The (Small) Risks of Statins

Statins are safe, well-studied drugs. But even they can sometimes have risks.

Statins are highly beneficial drugs. They work very well and are quite safe. Many people have used statins for a long time with absolutely no side effects. Lovastatin (Mevacor®) was the first statin approved more than 25 years ago. Statins can reduce the risk of heart attack or stroke by at least 20 to 25 percent. They are easy to use and can be taken with or without food at any time of the day.

But like the saying goes, no man is an island and no drug is without side effects. After all, even aspirin, an over-the-counter medication, has side effects. Statins are not 100 percent benign. They can cause muscle aches in some people. This usually isn’t dangerous, but it can be uncomfortable and in some cases painful.

In very rare cases statins can cause a sometimes fatal condition called rhabdomyolysis, which causes the muscle cells to break down. Rhabdomyolysis can lead to kidney failure. Symptoms of rhabdomyolysis are severe muscle pain, whole body weakness and dark colored urine. Those who take high doses of statins or take them in conjunction with Lopid®, another lipid lowering medication, and certain other drugs, are at higher risk.

Some statins don’t go well with grapefruit juice. Grapefruit juice can exaggerate the statins’ action and also its side effects. This usually doesn’t happen with small quantities of grapefruit juice, but you should discuss your intake of grapefruit juice with your healthcare provider before starting on a statin.

Another rare side effect of statins is liver damage. This doesn’t happen very often and it is easy to notice with proper monitoring. When starting a statin your physician should test your liver enzymes at baseline and again shortly after starting the drug or after any dose increase. Mild elevations in liver enzymes usually aren’t a reason to stop statin therapy.

When evaluating any drug, one has to weigh the benefits of that drug against its risk(s), both in the context of a population when discussing public health, and of an individual when prescribing therapy for a specific person. From a population standpoint the benefits of statin therapy in reducing the risk of cardiovascular disease so far outweigh the risks it is a no-brainer.

For an individual, that equation is based on the individual’s risk factors. For example, people whose immune function is compromised may have more problems with these drugs. Their need for lipid lowering must be weighed against the risk of complications from taking the drug. Recent studies have shown a slightly higher risk of developing diabetes in patients taking statins. This is more likely to occur in people with pre- diabetes, since they are already at increased risk for developing diabetes. Therefore, such individuals should be advised to re-double their lifestyle efforts before starting statins.

Since Mevacor® hit the market 25 years ago, a variety of competitors have joined its ranks. Each of these drugs works just slightly differently. Often the mild side effects cause by one brand of statin can be eliminated by trying another.

Statins aren’t perfect and they aren’t for everyone, but for the vast majority of people with diabetes who need lipid lowering, statins are the key to prevent heart disease and stroke.

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4 Responses to The (Small) Risks of Statins

  1. stephen quevedo says:

    Nice review, disagree about the part re: pre-diabetes. we know that vascular risk is clearly elevated in pre-diabetes, and that statins powerfully reduce that risk. The statement about “encouraging lifestyle changes” is a bit like America and apple pie: who couild say no.
    EXCEPT that there is little data supporting risk reduction in such high risk groups on a level comparable with that observed with statins. Thus, disagree with that one part.

    • Nora Saul, Manager Nutrition Services says:

      Dear Mr. Quevedo:
      You are correct: statins are very effective; for those with pre-diabetes it is an important conversation they need to have with their health care providers.

  2. I was wondering if you have heard about the Johns Hopkins researchers who are testing a new approach to treating patients with statins. They are seeing some promise when administering low-intensity statins in combination with ezetimibe or bile acid sequestrants. It seems like this would be a beneficial approach for patients that respond negatively to moderate to high-intensity statins. Given the number of people that are prescribed statins, I am surprised that this type of research wasn’t conducted earlier.

  3. David Schierholz says:

    And there is good evidence that vigorous exercise and statins don’t mix. And I for one can’t get a cardiologist to answer the question “what makes you so much smarter than NIH or American Heart Association guidelines?”

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