Statins as a drug class are generally safe and widely used to treat hyperlipidemia. They have proven effective in lowering cholesterol levels and reducing the risk of recurrent cardiovascular events in patients at risk.
There are also some concerns about side effects in this group of medications, including risks of muscle problems, hepatotoxicity, diabetes, cancer, and others. A fair amount of anti-statin commentary can be found on the internet, with individuals opining that statins cause more harm than good. Our patients may be influenced by these views, and some patients who could benefit from statins are reluctant to take them because of concerns about the problems these drugs cause.
Fortunately, science can often help sort out truth from fiction. In this vein, a recent article in Circulation: Cardiovascular Quality and Outcomes should be reassuring. The authors, from London, Rotterdam, and Bristol, scoured a number of online databases to find high-quality studies on statins published between 1985 and 2013. They identified 135 studies which encompassed a quarter of a million people. The authors focused on problems caused by statin treatment, and did not look at efficacy of the medications. Some key findings:
- As a group, statins are generally safe, though there are differences among the statins as far as side effects.
- As a group, statins increase the risk of diabetes by 10%.
- As a group, statins create a minimal risk of muscle enzyme elevations (present in 0.6% of all treated patients) and a minimal risk of myalgias.
- Meaningful transaminase elevations occurred in 1% of all statin-treated patients.
- There was no increase in cancer among statin-treated patients.
- Higher statin doses were correlated with a higher risk of side effects.
- Two statins emerged as safer than the others. Simvastatin and pravastatin had lower risks of all side effects than atorvastatin, rosuvastatin, pitavastatin, and fluvastatin. Lovastatin came in right behind simvastatin and pravastatin in its safety profile.
Certainly questions remain about when to use statins. Their use in secondary prevention is much more established than their use in primary prevention. In any individual patient, a statin might cause significant side effects. Of course, in any individual patient, leaving an elevated LDL untreated can also cause side effects. We clinicians always need to look at the risks of benefits of our treatment plans as they apply to each individual patient.
While not resolving every issue, this study does provide scientific evidence that statins as a drug class are generally very safe, and that within the drug class itself, two agents stand out with a lower risk of side effects. Those two statins, by the way, are on the PHC formulary.
Richard Fleming, MD
Naci, H,; Brugts, J.; Ades, T.; Circulation: Cardiovascular Quality and Outcomes, July 2013. (http://circoutcomes.ahajournals.org/content/early/2013/07/09/CIRCOUTCOMES.111.000071.full.pdf)