• Statin Drugs: Not Just for High Cholesterol?

    IMAGEHeart disease is the leading cause of death in the US, and cholesterol plays a major role in the development of heart disease. Fortunately, statin drugs are helping many people control their cholesterol.
    Research has also shown that statins may reduce the incidence of heart attack , stroke , and death in people without cardiovascular disease. But statins may also cause serious problems for some patients; while diet and exercise, can lead to health benefits without potential statin risks.

    How Do Statins Work?

    Statins have been used primarily to treat high cholesterol. High levels of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) especially when accompanied by low levels of high-density lipoprotein (HDL) cholesterol (the "good" kind) can lead to atherosclerosis (clogged arteries), which can then lead to heart failure and heart attacks. And, atherosclerosis can also contribute to strokes, explains Jacques Carter, MD, MPH, of Boston's Beth Israel Deaconess Medical Center.
    Statin drugs, like atorvastatin (Lipitor), pravastatin (Pravachol), simvastatin (Zocor), work by inhibiting a liver enzyme that is involved in the production of cholesterol. They are most effective at lowering levels of LDL cholesterol and may also contribute to increasing levels of HDL cholesterol.
    Statins have become a popular choice to treat cholesterol problems because they are effective and generally well-tolerated.

    What Are the Health Benefits?

    Researchers have investigated the potential health benefits of taking statins. There is evidence that statins may reduce the risk of:
    • Heart attack and death in people with heart disease (those with or without high cholesterol)
    • Cardiovascular events (including stroke) and death in people who are at high risk of developing cardiovascular disease
    • Heart attack, stroke, and death in people with elevated levels of C-reactive protein (a sign of inflammation in the body)
    • Heart events (eg, heart attack) in women who have cardiovascular disease
    • Need for revascularization (surgery to improve blood flow to the heart) and unstable angina in women
    • Cardiovascular events in people aged 70 years and older who have elevated levels of C-reactive protein
    Statins may also help lower blood pressure.

    What Are the Risks?

    If your doctor prescribes statins, some common side effects that you may have include:
    Serious possible side effects include:
    • Memory loss and confusion
    • Increased blood sugar levels
    • Liver damage—Taking statins can lead to changes in liver enzymes and occasionally liver damage. Because of this, your doctor may test your blood while you are taking statins.
    • Muscle pain or weakness—Some people who take statins develop myopathy (muscular disease). With severe cases, your body may release the protein myoglobin, which can damage the kidneys.
    • Cancer—There is some evidence that statins may increase the risk of cancer in older people. But, this is an area that needs to be researched more.
    If you have cholesterol problems, your doctor may recommend that you take statins. Be sure to discuss your medical history and any concerns that you may have about taking this kind of medicine. Keep in mind, too, that a healthier lifestyle depends on more than just taking statins. Your doctor will most likely recommend that you make lifestyle changes that include eating a healthier diet and exercising more.

    RESOURCES

    Heart Information Network http://www.heartinfo.org/

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/

    CANADIAN RESOURCES

    Health Heart.org http://www.health-heart.org/

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/

    References

    Baigent C, Keech A, Kearney PM, et al. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267-1278.

    Chan KA, Andrade SE, et al. Inhibitors of hydroxymethylglutaryl-coenzyme A reductase and risk of fracture among older women. Lancet. 2000;355:2185-2188.

    Jick H, Zomberg GL, Jick SS, et al. Statins and the risk of dementia. Lancet. 2000;356:1627-1631.

    Ichihara A, Hayashi M, Ryuzaki M, et al. Fluvastatin prevents development of arterial stiffness in haemodialysis patients with type 2 diabetes mellitus. Nephrol Dial Transplant. 2002; 17:1513.

    Douglas K, O'Malley PG, Jackson JL. Meta-analysis: the effect of statins on albuminuria. Ann Intern Med. 2006; 145:117.

    DynaMed Editorial Team. Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated March 29, 2011. Accessed April 19, 2011.

    DynaMed Editorial Team. Statins: overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated March 29, 2011. Accessed April 19, 2011.

    DynaMed Editorial Team. Statins and cancer risk: overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 18, 2010. Accessed April 19, 2011.

    DynaMed Editorial Team. Statins for prevention of cardiovascular disease: overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated March 25, 2011. Accessed April 19, 2011.

    Kshirsagar AV, Shoham DA, Bang H, et al. The effect of cholesterol reduction with cholestyramine on renal function. Am J Kidney Dis. 2005; 46:812.

    Friis S, Poulsen AH, Johnsen SP, et al. Cancer risk among statin users: a population-based cohort study. Int J Cancer. 2005; 114:643.

    Graaf MR, Beiderbeck AB, Egberts AC, et al. The risk of cancer in users of statins. J Clin Oncol. 2004; 22:2388.

    Gaist D, Jeppesen U, Andersen M, et al. Statins and risk of polyneuropathy: a case-control study. Neurology. 2002; 58:1333.

    Wegman S, deVries F, Leufkens B, et al. Use of statins and risk of fractures. JAMA. 2001;285:1850-1855.

    Wolozin B, Kellman W, Rousseau P, et al. Decreased prevalence of Alzheimer's disease associated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Arch Neurol. 2000;57:1439-1443.

    1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol. 2008;52:1769-1781.

    3/6/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA announces safety changes in labeling for some cholesterol-lowering drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm293623.htm. Published February 28, 2012. Accessed March 6, 2012.

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