Cleveland Clinic's 9 myths about statins

In previous a post, I described the new guidelines from the American Heart Association for managing cardiovascular disease risk. Overall the guidelines are more flexible than in the past, but one consequence is that more people are likely to take statins to lower their LDL (bad cholesterol); high LDL contributes significantly to atherosclerosis.

This has raised some concerns about the safety of statins. Unfortunately, there is a lot of misinformation about possible side-effects. Some of these misconceptions are discussed in a recent article from the Cleveland Clinic listing 9 myths about stains:

• Myth 1: Statins will hurt your ability to exercise.
• Myth 2: Statins will cause muscle damage and hurt your heart.
• Myth 3: You should avoid statins if you have diabetes.
• Myth 4: Statins cause cognitive dysfunction or dementia.
• Myth 5: Natural supplements like red yeast rice are safer than taking a statin.
• Myth 6: Being statin-intolerant means you will never be able to take a statin.
• Myth 7: Statins cause cataracts and liver damage.
• Myth 8: Everyone should take statins.
• Myth 9: The elderly do not benefit from statins.

Muscle aches (and possible muscle damage), which occur in about 5% of patients, are the most commonly cited side-effect of statins (Myth 2). These symptoms can range in severity from mild (most cases) to life-threatening:

"The most common statin side effect is muscle pain. You may feel this pain as a soreness, tiredness or weakness in your muscles. The pain can be a mild discomfort, or it can be severe enough to make your daily activities difficult. For example, you might find climbing stairs or walking to be uncomfortable or tiring. Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis (rab-doe-mi-OL-ih-sis). Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death. Rhabdomyolysis can occur when you take statins in combination with certain drugs or if you take a high dose of statins."

A second area of concern is that of possible liver damage (~1% of patients):

"Occasionally, statin use could cause your liver to increase its production of enzymes that help you digest food, drinks and medications. If the increase is only mild, you can continue to take the drug. Rarely, if the increase is severe, you may need to stop taking the drug. Your doctor might suggest a different statin. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin (Niacor, Niaspan), slightly increase the risk of liver problems in people who take statins."

My Mother had higher levels of liver enzymes after her initial statin prescription, and so the Doctor changed her to a different statin at a lower dose, and the liver issue went away.

There are additional minor issues associated with statins (listed here), but as with the Myths listed above, the risk for these is minimal or non-existent. For example, there is no evidence that the use of statins increases the risk of fetal abnormalities. Nevertheless, statins have been placed in pregnancy category X.

These mild side-effects (for most patients) have to be balanced with the potent benefits of statins which have been demonstrated to be very effective at lowering LDL (and raising HDL, the good cholesterol). Indeed statins are among the most highly prescribed drugs in the U.S. with ~20 million users.

If you have any questions or concerns about possible statin side-effects, you should talk to your doctor.

Figure 1. For most patients the benefits of statins outweigh the risks.