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What you should know about: Statins

Statins are among the most widely prescribed drugs in the world, because they are effective at lowering low-density lipoprotein (LDL, or unhealthy) cholesterol levels. Elevated LDL levels are a major risk factor for heart disease, heart attack, and stroke. But there are many opinions about who should take statins. Some cardiologists believe statins should be prescribed to people with mild heart disease risks. Others feel statins should be reserved only for those with moderate or severe heart risks.

Controversy

Two recent studies add to the debate. One, published in The Lancet, suggested that the guidelines for statin therapy be revised to include even people at low risk for a vascular event. The other, from Harvard-affiliated Brigham and Women’s Hospital (BWH), published in The Lancet, counters recent concerns that statins can be associated with an increased risk of type 2 diabetes. The BWH study found that the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard, even among those with the highest risk of developing diabetes. “The risk of developing diabetes while on statin therapy was limited almost entirely to people who had at least one major risk factor for diabetes prior to statin therapy,” says Dr. Paul Ridker, the study’s lead author and the director of the Center for Cardiovascular Disease Prevention at BWH. “Yet even in this high-risk group, the benefits of treatment greatly outweighed the diabetes hazard.”

What’s right for you?

Dr. Deepak Bhatt, a cardiologist with Brigham and Women’s Hospital, says the issue comes down to risks and benefits, though he emphasizes that people with established cardiovascular disease involving plaque buildup in the arteries should be on statins, provided they don’t have a documented allergy to the drug. “The higher the level of cardiovascular risk, the greater the benefit,” he explains. “Patients with mild risk factors are still likely to benefit, though the degree will be less. And while statins are extremely safe, we actually don’t know if there might be serious side effects that only emerge after decades of use.”

How statins work

Cholesterol production

Cholesterol production

Limiting cholesterol production

Limiting cholesterol production

Most of the cholesterol circulating in your blood is made by your liver; not from the food you eat. An enzyme called HMG-CoA reductase plays a key role in determining how much cholesterol the liver makes. Statins work by blocking the activity of HMG-CoA reductase.

Concerns

Most people who take statins experience no or relatively minor side effects. Muscle pain is the most common complaint. “A lower dose or a different brand can often reduce or eliminate muscle pains. Very rarely, muscle breakdown can occur. This can cause severe muscle pain, and lead to kidney failure and death. Again, this is extremely rare and is different from mild muscle aches,” says Dr. Bhatt. He adds that there are reports of statins being linked with memory problems. “However, this has never been noted in carefully done randomized clinical trials,” he says.

Statins can interfere with some drugs, such as immunosuppressants, certain antibiotics, and antidepressants. Statins may also become dangerously potent when taken with grapefruit juice.

Posted by: Dr.Health

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