Question from a patient about statin side effects.
I frequently get questions from patients from outside my practice who write because they learn of my research interests in exercise, heart disease prevention, cholesterol metabolism, and the muscle side effects of statins. I am going to post some of these and my response on this blog. Here is one of those interactions.
Question — In your practice, how common do you see your patients on statins have side effects?
My response — I run a specialty clinic that specifically sees patients with statin problems, so I see a lot of such patients. Our studies suggest that about 5% of people treated with HIGH dose statins (80 mg of atorvastatin) develop muscle discomfort. Actually, in our study of 420 people randomly assigned to atorvastatin 80 or to placebo, 10% of atorvastatin and 5% of placebo patients developed pain, so about 10% of people develop pain, but we think oonly about 5% have pain due to the statin. (See -Effect of statins on skeletal muscle function. Parker BA, Capizzi JA, Grimaldi AS, Clarkson PM, Cole SM, Keadle J, Chipkin S, Pescatello LS, Simpson K, White CM, Thompson PD. Circulation. 2013 Jan 1;127(1):96–103.. Epub 2012 Nov 26).
Question — Common side effects are muscle pain and diabetes. Have you seen other side effects? —
My Response- Diabetes does occur with statin use but is very rare, especially in people who do not have risk factors for diabetes. Also it is important to remember that in the Jupiter study, the study that showed an increased risk of diabetes, out of almost 8800 people in each of the rosuvastatin and placebo group, that they were only 54 more new diabetics with rosuvastatin but there are 134 fewer cardiac events. Also, the Jupiter study selected people who had a CRP above 2, and elevated CRPs are a risk factor for diabetes. Nevertheless there is for sure a slight increase in diabetes risk with statin therapy. (See — Statin-Associated Side Effects. Thompson PD, Panza G, Zaleski A, Taylor B.J Am Coll Cardiol. 2016 May 24;67(20):2395–2410. & What to Believe and Do About Statin-Associated Adverse Effects. Thompson PD. JAMA. 2016 Nov 15;316(19):1969–1970. Erratum in: JAMA. 2017 Jan 3;317(1):90. )
Other side effects that have been reported with statins include sleep problems, depression, elevated liver function tests, tendon rupture, hemorrhagic stroke, interstitial lung disease, and lower testosterone levels. Tendon rupture and hemorrhagic stroke are probably true, but not certain. Liver function changes are usually temporary. The others are very hard to prove. Slightly lower average testosterone levels have been reported, but the fact that the average is down means that some people may have larger testosterone reductions. I really do not know of good studies on that.
Question — If a patient on statins has LFT (liver function test) blood test every year and the result is normal, does that mean the statin did NOT injured or damaged the liver? Put it other way, can statin still hurt the liver while the blood test of LFT is normal?
My Response — -Statins almost never hurt the liver. They often cause slight elevations in liver function tests but this is often transient and goes away despite continuing the drug in about 12 weeks. I do not stop a statin unless the liver function tests go to 3 times the upper limits of normal as long as the patient is feeling well and needs the drug. If the liver function tests are normal that means that the liver has not been injured, but it rarely is injured with statins. .
