We understand why some doctors dislike hearing complaints from patients about drug side effects. After all, they have promised to “first, do no harm.” That was purportedly the message from the ancient Greek physician Hippocrates. It is painful to learn that a medicine that is supposed to be helpful has caused a patient harm. This appears to be especially aggravating for some doctors when it involves stories of statin side effects.
The very first statin was Mevacor (lovastatin). It was launched in 1987. Three decades later, this drug and its chemical cousins, atorvastatin (Lipitor), Fluvastatin (Lescol), pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor) and pitavastatin (Livalo) are among the most widely prescribed drugs in the world. These cholesterol-lowering medications form the bedrock of heart attack prevention.
Today, atorvastatin is taken by over 20 million Americans. Simvastatin is swallowed daily by more than 10 million people. Our back-of-the-envelope calculation suggests that roughly 45 million people in the U.S. take statins regularly.
How effective are these drugs for reducing the risk of heart attacks and extending life? You would be astonished how controversial that question is. We will not go down that rabbit hole in this article.
We will share with you an editorial by a renowned cardiologist, though. Rita Redberg, MD, MSc, is professor of medicine at the University of California, San Francisco Medical Center. She is Editor-in-Chief of JAMA Internal Medicine. Dr. Redberg and a colleague used a “decision aid” from the Mayo Clinic website to determine risks and benefits of statins.
They offered this perspective on statins for the primary prevention of heart attacks in JAMA Internal Medicine ( January, 2017).
“Using the current data, the decision aid shows that of 100 people who take a statin for 5 years, only 2 of 100 will avoid a myocardial infarction [heart attack], and 98 of the 100 will not experience any benefit. There will be no mortality benefit for any of the 100 people taking the medicine every day for 5 years. At the same time, 5 to 20 of the 100 will experience muscle aches, weakness, fatigue, cognitive dysfunction, and increased risk of diabetes.”
You can learn more about statin effectiveness at this link.
Do Statins Cause Side Effects?
This may seem like a ridiculous question. Virtually all drugs cause some side effects in some people. And yet statins have created a cloud of controversy that never seems to dissipate.
Despite the side effects that Dr. Redberg mentions in her editorial, many of her colleagues believe that statin side effects are extremely rare, if they exist at all.
“Only a small minority of symptoms reported on statins are genuinely due to the statins: almost all would occur just as frequently on placebo.”
Shhhh…Stories of Statin Side Effects are “Fear Mongering”
Stories of statin side effects are considered fake medical news by some cardiologists. An article in JAMA Cardiology (June 26, 2019) suggests that any questioning of the benefits of statins or describing stories of statin side effects equals “fear mongering.”
We are not so sure that is a fair characterization. While it is true that lots of people are able to tolerate statins without problems, we sometimes hear from people who experience serious complications. One reader took us to task for overlooking the complication they experienced.
Pancreatitis as a Side Effect of Statins:
Q. Why is pancreatitis so seldom listed as a side effect of statins? I took statins for many years and suffered from many of the side effects you described in a recent article. One serious complication you didn’t address is pancreatitis.
After a year of acute pancreatitis attacks, three different GI specialist exams and numerous tests and hospitalizations, the specialists determined that the cause was atorvastatin. I discontinued atorvastatin nine months ago and have not had another pancreatitis attack. Pancreatitis is only rarely listed as a statin side effect.
A Rare and Controversial Complication:
A. You have alerted us to a controversial adverse reaction to statin-type cholesterol-lowering drugs. There is a mention of pancreatitis in the official prescribing information for atorvastatin (Lipitor), but it is pretty well buried. This is considered a rare complication.
Pancreatitis is inflammation of the pancreas. Symptoms include abdominal pain radiating to the back. If someone touches the belly, the pain can be intense. Pancreatitis is also associated with nausea, vomiting, rapid heart rate and fever.
Researchers in Taiwan have found that people taking atorvastatin or rosuvastatin (Crestor) are more likely to suffer pancreatitis (Medicine, Feb. 2016; International Journal of Cardiology, March 27, 2015). However, a meta-analysis of 13 studies found no such association (United European Gastroenterology Journal, Oct. 2018).
Stories of Statin Side Effects:
“Almost 30 years ago, I was diagnosed with an autoimmune kidney disease for which there is no cure. I’ve kept my kidneys functioning since then with a non-standard therapy.
“At the time I was diagnosed, the attending nephrologist handed me a copy of a study in which patients with my condition took amino acids and DHA from fish oil to extend the life of their kidneys. He told me, ‘You’re an engineer. You can figure out the dosage from these data.’
“I pursued the fish oil approach. Instead of being on dialysis a year after diagnosis, as initially predicted, I have survived for decades with slowly degrading kidneys. I attribute these unusually good results to the fish oil study from Harvard.
“How does this connect to The People’s Pharmacy newsletter? Statins!
How Do Statins Affect Kidney Function?
“Three years ago, I gave in to my primary care physician (PCP) and agreed to take atorvastatin. My cholesterol had been hovering between 200 and 220.
“About five months ago, I started physical therapy for painful quad muscles in my right leg. The right thigh was noticeably thinner than the left, perhaps due to some atrophy.
“I was also feeling mentally foggy. Crossword puzzles and Sudoku that had once been easy were now challenging. I also had bouts of unusual fatigue and I ached all over (not in the joints, hence not arthritis). Nearly every night I had recurring abdominal pain. Most alarming, my GFR, a measure of kidney function, was dropping more rapidly than it had in prior years. When I asked my PCP about these problems, he said they were normal aging.
“Around this time, I read in your newsletter about some folks having the symptoms I was experiencing as a reaction to statins. I mentioned it to the physical therapist, who immediately contacted my PCP. As a result, I stopped taking atorvastatin three months ago. All my symptoms of fatigue, mental fog, all-over aches and abdominal pain have disappeared. I don’t plan to restart the statin, although the PCP is recommending it. I want to urge everyone to get educated on their own health and the medications they take. Be your own advocate!”
Balancing Benefits vs. Risks:
We were glad to hear that reader got in touch with their PCP. No one should ever stop any prescription medication without discussing the pros and cons with the prescriber. We also agree with our reader that everyone needs to be an active and informed participant in their own health care.
The official prescribing information for atorvastatin warns doctors that low kidney function may predispose patients to serious reactions affecting muscles.
“Advise patients to promptly report to their physician unexplained and/or persistent muscle pain, tenderness, or weakness.”
When patients report symptoms such as those our reader experienced, doctors should pay attention. If it is fear mongering to mention statin side effects, then the FDA is guilty of massive fear mongering.
Here is just a fraction of what the agency says about atorvastatin:
“The most commonly reported adverse reactions (incidence ≥ 2% and greater than placebo) regardless of causality, in patients treated with atorvastatin calcium in placebo controlled trials (n=8755) were: nasopharyngitis (8.3%), arthralgia (6.9%), diarrhea (6.8%), pain in extremity (6%), and urinary tract infection (5.7%).”
People who participated in clinical trials discontinued their involvement because of myalgia (muscle pain), diarrhea, nausea and liver enzyme elevation.
The FDA also notes that:
“There have been rare postmarketing reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use. These cognitive issues have been reported for all statins.”
Some doctors would doubtless accuse the FDA of fear mongering because of that notification.
Other Stories of Statin Side Effects:
Over the last 30+ years we have collected thousands of stories of statin side effects. Here are just a few:
Ellen describes the downward spiral her husband took:
“My husband was given statins back in 2000. The almost immediate terrible muscle pain crippled him. So, the doctor kept trying other statins.
“He then developed memory problems so severe that I thought I was going to have to put labels on everything in the house. He took tests for dementia, which he did not have.
“Then he developed peripheral non-diabetic neuropathy. Finally, he stopped the statins. But while his memory did improve, and the muscle pain eased, the neuropathy remained and got worse.
“The doctor he has now took statins himself and after experiencing side effects, he won’t prescribe them for anyone if there is any way around it. To us, there is no controversy about statins at all. They were harmful. They can affect the myelin sheath which protects the nerves in the body and the brain. We do not understand why doctors refuse to recognize that there are people who cannot take these drugs.”
Brenda lost her memory:
“I have been taking simvastatin for several years. Over the past 3 years I have experienced sudden memory loss while driving in very familiar areas. I am fully aware of where I am (city, state) but I have no idea how to get to my house. I feel confused about what street I am on and which way I need to turn to get home. Fortunately, I snap out of it before too long and recognize what I need to do. It used to happen near a certain intersection but now it occurs at a few different locations. I can’t help but think it is medication related.”
More Stories of Statin Side Effects:
Deloris lists what happened to her:
“My statin side effects? Let me count the ways…
1) Muscle cramps, pain, and weakness
2) Numbness and tingling
3) Shortness of breath
4) Calcification of my coronary arteries and valves
5) Increased joint pain
6) Rheumatoid arthritis
7) Psoriatic arthritis
8) Peripheral neuropathy in feet, legs, and right hand
10) Denervation atrophy of muscles
11) Exercise intolerance
12) Cataract at age 63
Cataracts: More Stories of Statin Side Effects
Cliff shared this story about statins and cataracts:
“Roughly 15 years ago I consulted a pair of ophthalmology researchers at a major medical school in Chicago. Upon learning I was taking a statin, they alerted me to a likely causal relationship between statins and cataracts, except they used the words ‘will’ and ‘when’ rather than ‘may’ and ‘if.’ I wound up switching to another class of medications, because the statin seemed to be really aggravating my essential tremor. I did indeed develop cataracts.”
Cecily developed early cataracts:
“I was mid 50’s when I had my first cataract. There was no family history of cataracts. I have no major health problems. It was a total shock. I later learned the connection with statins, which I had been on for 10 or more years.”
Of course there is no way to determine whether Cecily’s cataract was due to the statin she took. The medical literature does suggest there is an association between statins and cataracts (Regulatory Toxicology and Pharmacology, Dec. 2019).
Statins can be helpful for people who have had a heart attack. Such drugs reduce the risk of another cardiac event.
How well statins work to prevent a heart attack in otherwise healthy people remains highly controversial. Of course, no one should ever stop any medication without first checking with the prescriber. There may be other reasons to take a statin.
What about your experience with statins? Have you experienced any statin side effects? Have you taken statins for years without any problems? Whatever your story, we would like very much to hear from you in the comment section below.
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