News
ENLARGE
In my previous columns I talked about drugs currently available for the treatment of high cholesterol. I will talk about the statins in this column. Mevacor (lovastatin - 50 cents/pill), Pravachol (pravastatin - 39 cents/pill), Lescol (fluvastatin - 2.45 / pill), Zocor (simvastatin - 19 cents / pill), Lipitor (atorvastatin 3.80 / pill), Crestor (rosuvastatin - 3.20 / pill) are the statin drugs currently available in the United States. Lovastatin, pravastatin, and simvastatin are available in generic form and are cheaper (all prices are from Costco for roughly equivalent doses).
The statin drugs are the only drug class with data in both primary and secondary prevention of heart attack and stroke. Primary prevention refers to preventing heart attack and stroke in people who have not had a heart attack or stroke. Secondary prevention refers to preventing another heart attack or stroke in people who have had a heart attack or stroke. Statin drugs also have good data for mortality.
They are appropriate first-line treatment for all patients who can tolerate them who have cholesterol problems. Statins have effects on heart disease and stroke that exceed their ability to lower cholesterol. In other words, you can get to the same LDL and HDL levels with other drugs, but you will do better on a statin all things being equal. This is because they seem to do something very important besides lower cholesterol Ð they make cholesterol plaques less likely to rupture and therefore less likely to harm you.
This is the key point in treating cholesterol. High cholesterol is a problem because it causes plaques in the arteries that eventually cause blocked arteries that then cause heart attack or stroke. If a drug lowers cholesterol but doesn't affect the plaques, it may not do you any good.
Before I am accused of being paid off by the pharmaceutical manufacturers, let me point out that I receive no compensation from any drug company and do not knowingly hold any stock in any of them. I have pointed out in prior columns that I do not recommend certain prescription drugs based on a lack of data. I would recommend initiation of statin therapy with a generic drug to save money if at all possible.
Statins have acquired an undeserved reputation in my mind among many laypersons. Statins have fewer side effects than any of the drugs listed above with the exception of Zetia. Statins are far safer than any of the drugs above with the exception of Zetia. As a class, statins are the most powerful drugs for lowering your risk of dying of a heart attack due to elevated cholesterol.
Of course statins do have their problems, beginning with muscle soreness. Some people get mild soreness, and some are unable to move out of bed. If this happens, stop the drug, and the problem goes away. Muscle soreness seems to be less with fluvastatin or pravastatin, and can be safely tried even in folks who have not tolerated other statins.
This muscle soreness issue is to my mind a little overblown. If it happens, stop the drug, lower the dose, switch statins, or decide you cannot tolerate them. There's no permanent harm - unless you keep taking them despite severe pain and fail to tell your doctor.
One statin in particular (Baycol) has caused muscle damage to the point that it caused renal failure, but that drug is off the market and for the rest to cause that severe a reaction in general means that severe muscle pain was ignored either by the patient or their doctor for a prolonged period of time.
Liver toxicity is also not as common as people think. Periodic monitoring may be necessary, but this is not a firm recommendation as with niacin. Stopping the drug stops the problem.
Memory loss has been seen very rarely with simvastatin and atorvastatin and less so with the other statins. Stopping the drug also seems to stop the problem.
A little known fact about statins is that they should be taken at bedtime for maximum effectiveness.
There are possibly several secondary benefits to statin therapy, all of which do not have randomized data behind them but are probably worth mentioning. Statins may help prevent diabetes and osteoporosis, may lower blood pressure, may improve outcomes in patients with heart failure, may prevent dementia, and may certain cancers (though this particular data is quite weak in my mind), may preserve kidney function, and may prevent sepsis. None of these have been proven in a randomized fashion and would not be reasons to take this class of drugs without further data.
Overall I think there is a negative buzz about statins only because so many people are on them. One rarely hears about problems with the other classes of drugs because relatively few people are on them compared with statins and so the volume of complaints is low. Statins are actually quite a safe class of medications to take and have a lot of data behind them. If you ask physicians what they themselves are taking, many take statins as a preventative.
One final thing about statins - it is not a good idea to discontinue them abruptly, especially when hospitalized! Discontinuation of statin therapy has been linked with heart attack and one should try to wean if at all possible. Talk with your doctor before abrupt discontinuation.
You can search www.theunion.com for prior articles in this series as well as other columns. Please feel free to email with questions or suggestions for future topics at nicholas.browningmd@gmail.com
The statin drugs are the only drug class with data in both primary and secondary prevention of heart attack and stroke. Primary prevention refers to preventing heart attack and stroke in people who have not had a heart attack or stroke. Secondary prevention refers to preventing another heart attack or stroke in people who have had a heart attack or stroke. Statin drugs also have good data for mortality.
They are appropriate first-line treatment for all patients who can tolerate them who have cholesterol problems. Statins have effects on heart disease and stroke that exceed their ability to lower cholesterol. In other words, you can get to the same LDL and HDL levels with other drugs, but you will do better on a statin all things being equal. This is because they seem to do something very important besides lower cholesterol Ð they make cholesterol plaques less likely to rupture and therefore less likely to harm you.
This is the key point in treating cholesterol. High cholesterol is a problem because it causes plaques in the arteries that eventually cause blocked arteries that then cause heart attack or stroke. If a drug lowers cholesterol but doesn't affect the plaques, it may not do you any good.
Before I am accused of being paid off by the pharmaceutical manufacturers, let me point out that I receive no compensation from any drug company and do not knowingly hold any stock in any of them. I have pointed out in prior columns that I do not recommend certain prescription drugs based on a lack of data. I would recommend initiation of statin therapy with a generic drug to save money if at all possible.
Statins have acquired an undeserved reputation in my mind among many laypersons. Statins have fewer side effects than any of the drugs listed above with the exception of Zetia. Statins are far safer than any of the drugs above with the exception of Zetia. As a class, statins are the most powerful drugs for lowering your risk of dying of a heart attack due to elevated cholesterol.
Of course statins do have their problems, beginning with muscle soreness. Some people get mild soreness, and some are unable to move out of bed. If this happens, stop the drug, and the problem goes away. Muscle soreness seems to be less with fluvastatin or pravastatin, and can be safely tried even in folks who have not tolerated other statins.
This muscle soreness issue is to my mind a little overblown. If it happens, stop the drug, lower the dose, switch statins, or decide you cannot tolerate them. There's no permanent harm - unless you keep taking them despite severe pain and fail to tell your doctor.
One statin in particular (Baycol) has caused muscle damage to the point that it caused renal failure, but that drug is off the market and for the rest to cause that severe a reaction in general means that severe muscle pain was ignored either by the patient or their doctor for a prolonged period of time.
Liver toxicity is also not as common as people think. Periodic monitoring may be necessary, but this is not a firm recommendation as with niacin. Stopping the drug stops the problem.
Memory loss has been seen very rarely with simvastatin and atorvastatin and less so with the other statins. Stopping the drug also seems to stop the problem.
A little known fact about statins is that they should be taken at bedtime for maximum effectiveness.
There are possibly several secondary benefits to statin therapy, all of which do not have randomized data behind them but are probably worth mentioning. Statins may help prevent diabetes and osteoporosis, may lower blood pressure, may improve outcomes in patients with heart failure, may prevent dementia, and may certain cancers (though this particular data is quite weak in my mind), may preserve kidney function, and may prevent sepsis. None of these have been proven in a randomized fashion and would not be reasons to take this class of drugs without further data.
Overall I think there is a negative buzz about statins only because so many people are on them. One rarely hears about problems with the other classes of drugs because relatively few people are on them compared with statins and so the volume of complaints is low. Statins are actually quite a safe class of medications to take and have a lot of data behind them. If you ask physicians what they themselves are taking, many take statins as a preventative.
One final thing about statins - it is not a good idea to discontinue them abruptly, especially when hospitalized! Discontinuation of statin therapy has been linked with heart attack and one should try to wean if at all possible. Talk with your doctor before abrupt discontinuation.
You can search www.theunion.com for prior articles in this series as well as other columns. Please feel free to email with questions or suggestions for future topics at nicholas.browningmd@gmail.com
