If ever a type of medication could be called miracle drugs, statins fit
the bill. These cholesterol-lowering powerhouses lower total cholesterol
and LDL levels, which, in at-risk patients, significantly reduces the
risk of heart attack and stroke. Recent research shows that if a patient presents other risk factors for heart disease but has normal cholesterol levels, statins still can reduce heart attack risk. Claims also have been made that statins reduce the risk of Alzheimer’s disease and even some cancers.
Unfortunately, side effects with statins are common. As many as 10 percent of patients are unable to tolerate statins because of muscle inflammation (myopathy) that results in pain that is most severe in the arms, legs and shoulders. Muscle pain is usually mild, but severe muscle breakdown, called rhabdomyolysis, occasionally occurs. This can lead to severe kidney failure and death. Frequently, patients taking statins develop neuropathy, in which damage occurs to nerves, affecting the upper and lower limbs. Neuropathy also can cause numbness, tingling and difficulties with gait and balance.
Damage to the liver, as evidenced by abnormalities in liver function tests, is the other major side effect of statins. Liver damage occurs in 1 percent to 2 percent of patients taking the drugs. If abnormalities are minimal and do not increase over time, many experts believe that treatment with statins can be continued. However, if damage is considerable or if the abnormalities increase over time, use of the drugs must be stopped.
The risks of liver abnormalities are increased if other cholesterol-lowering drugs, such as gemfibrozil (Lopid), or therapeutic doses of niacin are prescribed in combination with statin therapy. Because abnormalities can be asymptomatic, liver function tests must be measured six weeks after a patient starts taking a statin.
Although statins appear to reduce the risk of Alzheimer’s disease, some patients taking these drugs complain of memory loss. In some cases, mood swings; behavioral problems and depression also have been reported. Rare but significant side effects include insomnia, indigestion, heartburn and constipation.
Side effects are more common in women, small-framed individuals, those taking multiple medications, diabetics and patients older than 65. If side effects develop in a patient taking statins, alternative approaches can be tried. More powerful statins given in lower doses either daily or every few days can be as effective in lowering cholesterol without side effects. Although much more expensive, rosuvastatin (Crestor) can be given at a dose of 2.5 milligrams either daily or two or three times weekly and can lead to adequate lowering of cholesterol. There is also some evidence that the addition of the dietary supplement coenzyme Q10 may reduce or prevent side effects caused by statins.
If changes in medication strength don’t relieve symptoms, other approaches can be tried. More intensive diet control and exercise may lead to a reduction in cholesterol, but other medications usually are required. Currently, the most frequently employed alternative drugs impair cholesterol absorption from the bowels. The most frequently prescribed is ezetimibe (Zetia), which has been shown to lower cholesterol levels, but not to reduce the risk of heart attack and stroke. Zetia also has been shown to cause myopathy and muscle pains.
Another alternative is cholestyramine (Questran), which is taken as a powder dissolved in water. Not without side effects, cholestyramine causes constipation. A dietary supplement, red yeast rice, has been recommended for many years as an alternative and natural therapy to lower LDL levels. In an article published in the Annals of Internal Medicine, 31 patients who were unable to tolerate statins received 1,800 milligrams of red yeast rice twice daily, and another 31 patients received placebos. This dose of the supplement resulted in therapeutically significant declines in total cholesterol and LDL levels with no muscle or liver side effects.