The Statins

"Statin" is shorthand for a class or type of medications that have been around since the late 1980's, which my daughter reminds me was a really long time ago.  It happens that their generic, chemical names all end in statin: pravastatin, lovastatin, simvastatin, atorvastatin, Brand-Xostatin... Hence, the name statins.

They were originally developed from naturally occurring chemicals, and only more recently (the mid-90's) synthetically created (Lipitor and Crestor).  Taking them reduces the production by your liver of LDL, or so-called "bad cholesterol".  The newer synthetic ones also reduce triglyceride production and increase HDL or "good cholesterol" production.

Perhaps more importantly, they turn out to have an unintended by benefical effect on reducing inflammation around cholesterol plaques and the blood vessel lining around them (the endothelium).  Lowering LDL production reduces the formation or enlargement of cholesterol plaques.  Raising HDL's actually reduces the number of cholesterol plaques in your arteries.  The statin-induced decrease in inflammation prevents cholesterol plaques from rupturing and actually causing heart attacks or strokes.

On average, you can lower LDL's through diet improvement by 7-14%, and raise HDL's through aerobic exercise by 2-3%.  I have certainly seen some patients do way better, but it's safe to say they added motivation to a lifestyle where there was lots of room for improvement.  Overall, this means most of the problems with cholesterol levels are genetic and tough to control.

As mentioned in the previous posts not everyone needs to be on a statin, and statins are not a substitute for a diet of modest amounts of meat, whole grain carbs, and plenty of fruits and vegetables and also putting in 150 minutes of cardio a week.

At the same time, there are a lot of myths and misunderstandings about statins.  I have already explained how statins work. The rest of this posting is to address what they can do for you, and their side effects (both real and putative).

Downsides:

• Can they hurt your liver? No.  This has been shown several times over the years.  Why do warnings still appear on the materials you get with the medications? Warnings are never removed.
• Can they cause severe muscle damage? Yes, but it's rare at well under 2% of the time.  (By comparison, your odds of "dying on the table" during a routine surgery is also less than 2%.) One study demonstrated occurence at a rate between 8-25 times in 10,000,000. That's mighty rare.
• Can they cause obnoxious muscle or joint pains that go away when you stop taking the statin? No?  We can't tell.  When you take a few thousand people and give half of them a statin and the other half a placebo (in which none know for sure which they are getting), 8-9% of the people on statin report this side-effect.  Thing is, exactly 8-9% of the people on the placebo report the side-effect, too.  So, either this is a side-effect that occurs in 8-9% of people, or in none.  It does demonstrate the "nocebo" effect: people are likely to experience a side-effect if they expect to.
• Otherwise, the most common side-effect is excessive flatulence (farting more than usual).  This may occur as frequently as 15% of the time, though I've never had a patient (or their spouse) comment on it. Hmm....

Upsides:

• Reduce your risk of ever having a cardiac arrest, heart attack, or stoke by nearly half.
• Also, reduce risk of Alzheimer's disease and colon cancer. (Technically these are side-effects, but we like them.)

The upshot?  Is it possible to have side-effects to a statin? Yes. Everything is possible.  However, the benefit significantly outweighs the down side. Risk of bad stuff: no higher than 8%, probably less. Risk of good stuff: 40-50%. 

Frankly, I don't prescribe medications lightly. Statins don't replace healthy eating and exercise, and not smoking.  But if you need one, taking one is a safe and effective way to prevent heart attacks and strokes.