Put Statins in the Water?

An article later this year will update our 2014 article on Drugs for Lipids, and there is plenty of updating to do. Our 2014 article was published shortly after the American College of Cardiology and the American Heart Association recommended using risk factors rather than specific cholesterol targets as indications for statins. There is general agreement that statins can decrease the incidence of coronary events and death in patients with atherosclerotic cardiovascular disease, and that they can reduce the risk of first cardiovascular events and death in patients with risk factors such as diabetes or elevated levels of LDL-cholesterol or inflammatory markers.

A recent article in The New England Journal of Medicine examined the effect of rosuvastatin 10 mg compared to placebo on intermediate-risk (estimated annual risk of a cardiovascular event ~1%) men >55 years old and women >60 years old without cardiovascular disease. After a median follow-up of 5.6 years, the hazard ratio for a composite of cardiovascular events was about 0.75 in statin-treated patients (S Yusuf et al. N Engl J Med 2016; 374:2021).

Only 2 side effects occurred significantly more often with the low dose of rosuvastatin than with placebo: cataract surgery (3.8% vs. 3.1%) and muscle symptoms (5.8% vs. 4.7%). Muscle symptoms are the biggest problem limiting wider prescribing of statins. Myalgias (no increase in serum creatinine kinase) and myositis (CK increased) are common, especially with high doses. Rhabdomyolysis and myoglobinemia leading to renal failure are very rare. CK levels should be measured if patients on statins develop myalgias, and if they are >3-5 times the upper limit of normal, the dose should be lowered or the drug should be stopped.

It seems as though every study of statins in whatever population shows a beneficial effect on the risk of cardiovascular disease. And the wind seems to be shifting in the direction of less concern about muscle symptoms. We will have more to say about all of this in our article. Coming soon.

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Comments

  1. What about diabetes and CHF, and do you recommend Q10? ,

  2. But the increasingly strange thing about this is that cholesterol itself and maybe lipids may not have anything to do with the outcome shifts. May only be markers.

  3. Kyle Lehenbauer, MD says:

    That study had a run-in period where every participant had to take the meds and only people who tolerated the meds were enrolled in the study. So looking at adverse events in this study isn’t anywhere close to what would happen in practice.

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