Overview
Though side effects of statins exist, doctors prescribe them widely when they are indicated.
This is because they are very effective at lowering blood cholesterol. Having too much cholesterol in your blood increases your risk of heart attacks and strokes. Statins protect you against heart attack and stroke.
Examples of statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor) and simvastatin (Zocor, FloLipid).
Side effects of statins drugs are rare. The most common side effects include headaches, nausea, muscle, and joint aches.
Other side effects include generalized muscle pain, weakness, constipation, abdominal cramps, headache, and interference with liver function causing dark-colored urine.
Statins are effective at lowering cholesterol and protecting against heart attack and stroke, although they may lead to side effects for some people.
High blood sugar and type 2 diabetes are other possible occurrences but are rare.
On these side effects presenting themselves, you must stop statins immediately and report to your doctor who will take the necessary action. There are other choices of drugs besides statins to lower your cholesterol.
Some people have reported neurological side effects such as memory loss, which however recovers a few weeks after stopping the drug. But, this is still uncertain.
Side effects of statins
The following are the major side effects that you should not ignore.
Muscle damage
Some people on statins commonly complain of muscle pain and weakness. Statin-induced myopathy typically presents as muscle pain, weakness, and/or cramps with elevated blood creatine kinase (CK) levels (at least ten times the normal upper limit).
However, replacing the prevailing statin with another statin of a milder potency can fix this problem.
Rhabdomyolysis. Statins are known to cause a more serious form of myopathy (muscle damage). This is called rhabdomyolysis and can be life-threatening. The skeletal muscles are involved, which break down rapidly, and in the process, the muscle cells release protein myoglobin into the bloodstream.
These proteins have a toxic effect on the kidneys and can even cause them to fail. Rhabdomyolysis can even lead to permanent paralysis.
However, rhabdomyolysis is extremely rare affecting a few cases among millions, and is seen in people who take high doses of statins over prolonged periods of time.
Liver damage
Two liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may be mildly elevated due to statin therapy.
The risk of liver dysfunction is found to be highest with Fluvastatin. The higher the dose more is the risk of liver damage.
However, it is safe to continue treatment unless the rise of these enzyme levels is three times the upper limit of their normal levels. Secondly, the liver damage is not permanent, and when statins are stopped the liver values return to normal.
The American Food and Drug Administration (FDA), now recommends that liver function tests and CPK levels should be performed before starting therapy with statins and there is no need to periodically perform these tests while on statin therapy.
The reason given is that serious liver injury with statins is rare and unpredictable and there does not appear to be any advantage in the follow-up tests unless there are clinical signs of liver damage.
These signs of liver damage can include unusual weakness, loss of appetite, pain in the abdomen, dark-colored urine, or yellowing of your eyes.
Erectile dysfunction
There is a misconception that statins cause erectile dysfunction. You should know that an erection is the direct result of extra blood flow into the penis.
High LDL cholesterol levels cause the formation of cholesterol plaques (atherosclerosis) on the inner walls of the arteries reducing the arterial lumen and blood flow. This causes the erection power to reduce.
Statins reduce LDL levels and even break up the plaques, thereby increasing the blood flow. Therefore, if at all, statins improve erectile dysfunction.
Neurological side effects
There have been reports of cognitive deterioration from statin use for several years.
The reports indicate memory loss, forgetfulness, and confusion in people of all age groups. This problem is not confined to any one type but from the use of all statins.
This side effect could arise after taking statins for a day or after use for several years. However, it is rare and reversible. It disappears within a few weeks after stopping the medicine.
Furthermore, whether statins can cause dementia is still uncertain. In fact, research indicates that statin use may help to prevent Alzheimer’s disease.
Johns Hopkins researchers found that statins do not disturb short-term memory or cognition. They further added that when the drugs are taken for more than one year, the risk of dementia is reduced by 29 percent.
The FDA warns that you should not stop taking the medicines but talk to your health provider who may suggest an alternative drug besides statin.
Diabetes risk
Should you worry? Does the use of statins induce diabetes? Here’s the take.
According to the National Center for Biotechnology Information (NCBI), high-intensity statins, such as atorvastatin 80 mg and rosuvastatin 20 mg, are associated with an increased risk of diabetes.
Research indicates that statins are associated with an almost 50 percent higher risk of type 2 diabetes.
The risk with moderate-intensity statins such as atorvastatin 10 mg, simvastatin 20-40 mg, or pravastatin 40 mg does exist but it is less. This shows that the diabetes risk increased with higher doses.
Statins increase diabetes risk by raising insulin resistance and it appears that the cholesterol-lowering drugs impair the pancreas from secreting insulin.
However, weighing the pros against the cons, the impact of diabetes is not important according to NCBI. The lowered risk of cardiovascular disease by taking statins far outweighs any diabetic risk.
However, do consult your doctor for a solution. In all probability, he would want to reduce your statin dose by advising you to go stricter on your “Therapeutic Lifestyle Changes” (TLC); meaning choosing your diet very carefully, increasing your exercise intensity, and following strictly the lifestyle rules.
He will likely monitor your sugar levels closely, try to lower the statin dose, or change to a statin alternative.
Do statins cause gallstones?
Gallstones are the result of the supersaturation of the bile with cholesterol. The major component of gallstones is cholesterol.
Statins, by their cholesterol-reducing property, have a direct action on the composition of bile and prevent the formation of cholesterol gallstones.
They reduce the cholesterol saturation of bile thereby preventing the formation of gallstones and even dissolving any existing ones.
People on statins have an 11% to 24% decreased risk of developing gallstones. Therefore, it will be wrong to say that the use of statins leads to gallstone formation.
Precaution: Statins and grapefruit
There is one precaution to take when on statins. Avoid taking grapefruit because it reduces the efficacy of the drug.
Grapefruit juice deactivates an enzyme in the liver, which is responsible for metabolizing statins. As a result, statins accumulate in the blood and can cause statin toxicity.
Avoid alcohol too, while on statins as there can be liver problems, and alcohol will only worsen or augment this problem.
Kidney and liver function tests have to be carried out before starting statins and then periodically when taking statins.
Who’s at risk of developing statin side effects?
Not everybody who takes statins develops side effects. Some people with certain characteristics are at a greater risk than others.
For example
- Those taking multiple medicines for their raised cholesterol
- Being of the female gender
- Those with a smaller body frame
- Being above the age of 80 years
- Those with kidney or liver disease
- Those who drink too much alcohol
- Those with certain conditions such as hypothyroidism or neuromuscular disorders.