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Q. My husband has high cholesterol, despite a very healthy lifestyle and weight. His doctor put him on Lipitor. After the dosage was increased, I started noticing that he wasn't as enthusiastic about our previously very active sex life. He was having difficulty maintaining an erection and uncharacteristically not initiating lovemaking.
When I asked, he said he just wasn't feeling aroused and that he'd noticed his usual morning erections weren't occurring. He asked his doctor if the Lipitor might be responsible, and the doc said to stop it for a month and see what happened.
Within a week his libido returned big time! For a few weeks he was as interested as when we first got married in our early 20s (we are in our early 50s).
Now our sex life is back to normal, as it was before Lipitor. He takes niacin, eats oatmeal every day and exercises regularly, but he is unwilling to have his cholesterol checked. He is afraid the doctor will prescribe Lipitor again. Your thoughts?
A. In searching the medical literature we found an article in Drug Safety (July, 2009) confirming that some statin-type drugs (Crestor, Lipitor, Zocor) are associated with reports of erectile dysfunction. Although this side effect seems to be rare, men may underreport it. We are sending you our Guide to Cholesterol Control and Heart Health for many other ways to get cholesterol down besides statins.
Cholesterol is a risk factor for heart disease and your husband should not simply ignore it. Working with his doctor to find an acceptable way to control cholesterol would be better.
Cholesterol does not cause heart disease, as is believed by millions, based on fraudulent and what I call "junk Science". Whether you believe in creationism or evolution, Man has been walking around with Cholesterol in virtually every cell in our body, for thousands of years, and heart disease was not a factor until the 1920's when we started refining and processing foods. And now with the advent of genetically modifying foods, who knows what kind of havoc this will wreak?
If you want to reduce your risk of heart disease, take a high quality fish oil for its Omega 3 fatty acids, and Folic Acid, Antioxidants found in foods like raisins, pomegranate, blue berries, black berries, spinach among other sources, will reduce inflammation (the amount of free radicals which cause oxidation in the body, which is what Heart Disease is a result of.
Can you comment on the website on sexual side effects of statins on women? My physician insisted on putting me on a statin, even though I have had difficulty with some of them when tried before (I do have terrible cholesterol numbers). The current one I am on a trial of is Crestor. Am already on Niacin as well.
Thank you, this would be much appreciated.
After much study, I've come to the conclusion that statin drugs are the 'HRT' of the 21st century. My husband had libido issues, and slowly lost strength in his legs. I believe that statin side effects are under reported, and that they cause more muscle damage than is tracked.
I was on Lipitor for several years and just recently, within the last four months was switched to Zocor for insurance reasons. I've not been feeling well on Zocor and I now have an ED problem that I never had before and Viagra does not help.
My doctor says it's not the Zocor ?? DUH!
Do you have information on alternatives to Zocor?
PEOPLE'S PHARMACY RESPONSE: SEE OUR GUIDE TO CHOLESTEROL CONTROL AND HEART HEALTH
I'm not sure where Joe and Terry Graedon received their credentials, but that school obviously didn't teach them anything about human steroid hormone pathways. Now read carefully because I'm going to teach you what you two don't seem to know. Cholesterol and specifically LDL, the "bad" one, is the precursor to all steroid hormones in the body. That includes testosterone, progesterone, estrogens, pregnenelone, DHEA, androstendione etc. A precursor means that in order for the body to produce sufficient amounts of testosterone, for example, it needs to have an ample supply of LDL cholesterol. Without those levels of LDL cholesterol, testosterone levels become subsequently low as well. Low testosterone levels are indicated in people who have low libidos. That includes women also. Haven't you noticed that when big pharma started really jumping on this lowering peoples cholesterol kick, they also jumped on the erectile dysfunction kick? Artificially lower cholesterol levels and you also lower sex hormone levels. That wasn't so hard, was it?
True, Cholesterol is a natural product that our bodies make but what you are failing to see is that an EXCESS of cholesterol is what causes heart disease. It has been proven that diets that are high in fats & cholesterol will lead to an increased amount of cholesterol in the body. This in turn could lead to heart attacks, stroke, and other cardiovascular diseases.
Omega 3 is one way to decrease your cholesterol which in turn will decrease your cardiovascular risk.
If you have any questions talk to your credentialed pharmacist or physician before coming to this website.
PEOPLE'S PHARMACY RESPONSE: IT IS ALWAYS A GOOD IDEA TO TALK WITH YOUR OWN HEALTH CARE PROVIDERS. INFORMATION FROM ANY WEB SITE, INCLUDING WWW.PEOPLESPHARMACY.COM, SHOULD BE PART OF THAT CONVERSATION AND DOES NOT REPLACE IT.
Lipitor, the scourge of the medical field. If I personally have two friends that died of liver cancer and one who died in a quick two years from ALS and another one who now has ALS, how many, many more people can say the same? Why are those lethal statin drugs still on the market? It makes me wish I had been raised a Christian Scientist.
A plausible theory, but not supported by evidence. See:
http://cebp.aacrjournals.org/content/16/8/1587.full
Do Statins Affect Androgen Levels in Men? Results from the Boston Area Community Health Survey
Susan A. Hall, Stephanie T. Page, Thomas G. Travison, R. Bruce Montgomery, Carol L. Link and John B. McKinlay
New England Research Institutes, Watertown, Massachusetts and Department of Medicine, University of Washington, Seattle, Washington
Requests for reprints:
Susan A. Hall, New England Research Institutes, 9 Galen Street, Watertown, MA 02472. Phone: 617-923-7747; Fax: 617-924-0968. E-mail: shall@nerisicience.com
Abstract
Background: In 2005, statins were among the most commonly used prescription medications in the United States. Some data suggest statins may affect cancer risk and/or disease severity. Because cholesterol is a required intermediate in sex steroid synthesis, it is possible that statins influence prostate cancer risk through effects on steroid hormone metabolism. We investigated whether levels of circulating androgens and their carrier protein, sex hormone–binding globulin (SHBG), varied by statin exposure among a sample of 1,812 men from a population-based epidemiologic study, the Boston Area Community Health Survey.
Methods: We measured serum total testosterone, free testosterone, dehydroepiandrosterone sulfate, luteinizing hormone, and SHBG. Statin exposure was collected through participant self-report and/or interviewer-recorded information. Multivariate linear models were constructed to account for potential confounding.
Results: The prevalence of statin use was 12.4% [95% confidence interval (95% CI), 10.3-14.9]. On average, statin users were older, had larger body mass index and more chronic illnesses, and used more medications. We found no relationship between statin use and free testosterone, dehydroepiandrosterone sulfate, or luteinizing hormone. A significant association between statin use and total testosterone was initially observed but was not robust to covariate control in a multivariate model that included age, body mass index, time since awakening, and history of cardiovascular disease and diabetes (−5.5%; 95% CI, −13.2 to 2.9%). In multivariate models adjusted similarly, SHBG levels among statin users were statistically significantly lower compared with nonusers (−10.6%; 95% CI, −18.8 to −1.6%).
Conclusion: In this sample, it is unlikely that statins affect circulating androgens and prostate cancer risk through a hormonal mechanism. (Cancer Epidemiol Biomarkers Prev 2007;16(8):1587–94)
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A 2008 analysis by the US Food and Drug Administration (FDA) of data from over 40 clinical trials did not show a link between statins and higher risk of amyotrophic lateral sclerosis (ALS), a neurodegenerative disease often referred to as "Lou Gehrig's Disease". The FDA said there is no need to change prescribing practice.
Reference: http://www.medicalnewstoday.com/articles/123519.php
Article Date: 30 Sep 2008
Likewise, there is no known relation between statins and liver cancer. In fact, diabetic patients taking statins reduce their risk of liver cancer. Previous data suggests that the progression of hepatocellular carcinoma (HCC), a highly fatal malignancy, can be reduced by statins, which exert a certain beneficial action. A study recently published in Gastroenterology (2009;136(5):1601-1608) looked at the relationship between statin use and HCC and other liver diseases.
Researchers analyzed a large group of patients with diabetes, whose risk for HCC was above average. Of the 1303 patients examined, 34.3% had at least 1 filled prescription for statins compared with those in the control group (53.1%). The results showed a significant inverse association between having statin prescriptions filled and the risk of developing HCC. Furthermore, longer and more frequent statin use resulted in a strong trend toward risk reduction (25% to 40% risk reduction).
As to whether "statin side effects are under reported, and...cause more muscle damage than is tracked" that may, to a certain extent, be plausible. But in the JUPITER trial (published in NEJM 2008), in which 17,802 men and women were randomized to Crestor vs. placebo, myopathy (muscle damage) did not occur more frequently with Crestor than with placebo. Specifically, a total of 19 myopathic events were reported: 10 in subjects receiving rosuvastatin and 9 in subjects receiving placebo (p=0.82). The median follow-up of subjects was 1.9 years, and no increased myopathy was detected in an analysis of participants who continued to receive Crestor for 4 or more years.
If there was a 10% incidence of myopathy symptoms, of the 8901 patients randomized in that study to Crestor, one would expect 890 patients to have reported myopathy symptoms. Yet there were only 9 (nine). Why is that???
Reference: Ridker PM, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. NEJM. 2008:359:2195-2207
Among the many side effects I experienced while on statins was decreased libido. As things happen gradually, I hadn't fully taken note of how normal night time erections had virtually ceased. I put off my lack of sexual interest to getting older. My wife felt I wasn't as interested in her anymore.
During the first week after I had stopped the statin, I had a sexual awakening like I was a teenager again. I didn't realize how far I had deteriorated until my libido came roaring back. Normal night time erections while sleeping returned. I also found myself inclined to stretching my muscles again as I woke up and got out of bed. I hadn't noticed that I had lost the urge to do that.
Part of the danger of statin drugs is that most symptoms come on gradually, as opposed say to some extreme alergic reaction. I think this is part of why statins are misinterpreted as being so safe, and statin damage sufferers are not fully documented.
My father, a doctor, told me that patients in a 16 week study who took 80mg per day of Lipitor {TM} reduced total cholesterol down to 140mg/dl in 6 weeks{Schwartz. et al., 2001}. Not only was there no evidence in the study that this was beneficial, but plenty of evidence was given that such low levels of TC are quite HARMFUL.
43 years old, great shape, not super bad cholesterol numbers, but Dr. prescribed Lovastatin beginning of '09, went thru 3 months, and noticed decreased interest, number of erections, the morning "wake up", etc. Prescription ran out, and lo and behold back came the good stuff.
I didn't go back to the doc, a few months pass and I decide I should have cholesterol checked again. Tell the doc the side effect, and he prescribes lipitor, well, insurance company will fill only generic, and doc does not back up to try lipitor, back on lovastatin. Figured, let me just verify my earlier "test" because that was fun. Well, lost interest is here and "wake up" gone again. Forget it, I'm done with the meds. I'll check out the natural path. Oh, and I'll get a new doc.
Carol, I believe the article you reference {Schwartz et al, 2001} was the landmark Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study which showed that statins may be started promptly after an acute cardiac event. In the MIRACL study, 3086 adult patients hospitalized with an acute cardiac event were randomized within 96 hours of their event to Lipitor 80 mg daily or a placebo for 16 weeks. The composite endpoint of nonfatal myocardial infarction, unstable angina and death was modestly but statistically significantly lower in the Lipitor group. Lipitor reduced recurrent symptomatic myocardial ischemia by 26% compared to placebo (p=0.02). Lipitor was well tolerated in the study, with only a slight increase in reversible elevation of liver enzymes in the active treatment group compared with placebo. There were no documented cases of myositis with Lipitor.
If indeed that is the study your father was referring to, there is clearly no basis for your statement "Not only was there no evidence in the study that this was beneficial, but plenty of evidence was given that such low levels of TC are quite HARMFUL." Carol, are we talking about the same study? I'm pretty sure we are, but if not, please reply so I can respond to the study in question.
For a summary (published in December 2006, so not reflecting the last 3 years of studies) of completed outcomes-based clinical trials evaluating statins for the management of cardiovascular risk, including discussion of the adverse effects of statins, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994009/
See
http://health.usnews.com/articles/health/healthday/2009/06/30/study-supports-wider-use-of-statins.html
for a more recent discussion about the evidence-based expanding role of statins in women and the elderly.
PEOPLE'S PHARMACY RESPONSE: THE SECOND ARTICLE DR. A CITES SUGGESTS THAT STATINS ARE BETTER THAN ASPIRIN. WE HAVE BEEN WAITING FOR YEARS FOR A STUDY COMPARING ASPIRIN TO A STATIN FOR HEART ATTACK PREVENTION. WE ARE STILL WAITING, AND DON'T PLAN TO MAKE UP OUR MINDS UNTIL WE SEE THE DATA.
Joe/Teresa: I don't understand the issue you're raising about statins vs. aspirin. They are not mutually exclusive choices. Whether (in a particular patient population) one is better than the other as monotherapy is irrelevant if the two combined are significantly better at reducing cardiovascular events than either one alone.
And remember, while you are waiting "to make up our minds" the American Heart Association estimates that in the United States 16.8 million people have coronary heart disease (history of heart attack, angina pectoris or both); cardiovascular diseases claimed 864,480 lives in 2005 (35.3 percent of all deaths); coronary heart disease caused 445,687 deaths in 2005 and is the single leading cause of death in America; and an estimated 1.26 million Americans have a new or recurrent heart attack per year. (http://www.americanheart.org/presenter.jhtml?identifier=4478)
I don't have the luxury of waiting to make up my mind. I have to treat my patients based on the best benefit vs. risk data currently available. Your readers deserve no less from you.
PEOPLE'S PHARMACY RESPONSE: WE THINK THAT BOTH ASPIRIN AND A STATIN DRUG CAN BE EXTREMELY HELPFUL FOR PEOPLE WHO HAVE HEART DISEASE OR A HIGH RISK OF HEART DISEASE. OBVIOUSLY, EITHER ONE OF THESE DRUGS UNDERTAKEN INDEFINITELY CALLS FOR MEDICAL SUPERVISION! WE FREQUENTLY TELL PEOPLE WHO PLAN TO TAKE DAILY ASPIRIN (OR NIACIN TO LOWER CHOLESTEROL, FOR THAT MATTER) THAT THIS IS NOT A DO-IT-YOURSELF PROJECT EVEN IF THE DRUG IS AVAILABLE WITHOUT PRESCRIPTION.
BOTH STATINS AND ASPIRIN HAVE SOME POSSIBILITIES OF SIDE EFFECTS, SO IT WOULD BE WORTHWHILE FOR PEOPLE TO DISCUSS THESE WITH THEIR PRIMARY CARE PROVIDERS. TOO MANY PHYSICIANS SEEM TO BE USING THESE MEDICINES INDISCRIMINATELY FOR PRIMARY PREVENTION (THE 'PUT IT IN THE WATER SUPPLY' APPROACH) AND THAT IS PROBABLY NOT APPROPRIATE.