Statins

[Bazile]

I've been reading on the net about people who are taking one the cholesterol lowering statin , drugs suffering symptoms of severe muscle / leg pains , which they attribute to said drug .

There are also some medical experts , posting on the net , who are against their use .

Should people stop taking them ?

[theprof]

This is a very difficult question to answer as we need to put it all into perspective.

First of all, there is undoubtedly evidence that for those patients who have suffered a cardiac incident, statins can prolong their life considerably. In addition, in those patients who have suffered a heart attack, a statin can reduce the risk of another occurring considerably. In fact, there is currently a school of thought that every adult over the age of forty should receive statins from their GP in the UK even if they have not suffered from a cardiac incident or are predisposed to do so. Obviously, mass medication in this manner is very controversial.

As far as the disadvantages of statins are concerned, it is true that patients often suffer from myalgia (muscle pain) in the initial days of treatment with statins. In a minority of patients, the myalgia is unbearable and these patients will generally be intolerant of all statins. Nevertheless, in most patients, the myalgia does gradually subside and few other side effects are encountered. It is true that muscle wastage does occur in a minority of patients and often, the wastage is irreversible. Nevertheless, regular initial reviews by the GP, pick up these side-effects and if necessary, the statins are discontinued or substituted for another. Other side effects have been known to occur too.

(continued)

[theprof]

So with all these side effects, why do we bother with statins? Well, in some patients, high ldl blood lipids are inherited and little can be done to control the levels. Diet alone will not control the problem. For these patients, statins are a lifesaver. There are also patients who for various reasons, simply cannot stick to a diet.

Personally, I'm all for statins. I've taken a daily dose of Simvastatin myself for over twenty years with very few problems. As for muscle wastage, my muscle mass is about the same as it was when I gained my martial arts belts years ago although my weekly visits to the free university gym visits may be a contributory factor here. My wife, who is a well-known cardiologist, supports statin therapy with little reservations.

Whilst I appreciate, that a few cardiologists and pharmacologists are opposed to statins per se, the consensus of opinion amongst specialists is that statins can be a lifesaver. Whilst the medical literature continues to report isolated extraordinary case studies, the British Heart Foundation is fully supportive of statins.

At the end of the day, patients will continue to have to make an informed choice on statin therapy based upon their own experiences.

[theprof]

Incidentally, since Simvastatin has become available as an OTC (Over the Counter) preparation from pharmacies, there appears to have been a marked increase in patients reporting muscle pain to their GP's.

I understand that it is now commonplace for a patient who presents himself or herself with myalgia to be asked if they are taking statins.

[theprof]

Yes, as I said in my previous posts, there are people out there that are completely intolerant of statins. Clearly, you are one niceboy.

The fact remains that there are thousands of patients out there with either minimal or nil side effects from statin therapy.

[Bazile]

Thanks prof

I've been taking 10 mg atorvastation since Sept 2003
Is it unusual to start having leg and muscle pain now , after all this time has elapsed ?

How do you measure muscle wastage ?

What is the difference between the different statins ?

I'm also taking Verapamil for blood pressure
The literature in the box for atorvastatin states that it can interact with Verapamil - is that something to worry about ?

Incidentally , are statins used for people who have had a TIA or a stroke ? - i seem to recall reading that somewhere

[theprof]

Hi Bazile

I've checked out my knowledge of statins with Mrs Prof, who's a senior cardiology lecturer at my university and a locum GP. This means you've got two experts for the price of one! Anyhow, here we go:

Atorvastatin (Lipitor) is one of the more recent statins. Usually muscle pain (myalgia) and muscle inflammation (myositis) occur in the first few weeks after treatment. More often than not, the pain and inflammation gradually subsides.

All the same, it's not unusual for the myalgia to come along years after the the first dose was taken. By right, you should report these symptoms to your GP for evaluation, but the good news is that if the symptoms become very uncomfortable and you are advised to stop taking the statin, then the muscle inflammation is completely reversible. If this has to be done, it's not the end of the world as a different statin may be more tolerable.

Muscle wastage is usually measured by comparing the girth of the same two limbs in a patient. Often, the affected limb might have striations visible on the skin which might be an indication that a degree of wastage has occurred. The limb girth is compared to the other limb and this gives doctors a good idea of what's going on. Any change in the girth of the limb over time could also be indicative of wastage.

(continued)

[theprof]

All statins work by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis, notably in the liver. There are some differences in the side effects that the five of them might cause and the newer ones tend to be better in this respect. They all do exactly the same job. There are some differences in the way they interact with other drugs though.

As far as verapamil and atorvastatin go, there is no real problem with interactions. The reason for the warning is that there is a theoretical increased risk of myopathy when taking verapamil but this has been based upon a recognised risk between verapamil and a similar structured statin called simvastin. It's only theoretical due to the close resemblance of the two statin molecules and there's no evidence that you're more at risk than anyone else taking verapamil.

Yes, current medical practice is to start statin therapy on TIA and stroke patients ASAP. Also diabetics over 40 years of age have been added to the list. They are also commonly prescribed for patients with raised triglyceride concentration, hypertension, or a family history of premature cardiovascular disease, sometimes as early as teenage years.

[Bazile]

Thanks again prof

One final question

You advise that the inflamation is reversible .
What about the muscle pain - is that reversible ?

My regards to Mrs Prof

[theprof]

Hi Bazile

Yes, the muscle pain is definitely reversible when the statin therapy is reduced or stopped altogether. The muscle pain arises mainly because of the inflammation that arises during statin therapy - remove the statin and you take away the pain.

Don't forget though that some statins may not cause muscle pain at all, so it's often worth trying another instead.

Mrs Prof sends you her best wishes!

[Bazile]

That's reassuring

Thanks