Statins: The New Wonder Drugs

Statins generally take between four which some call the to six weeks to reach their maximum | effectiveness. Dosages for statins vary | “drug of the century. : depending on the drug, but at least one dose will be taken at dinner or bedtime because the body manufactures more cholesterol at night than during the day.

Stick with It

Just because your cholesterol readings drop doesn’t mean you can stop taking a prescribed statin without your doctor’s say-so. Yet 25 percent of people 65 and older stop taking statins within the first six months, against their doctor’s orders. This is a bad idea for several reasons, not least of which is that statins can’t keep your cholesterol under control if you don’t take them. Moreover, some studies suggest that abruptly stopping the drugs could result in problems, including an increased risk of heart attack, unstable angina, and stroke. Studies in rats found that stopping the drug suddenly dried up production of nitric oxide, the compound responsible for keeping artery walls smooth and flexible and helping to make blood platelets less sticky.

Following the Plan may enable you to take fewer prescription drugs, or even stop taking them altogether eventually. But don’t taper off or forgo your medication without first talking to your doctor.

Paying for Statins

The cost of statins varies widely—from about $55 a month to more than $200 a month (without insurance)—depending on the drug and the dosage. If your insurance plan doesn’t cover prescription drugs, the cost can be quite onerous. But there are ways to spend less. For instance, because drugs are sold by the pill, not by the strength, you can ask your doctor to prescribe double the strength you need (80 milligrams rather than 40 milligrams, for example), then buy a pill-splitter and cut the pills in half. Grapefruit juice increases absorption of statins. If you take your medication with grapefruit juice, let your doctor know; you may be able to get by with a lower dose.

Expect prices to begin dropping since the first generic statin—lovastatin—was approved in 2001. At about $1 a pill, it. costs about half as much as its branded version, Mevacor. In coming years more generic statins will become available and may significantly reduce overall prices in this class of drug.

Let your doctor know if you’re having trouble paying for your drugs, Most pharmaceutical companies have special programs in which they provide prescription drugs for free or reduced rates to people who can’t afford them. Your doctor can tell you more.

The Downside to Statins

Like all drugs, statins have their drawbacks. While they’re deemed extremely safe, given the large number of people who take them and the fact that they’ve been in use for more than 14 years, in rare cases they can cause problems. Among the potential side effects:

Muscle and kidney damage. In 2001 Bayer AG voluntarily recalled its statin drug, Baycol (cerivastatin), from the U.S. market because of reports of at least 31 deaths in the United States linked to the drug. The deaths were the result of a condition called rhabdomyolysis, in which muscle cells break down, releasing proteins that become trapped in the kidneys. This interferes with the kidneys’ ability to filter out toxins from the blood, leading to kidney failure and, potentially, death. Symptoms include muscle pain, weakness, tenderness, malaise, fever, dark urine, nausea, and vomiting. 

While all statins have been associated with very rare reports of rhabdomyolysis, according to the FDA the risk was 16 to 80 percent higher with Baycol, particularly when used at higher doses, in elderly patients, and in combination with Lopid (gemfibrozil), another lipid. lowering drug, The rhabdomyolysis risk associated with the statins that remain on the market, especially when the drugs are used alone by people without rhabdomyolysis risk factors such as renal impairment, is extremely small.

Much less serious is the muscle weakness or pain experienced by some people taking statins. You’re more susceptible if you’re older than 80, have a small body frame or are frail, have a multisystem disease (such as chronic renal insufficiency), or take multiple medications. Generally about 5 percent of people taking statins will experience these side effects. They usually go away once the drug is stopped and can often be prevented by taking coenzyme Q10), which you read about in this Chapter .

Liver damage. Like most drugs, statins are broken down in the liver, thus putting additional stress on the organ. That’s why your doctor will monitor your levels of liver enzymes—an indication of the health of your liver—for the first few months that you are taking the drugs. You should also limit your use of alcohol, which puts additional stress on your liver and increases the risk of liver failure if you’re taking statins (or other medications). Elevated liver enzymes occur in 0.5 to 2 percent of people taking statins—generally those taking the highest doses. Full liver failure is extremely rare, and reducing the drug dose usually reverses elevated enzymes.

Depletion of coenzyme Q10. As we discussed in Chapter, statins also seem to decrease the body’s production of the important substance coenzyme Q1LO0. Cells need CoQ10 to help them use energy, That’s why we recommend you supplement with 100 milligrams daily of CoQ10 if you take statins.

Cataracts. Statins alone don’t cause cataracts. But according to a study published in the Archives of Internal Medicine in September 2001, taking Zocor along with the antibiotic erythromycin might increase the risk. Just a single course of antibiotic, typically taken for 10 days, appeared to double the risk of cataracts, while two or more courses tripled it. If you take statins and need antibiotics, talk with your doctor.

Nerve damage. Researchers studying 500,000 Danish residents found that people who took statins were more likely to develop a form of nerve damage called polyneuropathy than those who never took the drugs. The condition, also known as peripheral neuropathy, results in weakness, tingling, pain in the hands and feet, and difficulty walking. Taking statins for one year those prescribed to humans. However, two later studies examining large populations of people taking statins found no connection between this class of drug and cancer. increased the risk of nerve damage about 15 percent, or one case for every 2,200 patients; for those taking the drug two or more years, the risk increased 26 percent.

Six Side Benefits of Statins

The more researchers study statins, the more potential uses they’re finding for this class of drug, prompting: some doctors to jokingly suggest that it be added to the water supply. Among its potential uses:

Lowering CRP. Numerous studies have found that statins can lower levels of C-reactive protein (CRP), a sign of inflammation that researchers now suspect may be a better predictor of heart disease than even high cholesterol. A study in the journal Circulation in August 2002 showed that Zocor lowered CRP levels in just two weeks.

Reducing stroke risk. In several large studies of statins in patients with existing heart disease. the drugs reduced the risk of a first-time stroke between 11 and 30 percent, An analysis of several published trials suggests statins’ effect on stroke risk’ may be due to more than just its ability to reduce cholesterol. For instance, statins. improve the function of endothelial cells (the cells that make up the artery walls), probably by boosting their production of nitric oxide. This helps keep artery walls smooth and flexible and reduces the likelihood of plaque formation. Statins also. reduce inflammation, make blood platelets less sticky, exert some antioxidant effects, help stabilize plaque so it doesn’t burst, and help prevent blood clots.

Treating autoimmune diseases and preventing transplant rejection. In autoimmune diseases such as psoriasis and rheumatoid arthritis, am overactive immune system