A comprehensive new study has concluded that the majority of side-effects commonly associated with statins are not directly caused by the medication itself, as noted by The Independent.
Published in The Lancet, the research examined data from 123,940 individuals over an average of 4.5 years, drawn from 19 clinical trials that compared statins to a placebo. It found no significant increased risk from statins for almost all conditions listed as potential side-effects, including depression, sleep problems, fatigue, and headaches.
Expert Guidance on Statin Use
Following this research, Sindy Jodar, a senior cardiac nurse at the British Heart Foundation, outlined key factors for patients and clinicians to consider regarding statin therapy.
Statins work by lowering LDL, or ‘bad’ cholesterol, and triglyceride levels in the bloodstream, which helps prevent plaque build-up in arteries and reduces the risk of heart attacks or strokes.
In the UK, five types of statin are available on prescription: atorvastatin (Lipitor), fluvastatin (Lescol), pravastatin (Lipostat), rosuvastatin (Crestor), and simvastatin (Zocor). The choice of statin is made by a clinician based on an individual’s risk calculation and potential side effects, with atorvastatin being the most commonly prescribed.
Who is Prescribed Statins?
People are typically prescribed statins if they have high cholesterol, but they may also be recommended for those with normal cholesterol levels who have other risk factors. These include a strong family history of premature heart disease, diabetes, high blood pressure, smoking, or being overweight.
General practitioners use a risk calculation that incorporates factors such as height, weight, blood pressure, cholesterol results, and medical history. If this calculation shows a 10% or greater risk of developing a cardiovascular disease like a heart attack or stroke within the next decade, statins are usually recommended.
While statins are most commonly prescribed to older adults due to age being a significant risk factor, younger patients with very high cholesterol levels can also be prescribed them.
Contraindications and Precautions
Statins may not be suitable for everyone. For example, atorvastatin might not be suitable for those with a history of allergic reactions to it or other medicines, liver or kidney problems, or for individuals who are pregnant, breastfeeding, or have lung disease.
As statins reduce LDL production in the liver and can affect liver enzymes, they might not be appropriate for those with already deranged liver enzymes. The NHS also advises that patients should inform their GP if they have had a stroke caused by bleeding into the brain, regularly drink large amounts of alcohol, have an underactive thyroid, have experienced muscular side effects from statins before, or have a history of muscle disorders such as fibromyalgia, myasthenia gravis, or ocular myasthenia.
Taking and Monitoring Statins
Statins are usually taken once a day, typically at night after dinner. Before starting treatment, patients undergo a blood test to check cholesterol levels and liver enzymes, with a repeat test scheduled between six months to a year later to monitor these levels and liver function.
Patients are advised to inform their GP of all other medications they are taking to avoid interactions, and to avoid consuming grapefruit as it can impact the medication’s effectiveness. A healthy lifestyle—including quitting smoking, regular physical activity, and a balanced diet—is emphasised as working best alongside statins to enhance their benefits.
Long-Term Management
Statins are generally considered a lifelong medication. Patients should have regular reviews with their GP, who may reduce the dose if cholesterol levels stabilise at a good level. Stopping statins completely carries the risk of cholesterol levels rising again and negates their preventative role in protecting against future cardiovascular disease for those at high risk.
