Few medications have captivated physicians more than statins. It is estimated that anywhere from 20 million to 40 million Americans now take drugs like Crestor, Lipitor, lovastatin, pravastatin or simvastatin.
There is a strong belief that statins save lives by preventing heart attacks and strokes. There is data to support that idea, but only for people with clearly diagnosed heart disease. In other words, patients who have substantial obstruction in their coronary arteries or who have suffered a heart attack do seem to benefit from statins.
Three fourths of the prescriptions that are written for such drugs, however, are for primary prevention. In other words, doctors are prescribing Crestor, Lipitor and simvastatin to healthy people who have no symptoms. These are people who may have “risk factors” for developing heart disease, but who are otherwise doing pretty well.
Is it logical for physicians to prescribe statins to healthy people in the hope that such drugs will extend their lives? If doctors truly believe in “evidence-based medicine,” the answer has to be no. A recent analysis of 11 clinical trials involving over 65,000 people produced no evidence that statins saved lives (Archives of Internal Medicine, June 28, 2010).
Even though there is no good evidence that statins prolong life when prescribed for primary prevention, there is no doubt that these medications do cause side effects. Muscle pain and weakness are the most common complaints, but some people also report cognitive problems (memory and thinking not quite right), peripheral neuropathy and elevated blood sugar. There is even a report that statins are linked to cataracts (BMJ, May 20, 2010).
Nevertheless, some physicians find the idea of reporting stain side effects sacrilegious. One doctor offered this comment:
“The benefit to risk ratio of statins has been estimated at 400:1. As an endocrinologist with a focus on preventive cardiology I can assure your readers that far more “statin-phobic” patients are suffering and dying needlessly from preventable cardiovascular disease than are harmed by statins. Yet, the wildly exaggerated and irresponsible statin-bashing continues…
“By the mid 1990’s muscle complaints went from rare to common very soon after the statin companies started direct to consumer advertising, which included FDA-mandated warnings about muscle symptoms (warnings which were due to the very rare cases of rhabdomyolysis). Now I deal every day with patients blaming every ache and pain (left knee pain, right shoulder pain, left thumb pain, woke up this morning with neck pain, you name it) on their statins, often with no logical temporal connection.
“And they are telling all their family, friends and neighbors about it. I believe that some people do have muscle symptoms from statins. I also believe that the vast majority of aches and pains that are blamed on statins are not due to statins, but rather to this mass public hysteria, fed by word of mouth and fueled by the media.” M.D.A, MD
Well, we don’t want to start a statin war, but we do wish physicians would stay on top of the medical literature. The most recent article in the Archives of Internal Medicine and an accompanying editorial should be required reading for any doctor who prescribes a drug like Crestor, Lipitor or simvastatin to someone without heart disease.