Statins are the most commonly prescribed cholesterol-lowering medications that affect all aspects of the cholesterol profile: They lower LDL and triglyceride levels and raise HDL levels. Additionally, statins have been found to lower the risk of heart disease, as well as prevent subsequent heart attacks and strokes in those individuals who already have heart disease.
Even amid the benefits that taking statins may have, some individuals shy away from them because they are afraid that the side effects may cause more harm than good. Are they correct in trying to prevent complications from statins, or are they missing out on the potentially life-saving benefits that statins hold?
Side Effect #1: Liver Enzyme Elevation
All statin drugs have been shown to elevate liver enzymes to some degree. Liver enzymes include aspartate aminotransferase (AST) and alanine aminotransferase (ALT), which are monitored before beginning statin therapy, three months after beginning statins, and least every six months while on statin therapy. When your liver enzymes are elevated, may not experience any symptoms.When standard doses are given, liver enzyme elevation occurs in about one percent of individuals taking statins. This liver enzyme elevation is usually seen within the first four months of therapy. The likelihood of this elevation increases in older people and in those taking other medications that might interact with statins and also raise liver enzymes. The risk of developing elevated liver enzymes while on statins is also dose-dependent, which means that the higher the dose of statins you are taking, the more likely you will experience an increase in your liver enzymes.
Although there have been reports of liver failure and hepatitis associated with statins and elevated liver enzymes, these occurrences are rare. Current studies have not been able to establish a definite link between statin use and liver disease. If for some reason your liver enzymes do become elevated, they are restored back to normal once the statin is stopped.
Side Effect #2: Muscle Pain and Weakness
Myopathies, or muscle symptoms such as weakness and pain, are also another reason many individuals shy away from statin therapy. Myopathies range from mild myalgias, or muscle pains, to a life-threatening condition known as rhabdomyolysis. It is currently estimated that the most common myopathy associated with statin use, myalgia, only occurs in about one person out of every 1,000 people taking statins.The chance of experiencing myopathies while on statins increases as you get older, with higher doses and while taking other medications that may interact with statins. These symptoms will usually appear within four months of initiating statin therapy.
Rhabdomyolysis, another myopathy that can occur with statin use, is characterized by profound muscle pain, weakness, significantly increased amounts of creatinine phosphokinase in the body, and bloody urine (due to muscle breakdown and the release of myoglobin in body). Although this condition is deadly if not properly treated, it also extremely rare. Rhabdomyolysis occurs in one person out of 10,000 individuals taking statins.
The Benefits Outweigh The Risks
Although side effects are associated with statin use, these side effects are relatively uncommon when compared to the reduction in cholesterol and lowered risk of heart disease that can be gained in many individuals with statin therapy. If you are among the small percentage of patients who experience side effects while taking statins, be sure to notify your healthcare provider.
Sources:
Armitage J. The safety of statins in clinical practice. Lancet. 2007; 6736(07):60716-8.
De Denus S, Spinler SA, Miller K, et al. Statins and liver toxicity: a meta-analysis. Pharmacotherapy. 2004; 24(5):584-591.
Harper CR and Jacobson TA. The broad spectrum of statin myopathy: from myalgia to rhabdomyolysis. Curr Opin Lipidol. 2007; 18(4):401-08.
Jacobson TA. Statin safety: lessons from new drug applications for marketed statins. Am J Cardiol. 2006; 97(8A):44C-51C.
