Paging Dr. Frischer - Statins

By now, most of us have heard of the class of drugs known as statins, medications prescribed for those with high levels of cholesterol. About 35 million Americans take them regularly. Some in the medical community even recommend that all adults take them, much like aspirin, for prevention of atherosclerotic diseases like stroke and heart attack. Is that a good idea? Let's explore.Statins inhibit the action of an enzyme (HMG-CoA reductase) made in the liver, which is necessary for the production of cholesterol. The human body needs cholesterol in order to function, but high levels lead to atherosclerosis, a condition that causes plaques that clog the arteries and increase the risk of stroke and heart attack. The challenge with statins is to weigh their benefits against their undesirable side effects. There is no question that statins are relatively safe drugs, and they've saved thousands of lives over the past 20 years, particularly in men with established heart disease. But like any drug they can cause problems for some, including muscle aches, increased risk for diabetes, liver enzyme fluctuations, and, gaining recent attention, memory loss. The most common negative side effect is musculoskeletal, ranging from mild muscle pain (myalgia) to actual damage to the muscles. This happens to 5 - 10% of those taking statins. These symptoms appear to be dose related - the higher the dose, the greater the side effects. Most begin about a month after starting statin therapy or increasing to a higher dose, although these symptoms can take as long as six months to appear. Pain may be widespread, but is more common in the lower extremities. Another musculoskeletal issue with statins is tendon complications. Approximately 2% of those on statins develop this, ranging from tendonitis to tendon ruptures. These types of symptoms generally occur within eight months of starting therapy. The Achilles heel is the most common tendon affected, with swelling, warmth, stiffness and pain. Aside from ruptures, symptoms clear up after stopping the medication. The FDA recently issued a warning that taking a statin may increase the risk of developing type 2 diabetes. Some studies show as much as a 12% greater risk than for non-statin users. While the statistical benefit of reducing heart attacks far outweighs the risk of developing diabetes, you can bet that this issue is receiving more research attention. About 10% of patients see liver enzymes rise after starting a statin, but these eventually return to normal. Due to this side effect, your doctor will periodically check your liver enzymes. Interestingly, these mild elevations do not appear to lead to long-term liver problems, and some researchers are even investigating using statins to treat mild elevations resulting from a condition known as fatty liver. The most recent area of concern is memory loss. Studies suggest that memory loss or changes in thinking skills is a risk mainly among older statin users, that it has been observed for some within days of starting treatment with statins, and that the problem seems to disappear after stopping the drug. There is no evidence to suggest that statins lead to permanent memory loss. So, why should anyone take a statin? The possible benefits depend on your cholesterol level as well as other cardiovascular risk factors. If your only risk factor is high cholesterol, you may not need this medication because your risk of heart attack and stroke could still be low. Note that high cholesterol is only one of a number of risk factors for heart attack and stroke, which also include family history of heart disease, hypertension, having diabetes, obesity, smoking cigarettes, and living an inactive lifestyle. In conjunction with these other risk factors, however, it is very clear that high cholesterol levels do have a direct impact on heart attack or stroke risk. We can lower cholesterol levels (as well as triglycerides, another form of lipid in the bloodstream) in a number of ways: Eating a heart-healthy diet can reduce LDL ("bad" cholesterol) levels by 10% Losing 5 to 10% of body weight can reduce LDL by 15% and reduce triglycerides by 20% Exercising for at least two and a half hours per week can further reduce triglycerides by 20% to 30% Quitting smoking, managing stress, and making other lifestyle changes can lead to further reductions My patients and my regular readers won't be surprised to hear me preach that exercise and other lifestyle measures are the cornerstone to reducing cholesterol levels. However, it still may be necessary to take a statin or some other cholesterol-lowering medication. Statins can quickly reduce LDL (bad cholesterol) by 50% or more. They can also boost HDL (good cholesterol) by as much as 15%. These changes typically occur within the first month! But more important than simply lowering cholesterol numbers, statins have been shown to reduce the risk of coronary events by 25% to 40%. If a patient has existing coronary artery disease, statins can decrease atherosclerosis and stabilize plaque already formed in arteries (heart attacks start with plaque rupture). Statins are not meant to be a cure-all. They are potent medications with some potentially significant side effects. They don't benefit all who take them. When used for the appropriate patients, along with significant lifestyle changes, they offer enormous benefits to those with heart disease. Your doctor will guide you. Enjoy good heart health during this New Year! Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: January 10, 2013 - Volume 11 - Issue 39