Exactly how the cholesterol-lowering statin drugs act on many areas of the body is not completely worked out. This explains why some of the good and bad effects of these drugs are surprising. Statin drugs may decrease inflammation of the blood vessels even better than they lower cholesterol. That may be the main reason they reduce heart attacks in some people, rather than by lowering cholesterol.
Even though statin drugs may decrease inflammation in the vessels, they can definitely increase inflammation in muscle and in the liver. "Myopathy" is the term given to statin-caused muscle aches. This is a common reason for having to get off the drug. Patients should be warned that this could happen so that they don’t get mistakenly diagnosed with other things such as fibromyalgia or restless legs. Rarely, the toxic effect of the drug on the muscles is so severe that it can cause massive muscle destruction leading to kidney failure.
Statins seriously deplete the body’s store of a vital enzyme called co-enzyme Q10, or just co-Q10. When co-Q10 is low the cells that need energy the most can’t make it. Of course the heart needs lots of energy to keep up its strong pumping action. In Europe doctors routinely prescribe co-Q10 to their patients on statin drugs. In this country, the drug makers are seeking a patent on combining co-Q10 with a statin.
Statins can also cause liver inflammation, and sometimes this is so severe that the drug must be stopped. That is why blood tests for liver function have to be done when statins are started and each time the dose is increased, and twice a year thereafter.
Some studies show that the lower your cholesterol the higher your chance of cancer. Others do not. For example, a study followed LDL levels in people who were taking statin drugs every day for over 5 years. They reported one excess cancer in every 1000 patients. The highest incidence of cancer was in the people who had the very lowest LDL levels. Defenders of statins say that the increased cancer could have been because people are living longer on the statins, thus being more likely to get cancer instead of heart disease. However this does not explain that the people who got cancer were the ones with the very lowest LDL levels. Not only that, the increased cancer incidence was seen within just five years. The very newest cholestreol guidelines have even more people drastically lowering their cholesterol. Therefore, the true number of increased cancers may not really be known until years down the road.
The most disturbing side effect of many of the statin drugs is mental. Cholesterol is vital to hormone production. The cholesterol molecule also provides the structure to many bodily parts including cell walls, nerves and brain cells. Cholesterol is one of the most common and necessary substances in the brain. The brain produces all of its own cholesterol. This is because cholesterol in the blood stream is too big of a molecule to get across the protective barrier that separates the blood from the brain. However most statin drugs are small enough to pass through this barrier and cross into the brain. An unwanted drug effect is interference with the brain’s cholesterol production.
Statin manufacturers hoped that their drugs would act on brain cells to prevent or slow Alzheimer’s dementia. The problem with studying dementia is that it requires a long term observation. On top of that, the shifting cholesterol treatment guidelines every few years makes the data hard to evaluate. Many studies are from information collected over 10 years ago. This is complicated by the fact that most of the tests to measure dementia are very subjective, consisting of questionaires rather than biological measurements. The dementia studies give a mixed picture. For example, over one thousand elderly men were interviewed to see if they had signs of dementia in the beginning and again three years later. The men who were on statins at the beginning of the study had less progression to dementia than the ones who were not on statins at the beginning. This was widely reported in the news as “Statins protect against dementia.” But the news did not report the whole story. What it didn’t report is that there was less dementia only in the men who went off the drug before the second interview in 2004. The group that went off the statins had less progression to dementia than men who stayed on the statin for the entire three years. This means that the men who stayed on the drug for the entire three years had more dementia.
On the other hand, there has been some concern that statins may cause memory loss. Transient global amnesia is warned about on some statin package inserts but not on others. The person suddenly loses their memory, reaching many years back, but also preventing new memories from being formed. Despite this well-documented possible side effect, there is no warning against statin use in pilots and others in safety-sensitive positions. Even before widespread use of the new lower cholesterol guidelines, two percent of all the reports to the FDA for statin drugs were complaints of memory loss, mostly made by the patients themselves but some made by their doctors. Memory loss is vastly underreported. It is estimated that for every report to the FDA, there are 10 to 100 times that number of cases that are not being reported. In the real world of the doctor’s office, memory loss is often blamed on age, depression or on the fact that the patient has vascular disease. If you experience memory loss on a statin drug you and your doctor should consider that it may definitely be a drug side effect.
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