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Statins and their side effects

by Harvard Health Publications
May 13, 2008 02:54 PM EDT (Updated: May 13, 2008 02:56 PM EDT)
Statins (Lipitor, Zocor, other brands) are today's wonder drugs. Developed to lower "bad" LDL cholesterol, they've turned out to have a variety of anti-inflammatory effects as well. Because inflammation seems to be at the root of so many health conditions — cardiovascular disease included — statins may eventually be used to treat a range of conditions, from Alzheimer's disease and multiple sclerosis to lupus and rheumatoid arthritis.

Moreover, studies are showing that high doses of statins (80 milligrams in some studies) may have added benefits for some people. Current guidelines encourage high doses to drive LDL cholesterol to lower levels than had been previously recommended. In addition, there is some evidence that high doses may be beneficial even if LDL target levels can be reached with a lower dose.

Statins are beginning to seem like the drug that just keeps on giving, offering ever more benefits at higher doses. Some wonder if they might be another bubble waiting to burst as a result of bad news about unanticipated side effects, like the COX-2 inhibitors. Most experts, though, don't share those misgivings, pointing both to safety data from clinical trials and a track record from millions of people taking the drugs for years.

Effects on the liver
Still, there are side effects. Liver problems have been a concern. Like many drugs, statins are metabolized in the liver. Moreover, they work by blocking a cholesterol-generating enzyme in the liver.

Serious liver problems have been extremely rare. In the most recent study of high-dose (80 mg) atorvastatin (Lipitor), people on the high dose were more likely to have elevated levels of enzymes that sometimes indicate liver problems, but the number affected was quite low (60 out of 4,995 — or 1.2%). Liver enzyme increases are usually temporary and will go away when the dose is lowered or the medication stopped.

Muscle aches
Muscle problems are a well-known side effect. At the extreme are cases of complete muscle breakdown, or rhabdomyolysis, which can be life-threatening. Cerivastatin (Baycol) was withdrawn from the market in 2001 after being linked to cases of fatal rhabdomyolysis. Many more people experience milder muscle problems, or myalgias, and muscle weakness. Practicing doctors see more cases of statin-related muscle problems than would be expected from clinical trial results. It's possible some people blame the medications for problems completely unrelated to the drugs.

Coenzyme Q10
Coenzyme Q10 (also known as CoQ10, ubiquinone, and ubidecarenone) is a fat-soluble compound that exists in the body naturally. It is essential to the synthesis of ATP, a compound that is the primary source of energy for muscle and other cells. Sold as an over-the-counter dietary supplement in 50-to 100-mg pills, it's promoted as an energy booster, antioxidant, and general pick-me-up for the immune system.

Coenzyme Q10 has been tested as a remedy for everything from periodontal disease to chronic fatigue syndrome to Parkinson's disease. Some preliminary studies suggest that it might help heart failure patients and other people with damaged heart muscle. Researchers have also investigated whether it might reduce the side effects from cancer treatments.

No one knows for certain why statins cause muscle problems. But there is evidence that they suppress coenzyme Q10 levels, thereby interfering with ATP and robbing muscle cells of their energy source. Supplemental coenzyme Q10 may help muscles offset this series of unfortunate events.

Whiff of proof
Doctors have published case reports about patients with serious muscle problems whose condition improved when they quit taking a statin and started taking coenzyme Q10. Of course it's hard to know which made the difference, quitting the statin or taking the coenzyme Q10. A handful of small clinical trials suggest — but no more than that — positive effects. Results of a study presented at a meeting of the American College of Cardiology in March 2005 drew some attention. The randomized, double-blind trial included 41 people who had muscle pain while taking statins. Half took 400 IU of vitamin E daily; the others took 100 mg of coenzyme Q10. After a month, 18 of the 21 taking coenzyme Q10 said their pain symptoms improved, compared with just 3 of the 20 taking vitamin E. Still, this is a small, short study. More research is needed before coenzyme Q10 can be recommended.

So the bottom line is…
Dietary changes, such as cutting back on saturated fat, and exercise will lower cholesterol levels. Don't give up on them too soon.

If you're taking a statin that seems to be causing side effects, you need to bring that to your doctor's attention right away. If you're interested in trying coenzyme Q10, you should discuss that with your doctor as well. Daily doses up to 200 mg appear to be relatively safe.

The bottom, bottom line: Because statins are so important in preventing heart attacks in some people, it's critical that you and your doctor work together if side effects are a problem. That way you can make sure you're getting the best and safest treatment.

High Cholesterol
High cholesterol is a major contributor to heart disease, but how can you tell how much cholesterol is too much? What is the difference between "good" and "bad" cholesterol, and how can you achieve a healthy level of each? What to do about High Cholesterol is a special report from Harvard Medical School that gives you a step-by-step plan to set and reach your own cholesterol-level goal. Get tips on diet and exercise, medication options, and everything else you need to start lowering your cholesterol today.

http://www.gather.com:80/viewArticle...nav=Groupspace

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