Friday, January 30, 2009

Statins: "I heard cholesterol pills are bad for you!"

"Statins" are the most commonly prescribed cholesterol lowering medications, and have been around since the 1980's. The first four are now available generically, and were originally developed based on naturally occurring plant-based compounds. Lipitor was ground-breaking in the mid-1990's because it was more potent ("stronger") and mainly because it was completely synthetic in origin. Crestor followed in the same manner.

They are called "statins" because the chemical names all end in -statin: lovastatin, atorvostatin, pravastatin, etc., etc.

Concerns about rare but severe side-effects in news and magazines fail to make clear the extent of any risks and benefits in taking statins.

Downsides:
  • Flatulence (passing gas) is actually the most common side-effect. Not harmful, not associated with diarrhea; just more passing gas. I have, so far, never had anyone stop taking a statin because of this.
  • Liver injury. Turns out, increased liver function blood tests turn out to be from the effect that lowering your cholesterol has on allowing solidified fats in your liver to dissolve and return to normal. (so called "fatty liver") This is not a toxic effect on your liver. Unfortunately, warnings that go on drug labels rarely ever go off them.
  • Muscle injury. Actual toxic injury to muscle is rare with statins. Rare as in 10-25 times per 10,000,000 (10 million) prescriptions written. That's 1-2.5 in a million. Your chances of being struck dead by lightning are about 1 in 5,000. Please, let's put that in perspective.
  • Muscle aching. Here, were talking achiness that is not harmful, and goes away within a few days of stopping the medication. This occurs in about 4% of folks. Mind you, this comes from studies showing 21% of people taking a statin complain of achiness, but 17% of people taking a sugar pill (placebo) do, too. The human mind is a funny thing...
Upsides:
  • Reduced risk of heart attack or cardiac arrest by about 31-34%.
  • Similarly reduced risk of stroke.
  • Reduced risk of Alzheimer's dementia.
  • Reduced risk of colon cancer.
  • Reduced risk of osteoporosis.
Short story:
  • Statins can make you pass gas more often, but can't hurt your liver. Muscle aching is uncommon and actual muscle injury is extremely rare.
  • They do reduce you risk of heart attack, stroke, Alzheimer's, colon cancer and osteoporosis.

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