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July 24, 2013 at 8:00 AMComments: 0 Faves: 0

Statin Medications for Cholesterol: The Good vs. the Bad

By Jeffrey VanWingen M.D. More Blogs by This Author

High cholesterol is common; one in four adults have it. As a family doctor, it's one of the most frequent problems I deal with. Normal cholesterol lowers risk for heart attack and stroke while high cholesterol increases the risk. When blood testing reveals a high level of cholesterol, measures are recommended to bring things back to normal. Initial recommendations primarily include lowering the intake of cholesterol in the diet.

When "lifestyle" changes are not enough, however, it may be time to consider medication. The most common form used for high cholesterol are the statin medications. Time and again, however, when I bring up this option, I field various fears about the perceived evils of these medications. Therefore, I'd like to clear the air by addressing the pros and cons of statin medications, highlighting the results of a new large-scale analysis.

Statin Medications at a Glance

Statin medications work by inhibiting an enzyme called HMG-CoA reductase, which is instrumental in the cholesterol production, which happens in the liver. By blocking this enzyme, blood cholesterol levels plummet.

Over the years, a number of statin medications have hit the market for use. Ten years ago, the statin Lipitor was hailed as the greatest selling pharmaceutical product of all time.

The Good

Simply put, statin medications have been shown to save lives. In those with existing heart disease, studies have shown as much as a 60% reduction in cardiac events such as heart attack and sudden cardiac death. Also, in this group, stroke risk was reduced by as much as 17%. The results are so convincing that hospitals are graded and bench-marked on patients being released the hospital after a heart event on a statin medication.

The Equivocal 

Most of the patients I diagnose with high cholesterol do not have heart disease. Relying on date, it is a bit difficult to say with conviction that lowering cholesterol levels will definitely lower their risk for developing heart disease or having a stroke.  While studies have shown this association, others have not.

The Bad 

As statins work in the liver, they can tax the it. Occasionally, enzyme by-products of the liver are elevated. For this reason, periodic liver function testing is recommended for most statins. The problem is quite uncommon, however. Most patients are concerned about the potential for muscle aches (myalgia). I do occasionally see patients with muscle aches with suspicion that their statin medication is to blame. Still, a large analysis of 135 studies showed no significant increased risk of myalgia. If concern is raised, I will have patients stop the medication for two weeks, looking for a causal relationship. As aches go, however, they often resolve on their own. To account for this, I always have patients start the medication back up to see if the myalgias return. Though the analysis did not show myalgia, it did confirm suspicions that statin medications increase diabetes risk. A nine percent increase was noted compared with placebo. While the analysis did not mention memory problems or depression, I have had patients claim that these issues were caused by their statin. Reports in the medical literature do report such a relationship, but they are quite limited. The feared side effect, severe muscle breakdown (rhabdomyalysis), is extremely rare and most often present with other medications taken at the same time known to increase risk. 

In Conclusion

Statin medications are commonly prescribed for the common problem of high cholesterol. The consensus is that the medications are safe and can reduce the risk of heart disease and stroke which can, in turn, save lives. Public fear has cast a cloud of concern about potential side effects. While they do exist, a recent large-scale analysis has shown that they may not be as common as thought. Still, as I often say to patients, any medication can do anything to anybody. They only way to know for sure is to take the medication and monitor. And with any medication, the risks and benefits need to be weighed and considered.

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