It is now a fact that people who are at high risk for cardiovascular disease may benefit from using statin therapy and reduce their risk for premature death from all causes and cardiovascular events like strokes.  Recently, the US Preventive Services Task Force (USPSTF) has published a review on JAMA Evidence Report confirming the benefits from statin therapy. 

The USPSTF review is based on data from 19 trials of 71,344 participants, which were intended to compare statins with placebo or no statin.  It finds that men and women using statin therapy were at 14%, 31%, 29% and 36% reduced risks for all-cause mortality, cardiovascular mortality, stroke, and heart attack, respectively, compared to those who did not statin therapy.  The absolute benefits were found more significant for those who were at higher cardiovascular risk at baseline.

The review does not find statin therapy associated with increased risk for serious adverse events (1% lower), myalgias (4% lower) (muscle pain), or liver-related harms (10% higher).  Statin use was not associated with diabetes mellitus either, according to the review.  The data were highly heterogeneous and one trial linked statin use to 25% increased risk of diabetes mellitus.

Other studies have found adverse effects of statins more common than the review did.  A report released this year in Acquired Neuromuscular Disorders points out that statin can induce myopathy including myalgias (muscle pain) and weakness, with or without creatine kinase (CK) elevation and in its most severe form rhabdomyolysis with kidney failure.    The report says that statin induced myalgias occur in about 10% of statin users while myopathy with CK elevation is much rarer.

A few things statin users need to know

1) Patients should know which statin to use if they are also using along with a statin other medications that may interfere with the cytochrome P450 (CYP3A4) detoxification system.  To avoid such interference, statins like pravastatin, fluvastatin or rosuvastatin should be used because they are less likely to interdfere with other medications.

2) When prescribing a statin, doctors should consider both patient characteristics such as age, illness, vitamin D deficiency, neuromuscular disorders, genetic variants of certain drug transporters and drug characteristics like type and dose of stain and whether or not another medication is used along with statins.

3) Should a patient suffer statin-induced myopathy, the patient should discontinue using the statin to relieve the adverse effects and then he may re-use the same statin at a lower dose or a different statin with less myotoxicity.   If symptoms or CK elevations are persistent for more than six months after the discontinuing of the statin therapy, other diagnoses instead of statin-induced myopathy should be considered. (David Liu)