, and not with low doses. The high doses of the medication raise the risk by as little as 0.2%. Patients with an increased risk of diabetes also have an increased risk of heart attack: For each case of diabetes implicated with the medication, five heart attacks were prevented. In other words, the population at risk for diabetes is more likely to be helped by a statin than to be harmed by one.
Do statins cause memory loss, or do they prevent it? There are uncommon reports of patients having confusion, and some of these cases have resolved promptly when the medication was stopped. Conversely, there are trials showing a decrease of dementia with statins. From 1997 to 2002 there were only 60 reports of confusion among millions of prescriptions written. Statins that are fat soluble and enter the brain have been more frequently reported, supporting that it may be a rare real effect, but it is debated whether this side effect is real, given how rare the reports are and that it has not been seen in trials.
I think the importance of these side effects needs to be weighed against the value of the benefits. The muscle-ache side effect is real, but reversible. The diabetes effect is small, and is likely outweighed by the benefits. The memory effect, if real, is exceeding rare and other data shows a preservation of memory with statins.
Half of the American population will die of vascular disease, but half of them won’t. Whether to take a statin mostly depends on how great is the risk of heart attack and stroke without one. Remember, trying a statin is not committing you to taking it for life; if the drug causes a problem, it can be stopped.