Are doctors minimizing side effects of statins?

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Are

doctors minimizing side effects of statins? UCSD researcher's report

suggests some downplayed

By Keith Darcé <http://www3.signonsandiego.com/staff/keith-darce/>

(Contact<http://www3.signonsandiego.com/staff/keith-darce/contact/>)

 

Union-Tribune Staff Writer

 

2:00 a.m. January 28, 2009

Statin facts

 

Class of prescription drugs used mainly to lower levels of LDL

cholesterol, which contributes to heart disease by causing plaque buildup in

arteries.

 

Include lovastatin (brand name Mevacor), simvastatin (Zocor), pravastatin

(Pravachol), fluvastatin (Lescol), atorvastatin (Lipitor) and rosuvastatin

(Crestor).

 

Generated worldwide sales of more than $25 billion last year.

 

Side effects include muscle soreness or pain, tendon problems, cognitive

impairment, liver disease, diarrhea and nausea.

 

SOURCE: U-T research

 

Doctors who prescribe an increasingly popular family of drugs to prevent

strokes and heart attacks may be downplaying the wide range of side effects,

said a UCSD researcher who helped analyze nearly 900 studies of

cholesterol-lowering statins.

 

Physicians who fail to recognize those complications – willfully or through

ignorance – could put patients at risk of developing more serious health

problems, according to the review, published yesterday by the American

Journal of Cardiovascular Drugs.

 

Memory loss, insomnia, numbness in the fingers and toes, sexual dysfunction,

weight gain, vision impairment and several dozen other conditions that

surfaced in the studies are rarely blamed on statins when they occur outside

clinical trials, the report said.

 

Muscle and liver damage are the best-known side effects. But even then, too

many doctors dismiss muscle soreness, pain and weakness as symptoms linked

to other factors such as aging, the review concluded.

 

" Unfortunately, physicians who aren't aware of a problem with a drug often

won't consider that drug when the problem arises, " said Dr. Beatrice Golomb,

a widely cited statin expert and an associate professor of medicine at the

University of California San Diego.

 

Golomb urged patients and doctors to look more closely at the list of

possible side effects for statins, which include Lescol, Pravachol, Zocor

and Lipitor.

 

" They should familiarize themselves with (it) so they can make appropriate

treatment decisions, " she said.

 

Golomb co-wrote the report with UCSD undergraduate student Marcella Evans,

who is now enrolled in UC Irvine's Medical Scientist Training Program.

 

Statins are one of the most well-received groups of drugs in developed

countries, with hundreds of millions of prescriptions written annually.

Worldwide sales of the medications – the bulk of which occur in the United

States – totaled more than $25 billion last year, according to

pharmaceutical industry associations.

 

Researchers consistently have shown that statins can lower levels of LDL

cholesterol, which causes plaque buildup in the arteries, by 20 percent to

60 percent while helping to increase levels of beneficial HDL cholesterol.

 

Formation of plaque can lead to heart attacks and strokes. About 1.3 million

Americans will have a heart attack this year, and about 700,000 will suffer

a stroke, according to the American Heart Association. More than 450,000

people will die from heart disease in that time, while at least 150,000 will

die from stroke.

 

A major study last year also found that Crestor, a powerful statin, also can

significantly reduce the risk of heart attack in people with normal levels

of LDL cholesterol but high counts of a protein that causes inflammation.

 

More doctors have become enthusiastic about statins after seeing

overwhelming evidence of their benefits and reading a growing body of

research that sets ever-stricter targets for what are considered to be

healthy levels of LDL cholesterol. They're prescribing the drugs to a wider

range of patients – and in higher doses.

 

That means the number of reported side effects – even for rare conditions –

probably will rise in the future, Golomb and Evans said.

 

Not all health providers share their concerns.

 

Dr. Alfred Bove, chief cardiologist at Temple University Hospital in

Philadelphia and president-elect of the American College of Cardiology, said

many of the side effects documented in the report surfaced in research

involving small groups of patients. He also said some of those findings have

been challenged by other studies that failed to produce similar results.

 

Doctors worry that if they talk too much about potential side effects, their

patients might have second thoughts about the drugs, Bove said.

 

" My statement to my patients is, 'Live until you're 80 and have muscle aches

sometimes,' " he said. " If I were to list all of these things, nobody would

want to take a statin. "

 

Dr. Mark Hlatky, a professor of health research and cardiovascular medicine

at Stanford University, said the report should trigger more interest in

finding ways to prevent or treat statins' side effects. But he said patients

taking the drugs shouldn't let the new concerns become reasons for going off

the medication.

 

" Many people taking statins need to take them. If they give up on them too

soon, that's not good either, " Hlatky said. " If they feel like they're

having a side effect, they should talk to their doctor. "

 

The extensive review of research literature by Golomb and Evans turned up a

number of characteristics associated with statin complications, including

being female, elderly, obese, an alcoholic or a diabetic.

 

Such risk factors and many of the side effects were tied to a single process

triggered by statins, one that damages the body's ability to deliver energy

to muscles and the brain, the UCSD report said.

 

In that process, statins interfere with the production of coenzyme Q10, a

compound central to the production of energy within mitochondria, the power

plants of cells.

 

Those findings have prompted some doctors to treat statin complications with

coenzyme Q10, Bove said.

 

Physicians also relieve statin-related muscle aches with tonic water that

contains quinine, a naturally occurring substance that has anti-inflammatory

properties.

 

Bove said he tells patients who are on statins to drink half a cup of tonic

water when they experience soreness