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.