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Coping with statin side effects

Some people experience muscle aches or muscle cramps, but trying these tips may help.

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About 10% to 20% of inidividuals who take statins report that they experience muscle pain or muscle cramps.
Image: rogerashford/Thinkstock

Statins, such as atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor), and lovastatin (Mevacor), are commonly prescribed medications that lower “bad” LDL cholesterol and have been shown to help reduce the risk of heart attack, stroke, and death.

How they work

Cardiologist Dr. Jorge Plutzky, medical editor of the Harvard Special Health Report Managing Your Cholesterol and director of preventive cardiology at Brigham and Women’s Hospital, points out that most of the cholesterol in our blood does not come from the food we eat. Instead, it is made in the liver, and later is removed from the blood by the liver. Statins primarily increase cholesterol removal from the blood, thereby lowering LDL and total cholesterol blood levels. Statins also slightly increase “good” HDL cholesterol and slightly lower triglycerides.

Statins are recommended for all people with known heart disease, people with very high LDL (190 milligrams per deciliter or higher), and middle-aged adults with type 2 diabetes. Statins are also advised for people with no prior heart problems but who have a 7.5% or higher risk for heart attack or stroke in the next 10 years (as calculated using certain standard formulas). For example, a statin might be recommended for someone who smokes and has high blood pressure, even if his or her cholesterol level is average.

It’s not always rosy

Although they offer substantial benefits in decreasing heart attacks and strokes, statins sometimes cause side effects. About 10% to 20% of people who take statins report experiencing muscle pain or muscle cramps, while others complain of nausea, trouble sleeping, diarrhea, or constipation.

Some people who take statins experience an increase in blood sugar and may develop diabetes, but “the evidence suggests that this happens in people who are already at a high risk for diabetes. This slight risk is greatly offset by the effect of statins in reducing the risk of heart attacks,” says Dr. Plutzky.

In rare cases, statins may cause liver problems or a potentially life-threatening breakdown in muscle cells. There are also rare claims of fuzzy thinking as a side effect, although the evidence this is caused by statins is difficult to establish.

What you can do

Keep track of any new symptoms that develop when you begin taking a statin, and report them to your doctor. Some symptoms may go away as you continue to take the medication.

There are no treatments proved to reduce statin side effects. Some studies suggest a possible benefit from vitamin D therapy (in people with low blood levels of vitamin D). Dr. Plutzky thinks that stopping the statin for several weeks, then taking coenzyme Q10 for several weeks, and then restarting the statin may prevent a return of the side effects.

To minimize muscle cramps, doctors often recommend doing stretching exercises, wearing compression stockings, avoiding high-heeled shoes, keeping the arms and legs warm, and taking magnesium supplements.

If, after a few weeks, none of these solutions work, Dr. Plutzky says you and your doctor should consider going to a lower statin dose; switching to a different statin; and for some, trying that new statin on a different schedule, such as every other day. Adding another type of cholesterol-lowering drug called ezetimibe (Zetia) to a statin decreases the risk of heart attacks and can allow your doctor to lower your statin dosage. If you still don’t find relief, you may be a candidate for a statin alternative (see “What about PCSK9 inhibitors?”).

What about PCSK9 inhibitors?

In 2015 the FDA approved two powerful new medications to lower cholesterol. Alirocumab (Praluent) and evolocumab (Repatha) are in a group of medications called PCSK9 inhibitors, and they don’t have the same types of side effects as statins. “They may be a good alternative for people whose cholesterol remains too high, even with statins and ezetimibe. But we don’t know yet that they decrease heart attacks and strokes, as statins do,” says cardiologist Dr. Jorge Plutzky, director of preventive cardiology at Brigham and Women’s Hospital.

PCSK9 inhibitors come with a very high price tag (about $15,000 per year). Dr. Plutzky says he is seeing insurance companies, including Medicare, pay for the drug when treatment with statins is either inadequate or causes adverse effects. “It’s challenging, and it takes time to prove that a statin won’t work for you,” he says.

Will the price ever come down? “Drug companies are trying,” says Dr. Plutzky, “but if a statin will work for you, it’s important to stick with it.”

Posted by: Dr.Health

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