This class of drugs, also called HMG-CoA reductase inhibitors, is generally found in medication designed to reduce lipids in the organism. So, statins are known to be quite potent and have been linked to greatly reducing CVD (cardiovascular disease).
Like any miracle drug, however, statins don’t come without side effects. It’s our scope to present to you a comprehensive overview of the drug and its respective adverse effects.
First, we need to define statins. It’s important to note the number of statins and the general differences between them. Secondly, we will be looking at the medical uses generally associated with this type of reductase inhibitors.
In the second half of this review, we will dedicate to listing the numerous adverse effects. From the slightest to the most severe, the statin side effects, one needs to be on guard. Neuropsychiatric or physical, these secondary properties can be severely damaging to an individual.
What is a statin, to be precise? Simplifying this explanation is not possible, but let us try. Statins inhibit the synthetization of cholesterol. The first statin to be discovered, lovastatin, is made from several types of fungi. This includes aspergillus terreus (where it was first uncovered), as well as red yeast rice, oyster mushrooms, and Pu-erh.
Statins act upon the HMG-CoA reductase, aggressively inhibiting it. The HMG-CoA (shortened from 3-hydroxy-3-methyl-glutaryl-coenzyme A) reductase is an enzyme that controls the rate of the mevalonate pathway. What is the mevalonate pathway? Basically, the biochemical process by which cholesterol, among other terpenoids, comes to be. Terpenoids are part of the process by which steroids are produced. Cholesterol itself is a sterol (a modified steroid).
This definition may seem long, complex, and full of terms beyond understanding. It is. However, biochemistry tends to be that way, and remember this is a simplification. Pharmacy majors learn things many times more complicated.
Currently, there are a total of 13 statins available on the pharmaceutical market. These range from synthetic to naturally occurring, and some are sold under multiple brand names. We will divide these into low intensity, moderate intensity, and high-intensity drugs.
Note that the category to which a statin pertains depends on the type of statin as well as the dosage prescribed.
The following statin treatments reduce LDL cholesterol between by 21 and 29 points percentile.
- Fluvastatin (20 or 40 mg daily). Synthetic statin found on the market as Lescol.
- Pravastatin (10, 20, or 40 mg daily). Fermentation made statin. Found on the market as Pravachol, Selektine, and Lipostat.
- Simvastatin (10 mg daily). Statin made via fermentation. Found on the market as Zocor and Lipex.
These statin drug treatments lower the LDL cholesterol between by 32 and 38 points percentile.
- Fluvastatin (80 mg daily). Found under the brand name Lescol XL.
- Simvastatin (20 or 40 mg daily).
- Atorvastatin (10 mg daily). Synthetically made statin. Sold under Lipitor and Ator.
- Rosuvastatin (5 mg daily). Synthetic drug, otherwise known as Crestor.
These statin drugs significantly decrease LDL cholesterol for between 42 and 55 points percentile.
- Simvastatin (80 mg daily).
- Atorvastatin (20, 40, or 80 mg daily).
- Rosuvastatin (10, 20, or 40 mg daily).
Apart from these widely used statins, there are a few that are less common. These are: lovastatin, mevastatin (Compactin), and pitavastatin. Cerivastatin, an older statin drug, is no longer available on the market after it was directly linked to rhabdomyolysis (more details on this illness in the second half of this article).
Apart from the main treatment – for cardiovascular disease, statins are also used for several other treatments including nephropathy. However, the bulk of their medicinal uses resumes to the cholesterol-reducing properties of statins.
Physicians, health care providers, and dietitians don’t recommend the use of statins as replacement treatments for exercise and dieting. Before commencing treatment with either low, moderate, or high-intensity lipid-lowering medications, the two options should be considered. Unfortunately, statistics show an alarming number of people in the US resort directly to statins.
An April 2015 study in The Lancet proved that therapy with statins had no clear difference of effect on men versus women. Furthermore, a 2010 report by the NCHS connected surveys of men and women using statin drugs from 1988 up to 2008. Some results (as we see below) were shocking.
There are two methods of using statins to improve cardiovascular health. The first type, primary prevention, implies using statins as preventive treatment for heart conditions. Before the onset of disease, people with high cholesterol prescribed with these drugs have shown signs of improvement.
Even though benefits of statin treatment were found for both men and women, the risk of cardiovascular events is only reduced in men. The same goes for mortality rates. Several studies pointed out that while women benefit from statin drugs, their mortality rate does not improve. Neither does the chance of a heart failure decrease.
The recommended statin treatment may only begin if one or more the following conditions are met:
- If the patient has had a 10% or greater risk of developing CVD over the last 10 years.
- When the patient has shown an increased risk (over 7.5%) of a stroke or a heart attack for 10 years.
- In cases where patient has an LDL cholesterol level greater than 190mg/dL, or 70 to 190mg/dL for people over 40 that also suffer from diabetes.
The second method to use statins for cardiovascular health is secondary prevention. This implies that the patient already suffers from cardiovascular disease. Significant amounts of research have shown statins to be revolutionary in treating CVD.
By lowering cholesterol, statins decrease the likelihood of cardiac failures by 60%. Long-term treatments also provided promising results, reducing stroke chances by 17%.
Children should not take statin treatments if they are not suffering from severe forms of familial hypercholesterolemia. No studies exist that assert the long-term effects on kids’ health.
Like with adults, kids should only take statins under certain conditions. First, they need to have implemented a strict diet with their physician. Secondly, they need to have a routine exercise program.
Caution is the case since several studies have shown that familial hypercholesterolemia does not respond to statin treatment as easily as CVD in adults.
Contrast-induced nephropathy and the risks associated with this condition were also found to be reduced by using statins. The 2014 report said that patients that suffered coronary angiography interventions or percutaneous interventions had a 53% lower risk of developing the condition.
Though they are popular, statins have their own series of dangerous adverse effects. Because they act upon the cholesterol levels in the body, statins often cause irreparable muscle problems. Consequently, these problems can worsen and lead to more severe ones such as bleeding strokes, diabetes, and liver damage.
Even though you may think that eliminating cholesterol from your body is a good thing – that’s far from the case. Cholesterol is an essential sterol in our bodies. So, it is responsible for many different beneficial processes in our bodies.
One important such process is producing the Coenzyme Q10. You may know the CoQ10 from beauty creams or other skincare products. However, this vitamin-like antioxidant helps with treatments for cancer, heart disease, infertility, Parkinson’s, and autism.
When statins and other lipid-lowering substances regulate cholesterol production, they cut off the supply of CoQ10 (among others). Coenzyme Q10 deficiency makes muscle cells less efficient. Therefore, muscle problems appear. Furthermore, lack of sufficient CoQ10 throws the blood sugar levels off balance. This, in turn, leads to diabetes.
Several reports have linked statins to cognitive decline. Studies show that the following symptoms or conditions may be caused or to made more severe by statins:
- Memory loss;
- Mild cognitive impairment.
On the other hand, some studies show that these effects not serious. Consequently, the FDA has reviewed the evidence and concluded that the labels of statin drugs should mention the conditions as “nonserious and reversible.”
Case Study: Statins and Memory Loss
Because of how alarming memory loss can be, the information from one of the studies became a common myth. After the reports surfaced, many people began believing that statins directly cause memory loss. A 2015 JAMA Internal Medicine study, cited in Harvard Health, gave this a closer look.
The report looked at the healthcare histories of over 11 million patients. These records went as far back as 1987 and ended in 2013. Out of the millions, the researchers got one million who were connected to CVD in some way. They split the group into 483 thousand that took statins to lower cholesterol, 26 thousand that took other drugs (niacin, fibrate), and another 483 thousand that did not take anything.
The results were solid. Not only did statin patients report memory loss 4 times more than the control group, the group that used other lipid-lowering meds did the same thing. So, a possible conclusion would be that lowering cholesterol via medication is clear to cause instances of memory loss.
The researchers did not rule out coincidence, however. They cited several different studies that show links between patients undergoing new treatments and their being skeptical about any abnormalities in health. In other words, if you’re taking a new drug, you’re likely to think that even the common flu is connected to it.
There is a long list of statin side effects. These range from more common ones to severe disorders. Here they are in order of acuteness:
- Abdominal cramps;
- Skin flashing;
- Problems sleeping;
- Nausea and vomiting;
- General weakness and muscle pain.
Type 2 diabetes may set in after prolonged statin treatment because of CoQ10 deficiency.
Myositis is a serious condition that can set in after using statins. Its symptoms include inflamed muscles and increased risk of injury. If one takes a statin together with a fibrate (both lipid-lowering drugs), the severity of the muscle pain could greatly increase.
CPK levels going through the roof. Another enzyme that is codependent on the existence of cholesterol, creatine kinase levels can be thrown off balance by statins. While this occurs on fewer instances in patients undergoing statin treatments, it should not be ignored. Reducing CPK levels to normal is a long and complicated process.
Rhabdomyolysis can also set in in extreme cases. People under statin treatments that do not take CoQ10 supplements may see their myositis evolve into rhabdomyolysis. This is an acute condition resulting in extreme muscle inflammation coupled with severe pain. Furthermore, this severe condition can lead to other dangerous complications like kidney failure which automatically leads to death.
Still, research results show that rhabdomyolysis only sets in very rarely and after continued misuse of statins. On average, statistics show its chance of occurring as less than one in 10 thousand patients undergoing treatment.
However, because of an increase in people who take statins to reduce LDL cholesterol, the likelihood of severe side-effects in the general population also increases. Surveys show that almost 10 percent of people 40 to 64 take statins without prescriptions, while eight percent don’t even have health insurance. This is highlighted in the survey below.
Statins are not to toyed with. While they can be incredibly helpful in reducing the risk of CVD, they should be taken with caution. Because they are HMG-CoA reductase inhibitors, statin drugs tend to throw the body off balance. Therefore, dieting, exercise, and period doctor’s appointments are more than recommended.
If you or a person close to you are under statin medication, be extra careful about the issues and warning signs in this article. Remember, cholesterol is not entirely your enemy. Lifestyle and diet changes can work miracles without confusing your biochemical makeup with statins.
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