Most patients tolerate statins well, but like all medications, statins can cause side effects, which tend to be more severe as the statin dose and potency increase.

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Statins are the primary medical therapy used to reduce LDL cholesterol. They can also effectively total cholesterol and they have some triglyceride-lowering and anti-inflammatory effects. They also may modestly raise levels of beneficial HDL cholesterol. Yet, statins have important side effects that you need to know about.

What Statins Do

Statins work by blocking the action of an enzyme (HMG-CoA) responsible for cholesterol production in the liver. Most of the drugs are available in generic forms.

Although they belong to the same drug class, not all statins are equal in terms of their potency and the degree to which they reduce LDL—atorvastatin and rosuvastatin are among the most potent statins, while fluvastatin and pravastatin are among the least potent.

Other Statin Benefits

Statins may have a number of pleiotropic effects, or beneficial effects that are independent of the drugs’ intended action: LDL reduction.

Not only can statin drugs reduce LDL cholesterol, but some research suggests that high-intensity statin therapy may help stabilize coronary atherosclerotic plaques and make them less susceptible to rupture and cause heart attacks and strokes.

Other evidence suggests that statins also can slow—and potentially reverse—the progression of atherosclerotic plaque. The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) compared the effects of 80 mg of atorvastatin versus 40 mg of rosuvastatin (the highest doses available) on plaque progression in 1,039 people with stable coronary artery disease.

As expected, both medications significantly reduced LDL cholesterol and had some beneficial effects on HDL cholesterol. But, most notably, 63.2 percent of people taking atorvastatin and 68.5 percent of those on rosuvastatin experienced a regression, or reversal, of their atherosclerosis. The researchers reported few adverse events, no serious side effects, and a low incidence of heart attack or stroke among the study participants.

Statins also have anti-inflammatory effects. Some studies have shown that even if you have a normal LDL level, you still may be at increased risk of cardiovascular events if you have elevated levels of inflammatory markers such as C-reactive protein (CRP). In one trial—Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)—investigators reported that rosuvastatin reduced the risk of heart attack, stroke, and death by 44 percent in more than 17,000 people with normal LDL but elevated CRP levels.

Statins aren’t thought of as antihypertensive medications, but recent research suggests that for many patients with high blood pressure, adding statins to their antihypertensive medication regimen may make a huge difference.

In the Heart Outcomes Prevention Evaluation-3 (HOPE-3) trials, researchers reported that a combination of statin therapy and antihypertensive therapy significantly lowered the risk of cardiovascular events among intermediate-risk patients with high blood pressure. However, the researchers found that the outcomes with the combination of rosuvastatin and antihypertensive therapy (candesartan plus hydrochlorothiazide) were not significantly better compared with those of rosuvastatin alone, emphasizing the importance of the statin drug.

Managing Statin Side Effects

Most patients tolerate statins well, but like all medications, statins can cause side effects, which tend to be more severe as the statin dose and potency increase. Some of the more common statin side effects include headache and gastrointestinal symptoms. Other potential side effects include:

• Myopathy. An estimated 5 to 20 percent of statin users report muscle pain and stiffness, or myopathy. Rarely, statin users may experience rhabdomyolysis, a potentially life-threatening muscle breakdown. But, the exact percentage of statin users who experience muscle pain is a widely debated subject.
• Liver abnormalities. Statins can cause elevations in liver enzymes, suggesting potential liver damage. So, your doctor may recommend liver-function tests in certain situations.
• Blood-sugar elevations. Some studies have found an increase in blood sugar among statin users. These findings prompted the FDA to add to the statin safety information an advisory that the medications may slightly raise blood sugar, enough to push some patients’ glucose levels across the threshold of diabetes.
• Cognitive problems. Some patients may experience cognitive problems, such as forgetfulness and mental “fogginess,” while taking a statin. Consequently, the FDA has added to the statin safety information a notice about possible cognitive problems associated with statin use. These side effects typically subside after stopping the medication. Overall, whether statins actually cause cognitive problems is unclear.
• Cataracts. In a study involving nearly 7,000 patients, statin users were 9 percent more likely than non-users to develop cataracts. Another study found an association between statin use and a greater likelihood of cataracts requiring surgery. But, although these studies have identified an association between statins and cataracts, a causal relationship has not been established.

Overcoming Statin Intolerance

In some cases, statins can cause muscle-related and other side effects significant enough to prompt some patients to stop taking the drugs—a situation known as statin intolerance. Still, many people who are statin-intolerant can find a cholesterol-lowering strategy that agrees with them.

In one study, researchers reviewed data on 1,605 patients with intolerance to two or more statins. The researchers gave the patients a statin once a week and then administered varying doses and dosing schedules to determine what they could tolerate.

Overall, more than 72 percent of the patients who were previously statin-intolerant were able to resume statin therapy, often with the help of dosing adjustments or switching to a different medication in the statin class. While most of the patients could return to a daily statin regimen, others could tolerate only intermittent therapy, taking the drugs every other day or as infrequently as once a week. The patients who resumed daily statin therapy overall achieved greater LDL reductions than those on intermittent therapy, but both groups experienced greater LDL reductions and were more likely to achieve their LDL goals compared with those who discontinued statin use, the study found.

For more information about statins and other cholesterol-lowering medications, purchase Managing Your Cholesterol at www.UniversityHealthNews.com.