Many people stop taking cholesterol-lowering statins due to muscle pain or nausea, but most people are able to resume taking a different type of the same drug.
Statins are among the most prescribed medications in the U.S., with one in four Americans over age 45 years relying on the drugs to lower cholesterol, according to the latest government statistics. But recent reports about their side effects, including serious muscle weakness, memory loss and an increased risk of diabetes, prompted many to discontinue the medications, at least temporarily.
In a study of more than 107,835 patients prescribed statins between 2000 and 2008, about 20% reported experiencing a side effect such as muscle pain or nausea related to the drugs, and about half of these patients stopped taking the statin. But more than 90% of these patients who started taking statins again, often turning to a different version of the drug, were able to tolerate the medications the second time around.
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Published in the Annals of Internal Medicine, the findings encourage both patients and physicians to consider restarting statin therapy, even if side effects lead them to stop for a brief period of time. A previous investigation of how discontinuing statin therapy could affect patients wasn’t so optimistic; in 2006 researchers reported at the annual meeting of the American College of Cardiology that patients who stopped taking their statins saw an increase in their LDL cholesterol and inflammation levels, both of which increase the risk for heart disease.
That study, however, involved a relatively small number of patients — 566 — so Dr. Alex Turchin, of the Division of Endocrinology at Brigham and Women’s Hospital and his colleagues set out to study the effect in a larger group of people. “There’s the dichotomy of what we see in the front-lines of routine clinical care and what’s coming out of clinical trials,” says Turchin, the study’s senior author. “In routine clinical care, we hear all the time from doctors or patients that they develop side effects to statins and that they have to stop statins. On the other hand, if you look at data from clinical trials, which compare statins to placebos, the incidence of side effects is almost the same between the statins and the placebo. So there was this discrepancy between the anecdotal experience and rigorously done studies. We wanted to do a more quantitative study to see what is actually going on.”
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Turchin and his team reviewed medical records and doctors’ notes of the study participants from two different Boston hospitals. The majority who stopped using statins due to minor side effects were prescribed the drugs again within a year, and over 90% were still taking the statins within the year after they reported quitting. Some were taking the same statin, and others were taking a different type or at a different dosage.
The results suggest that the side effects may be tolerable, or, by switching to another brand or dose of statin, even avoidable. The findings underscore the importance of balancing the benefits and risks of the medications; most studies show that the ability to control cholesterol and inflammation in heart patients outweighs the adverse effects of the drugs. “Statins are one of the few classes of medications that we actually know save lives. There have been many studies that showed statins decrease all-cause mortality in both patients with a high-risk of heart disease and individuals who just have high cholesterol with no known heart disease,” says Turchin. “This has not been unequivocally shown for other cholesterol lowering medications; just for statins. Generally there are not many medications out there which we can reliably say they save lives.”
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The study should reassure patients who want to take advantage of the cholesterol-lowering and inflammation-controlling benefits of statins but are concerned about side effects; if one statin produces too many adverse events, then they should talk to their doctor about their complaints and consider switching to another statin, says Turchin. “Many patients can actually tolerate these literally life-saving drugs even if they may have had a side effect to one of them if [they] try a new version or a lower dose,” he says. Such discussions are crucial if patients want to improve their heart health but protect themselves from some of the potential risks associated with these medications. And researchers say that as useful as medications like statins are in extending lives and lowering risk of heart disease, they’re even more effective when combined with a healthy diet and regular exercise.