What are Statin Side Effects? Are Statins Bad for You?
Should I take a statin?
To take a statin or not is one of the most common discussions I have with my patients – and I understand why people are cautious.
Nobody wants to take medications that aren’t beneficial or that cause side effects.
On the other hand, we also don’t want to miss an opportunity to improve our future health and potentially avoid the leading cause of death and disability – heart disease and stroke.
So, how do you make the best decision about statins for yourself?
#1 – Get as clear as possible on your goals.
What’s most important to you? Is it doing everything possible to avoid a future heart attack, stroke, and early death? Or is it to not take medications?
#2 – Understand the benefits and risks of statins as well as you can.
Fortunately, statins are among the best-studied medications in the history of medicine. They’ve been prescribed since the 1980s, and we know tons about their benefits and risks. On the other hand, statins are highly controversial. There are a lot of people who believe that statins are overprescribed, that they don’t provide much benefit and have a significant amount of risk.
My goal is to give you the perspective of preventive cardiologist who has prescribed statins for thousands of patients over a 25 year career, who has decided to take a statin myself, but does not believe that everyone should be on a statin. But first…
What are Statins?
Statins is the short name for cholesterol-lowering medications called HMG-CoA reductase inhibitors. They are called statins because each one of these medications’ names ends with -statin. (E.g., rosuvastatin, atorvastatin, simvastatin, pravastatin. lovastatin, pitavastatin, and fluvastatin.)
What are the benefits of statins?
Statins are among the most prescribed medications because they have a mountain of evidence that they lower the risk of heart attack, stroke, and death in those at high risk for heart disease.
Statins may be the most studied medicine in medical history, with more than 40 trials where statins were compared to placebo and shown to lower the risk of heart attack, stroke, and death in a high-risk group. Among credible medical experts, there is little debate these days on whether statins work in high-risk patients. Instead, the debate more commonly is how we define high-risk.
To be clear, in almost all high-risk populations (exceptions are those with kidney failure on dialysis or symptomatic heart failure) studied, those who took statins had 20 – 40% fewer heart attacks, strokes, and deaths over 2-5 years than those who took the placebo.
If that doesn’t make sense to you, if you don’t believe the medical research, then I would agree you shouldn’t take a statin because if there is no benefit, why would you take any risk?
What are the risks of statins?
Like all medications, statins can cause side effects. In most research trials (and my clinical experience), side effects occur in about 10% of people taking a statin.
Far away, statins’ most common side effect is muscle aching, also called myalgias.
But here’s the interesting thing about muscle aches on statins.
When people don’t know if they are taking a statin or a placebo, the side effects are roughly the same for both. For example, a (opens in a new tab)of over 129,000 people taking either a statin or placebo found that 13.3% of people taking the statin stopped it due to side effects, whereas the placebo was stopped in 13.9% of people.
In another (opens in a new tab) people with a history of not being able to tolerate a statin were given alternating months of placebo pills or statins but didn’t know what they were taking. An app tracked symptoms and found that about 90% of the symptoms that occurred when taking the statin occurred when taking the placebo.
The point is, whether muscle aches from statins are due to the medication or the impact of our mind’s negative expectations (which is called the “nocebo effect”) is unclear. But here’s why this might be relevant. When those people in this study were shown that their symptoms were as likely to happen on the placebo as on the statin, about half of them decided to start taking a statin again.
Worrisome side effects of statins
What about more worrisome side effects from statins? Well, again, fortunately, we know a lot about statins because they’ve been around for so long, and so many people have taken them. Here’s what we know:
Liver inflammation can occur from statins but it is exceedingly rare. In my 25 years as a physician, severe liver test abnormalities have occurred in less than five patients. The FDA recommended stopping routinely checking liver tests for those on statins ten years ago.
Life-threatening muscle breakdown
Life-threatening muscle breakdown (called rhabdomyolysis) is also very rare. I have never had a patient who has had rhabdomyolysis from a statin. The incidence has become even rarer now that we infrequently prescribe statins with a higher potential to interact with other medications, like simvastatin 80 mg.
Dementia or cognitive decline
Cognitive impairment is a common concern among my patients who are considering statins. However, the (opens in a new tab) does not show an increase in cognitive impairment and, in fact, shows a decrease in dementia.
That being said, I have had a few patients convinced that statins impaired their cognition which went away when the medication was stopped.
High-strength statins (such as atorvastatin and rosuvastatin) at high dose has been associated with a small increase in diabetes. However, it’s important to keep this in perspective. Statins may increase blood sugar levels a few points and push those who are almost diabetic over the threshold level. But, those people are at high-risk for heart disease, so likely, the protective benefit of the statin outweighs the risk.
Kidney impairment appears to be specific for (opens in a new tab). I am more likely to minimize the dose of rosuvastatin or choose another statin for my patients at high risk for kidney impairment.
What to do if you have statin side effects?
Although serious adverse effects from statins are rare, stop the medicine and seek urgent medical attention if you have severe symptoms.
While it’s true that ninety percent of people can take a statin with no side effects, I’ve had a lot of experience with people who have side effects from statins. When I worked at the Mayo Clinic, I (half) jokingly said I saw everyone in the system who couldn’t take a statin because my colleagues would send them to me for evaluation. I met many people who were desperate to take a statin because they believed in the benefits but just could not tolerate the side effects.
To help these patients make the best decision for themselves, I would try to answer these questions with them:
- Do you really need a statin?
Understand the risks and benefits. If you’re not at high risk for a heart attack or stroke, maybe a statin isn’t the right choice for you even if your cholesterol is higher than you’d like.
- Are your symptoms really from the statin?
Recognize our mind is powerful, and the nocebo effect is real. If you’re unsure whether your symptoms are indeed from the statin or not, work with your doctor to see if you can find a regimen that works for you.
- Is there something else going on?
Sometimes there is something else causing the symptoms. Other conditions like arthritis, autoimmune diseases, excess alcohol use, low thyroid, heavy exercise, and low Vitamin D levels have all been associated with increased statin intolerance.
- Is a different statin or dosing schedule better for you?
Just because you’ve had side effects on one statin doesn’t mean others won’t work for you. Different statins, dosages, or alternative schedules can be effective. Under a doctor’s supervision, statins are almost always safe.
- Is there a better choice for you than a statin?
Ask your doctor if other cholesterol medications are an option. Both ezetimibe and the PCSK9 antibody medications have been shown to lower the risk of heart attack and stroke.
I believe statins can be a powerful tool to lower the risk of heart attack, stroke, and death for SOME people. Whether that is you or not can only be decided between you and your doctor, and to take a statin or not should always be a personal choice. If you look at the evidence and determine a statin isn’t right for you, then don’t take it. Ultimately, you’re the one who suffers the consequence or enjoys the benefits of the decision – nobody else.