The Sunday Leader

Dilemma of STATINS

By Dr Harold Gunatillake
Health Writer

Can you find a person not taking statins in any part of the world today? Even the domestics in Sri Lanka are on statins prescribed by their GPs, draining half their monthly salaries on the drug. Some labels of statins manufactured in the US, one tablet may be more than the price of a packet of rice and curry. If you have got high cholesterol – good or bad, doctors now advise you to take statins specially if you are 40 and over. Even if you suffer from side effects the doctors advise you to continue, assuming that the side effects will subside. My wife could not get up from bed one morning, could not walk, crying, ”I am going to die”. I stopped the statin she was on, and next day she was back to normal.

The sales of statins are growing in leaps and bounds, but more and more people around the world are getting more cardiovascular disease including stroke. Most people getting heart attacks have been on statins for years, but the incidence of MI has not dropped. The doctors may say that statins have brought down the incidence of heart attacks, then why long waiting lists in private and public hospitals for open heart surgery and ballooning and stenting?

Low levels of HDL cholesterol, even among statin-treated patients, are associated with a significantly high increased risk of cardiovascular disease, particularly the risk of MI, new studies have shown. Patients are made to feel by lowering the LDL cholesterol level in blood with statins, removes their cardiovascular risk.

Statins taken daily can bring down the LDL cholesterol by 50% or more, but may not increase the “good” HDL cholesterol, though stated that it boosts the “good” cholesterol by up to 15%. In most cases though the total lipid content drops, including LDL cholesterol, with daily statin intake, it seems, it has noeffect on triglycerides and HDL “good” cholesterol. Most studies reveal lower the HDL-cholesterol level, the higher the cardiovascular disease risk.


Statin and muscular-skeletal injury

The use of statins appears to be associated with an increased risk of musculoskeletal injuries, including an increased risk of dislocations, strains, and sprains, according to a new analysis. Researchers suggest the full range of musculoskeletal adverse events might not be fully known and that further studies are needed, especially in active individuals.

“These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated,” report Dr Ishak Mansi (VA North Texas Health Care System, Dallas) and colleagues in a paper published online June 3, 2013 in the Journal of the American Medical Association: Internal Medicine. “Moreover, the numbers needed to be exposed for one additional person to be harmed were 37 to 58 individuals for various outcomes.” The study included 6967 statin users propensity-matched with 6967 nonusers. Of the statin users, the majority was treated with simvastatin (73.5%) and approximately one-third had been prescribed maximum doses of the drugs, including simvastatin 80 mg, atorvastatin 80 mg, or rosuvastatin (Crestor, AstraZeneca) 40 mg. Simvastatin 80 mg is currently restricted on the US market because of concerns about muscle damage.


Statins and older women

Use of cholesterol-lowering statin drugs may be associated with an increased risk of diabetes in middle-aged and older women, a new study suggests. Experts say the evidence as a whole suggests that the risks are slight and that for most women who take statins, the benefits for preventing heart attack and stroke outweigh those risks.

Researchers analyzed data on nearly 154,000 women followed for an average of seven years.

Women who reported taking a statin such as Lipitor, Pravachol, Zocor, or other statin drugs were almost 50% more likely to report developing type 2 diabetes than women who did not take statins, according to study researcher Yunsheng Ma, MD, PhD, MPH, of the University of Massachusetts Medical School.


Statins and kidney problems

Taking strong doses of simvastatin, atorvastatin or rosuvastatin increases the risk of being hospitalised with a condition called acute kidney injury, or AKI, by 34 per cent on average, found the Canadian team.

AKI occurs when the kidneys “suddenly fail to work as they should”, according to the Kidney Alliance, and it causes anywhere between 62,000 and 210,000 deaths a year in Britain. It is more common in those with long-term health conditions like heart failure, diabetes and chronic kidney disease. Between five and seven million people take cholesterol-lowering statins in Britain, mostly over 60. The vast majority take simvastatin, the cheapest type, although some take others including atorvastatin, better known by its brand name Lipitor, and rosuvastatin, sold as Crestor. These latter two are more potent, requiring smaller doses for the same effect. Researchers at the Lady Davis Institute for Medical Research in Quebec defined high-doses as 40mg+ for simvastatin, 20mg+ for atorvastatin, and 10mg+ for rosuvastatin. After analysing the health records of two million Canadians, they found that among people without chronic kidney disease, those taking high-dose statins were at a 34 per cent increased risk of hospitalisation for AKI, compared to those taking low-dose statins.

Although this figure related to the first 120 days of treatment, the researchers said the increased risk seemed to last for two years. Rates were not significantly increased in those who had chronic kidney disease. Their study is published in the online edition of the British Medical Journal.


Statin and other drugs

Doctors now seem to reduce the daily dosage of statins due to fear over side effects, it has emerged. Medicines regulators have warned that patients taking simvastatin at the same time as other drugs used to reduce high blood pressure are likely to suffer more aches and pains. Around 2.9m prescriptions for simvastatin 40mg dose were issued by GPs in England last year. Statins can reduce the level of bad cholesterol in the blood to lower the risk of a heart attack in people at high risk. They have been hailed as a wonder drug that everyone over 50 should be taking but there have also been concerns raised about side effects.

The MHRA has produced a patient leaflet for the first time to inform people of the changes being made. Sir Rory Collins, of Oxford University, said taking cholesterol-lowering statins before warning signs start to appear could provide much more protection from heart attacks or stroke.

He accused medical regulators of overstating the possible side effects of statins, the majority of which have not been borne out in clinical trials, because it could encourage them to stop taking the medication and put their health at risk.

He disputed claims that statins can cause sleep disturbances, memory loss, sexual dysfunction, depression, lung disease, cataracts, diabetes, memory loss and confusion. The only side effect proven by experiments is a very low risk of myopathy – a condition which causes muscles to weaken – which is easily outweighed by the benefit to the heart of taking the drugs, Sir Rory said.

Sir Rory said current guidelines on statin use should be scrapped and patients encourage to use  the medication earlier. He was speaking after his keynote lecture at the European Society of Cardiology’s annual congress in Munich yesterday.


Exercise Vs statins

Brisk walking and cycling can be more effective at reducing the chances of dying prematurely than being unfit and taking statins, a study has found. Researchers compared fitness levels in 10,000 middle aged people who were taking statins against those not taking statins.

The fittest people who were not taking statins were 50 per cent less likely to die over the next ten years than the unfit test who were on the drugs, the study found. The findings highlight the importance of moderate exercise and the scale of the health benefits achievable through staying active, the researchers said. Exercising is cheaper and has fewer side effects than taking drugs, experts said. Brisk walking or cycling for 150 minutes a week was enough to class someone as highly fit in this study of people with high cholesterol levels, the authors said.


Statins and fatigue

Statins can cause tiredness in many people, according to medics who say doctors should take more account of possible side-effects when deciding whether to prescribe the cholesterol-lowering drugs. The drugs are taken by about five million people in Britain deemed to be at higher risk of heart attacks. Some scientists say they should be prescribed by four times that number.

However, academics found four in 10 women on a cheap form of statin called simvastatin reported that they had lower energy levels or exercise fatigue, six months after being put on the drug. A tenth said they were “much worse” on both measures, according to a study of more than 1,000 people, none of them had a history of heart disease.

The volunteers were randomly assigned either a 20mg daily dose of simvastatin; 40mg of pravastatin – another drug widely prescribed on the NHS – or a placebo ‘dummy pill’. Dr Beatrice Golomb, associate professor of medicine at the University of California, San Diego, said: “Side effects of statins generally rise with increasing dose, and these doses were modest by current standards


Statins and Glaucoma

Dr Joshua Stein, of Michigan University, said: “Statins’ apparent ability to reduce glaucoma risk may be due to several factors, including improved blood flow to the optic nerve and retinal nerve cells and enhanced outflow of the aqueous fluid, which may reduce intraocular pressure.

“While more research is needed, we hope our results may contribute to saving the sight of thousands who are predisposed to glaucoma.” But David Wright, chief executive of the International Glaucoma Association, warned the study far from proved statins lowered the risk. Strict randomized controlled trials were needed to test the theory, he said. “I’d love it to be the case, but we can’t say statins do lower the chance of glaucoma at the moment,” he concluded.

This article on statins prescribed by doctors to reduce serum cholesterol levels benefits to reduce risk factors for heart disease, stroke and others. At the same time, the fear of taking statins for long periods causing side effects also need to be evaluated. Readers of this article should discuss with their doctors, if they have any problems with statins.

We advise- exercise daily, enjoying a Mediterranean type of diet with plenty of fruits, vegetables, nuts and fish that would suffice to lower your blood cholesterol levels to normal range. Avoid eating in restaurants, and stick to home cooked food.


1 Comment for “Dilemma of STATINS”

  1. moy peralta

    Statins and the wilful destruction of the patient:

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