Read on Murmurs Issue 34 (May - Aug 2019) for the latest updates from National Heart Centre Singapore.
Statins are commonly prescribed to help lower low-density lipoprotein (LDL) cholesterol, and reduce the risk of heart attack or stroke. While statin therapy is proven to be effective in reducing the risk, there are still misconceptions on its use and the side effects.
Too much cholesterol in the blood can lead to a build-up of plaque in the arteries and significantly increase the risk of cardiovascular disease. Statins are used primarily to reduce LDL (or known as the ‘bad’ cholesterol) and studies have proven that statin therapy reduces risk of major vascular events by 25% for 1 mmol/L reduction in LDL cholesterol1. Although adverse events have been shown to be related to statin use, the occurrences are relatively rare. Let us now look at some common myths on statins.
MYTH 1: Statins frequently cause muscle ache
Truth: Statins rarely cause muscle ache.
Much of the reported symptoms are likely to be due to misattribution. Researchers found a “nocebo” effect to perceived muscle ache and statins, where patients who were given statins were more likely to think they were experiencing side effects as they expected them2. When the patients were unaware they were given statins, there was no reported increase in muscle-related symptoms. But, when the patients knew they were given statins, they were more likely to report symptoms, a finding consistent with the “nocebo” effect.
MYTH 2: Statins can lead to liver and kidney damage
Truth: It is rare that statins will cause a serious liver problem, and there is no evidence that proves statins can cause an adverse effect on kidney.
Statin therapy can lead to mild increase in liver enzymes but this can be managed by lowering the dose or changing to another brand.
Randomised controlled trials have shown that there was no support for an adverse effect of statin therapy on the kidney; instead, results indicated that statin therapy might slow the progression of renal impairment3.
MYTH 3: Natural supplements are safer than taking statins
Truth: There are no controlled or reliable studies to prove that supplements are safe and can prevent heart disease.
Health supplements are currently not subject to pharmaceutical regulations. Unlike medicines prescribed by the doctors, health supplements generally do not require to go through stringent clinical trial requirements and approval. They may vary in dose strength and contain ingredients that may not necessarily be identified. “Natural” supplements may not necessarily mean that they are safe for every individual, as some supplements may cause harm instead, depending on the person’s health condition and whether the supplements are taken with any other medicines.
MYTH 4: Statins cause diabetes
Truth: Statins are associated with a small increase in risk of diabetes, mainly in those who are at risk of diabetes.
It is important to note that the benefits of reducing cardiovascular risk with statins outweigh the increased risk of diabetes. In addition, patients with diabetes also benefit greatly from statins, which reduce their risk of heart attack, stroke and death.
MYTH 5: Statins cause memory loss and confusion
Truth: Evidence has shown that statins are neither associated with memory loss nor have adverse effects on cognitive function4,5.
There were studies that found that statins may have a protective and symptomatic benefit in dementia and cognitive changes, and can prevent dementia, especially with long-term use6.
MYTH 6: Being intolerant to statins means I will never be able to take statins
Truth: Most people can tolerate statins either by changing the type of statins or by staggering their doses.
Patients should consult their doctors on the treatment options available.
MYTH 7: I have never been told I have high cholesterol, so I will not need statins
Truth: Studies have shown that patients who took statins have lowered their LDL cholesterol and reduced their overall risk of cardiovascular events, regardless of their cholesterol concentrations1.
High-intensity statins regimen is warranted in patients with elevated risk of cardiovascular events even if they are presented with average or below average LDL cholesterol.
MYTH 8: Does changing my diet work as well as taking statins?
Truth: A healthy diet is very important in helping to prevent a heart attack and stroke. With both statins and diet modification7, the risk of heart attack/ stroke and cholesterol can be reduced.
Statins do not just lower cholesterol level. They reduce the risk of plaques breaking off in the blood vessels, thereby reducing risk of causing a heart attack or stroke.
The claims on the side effects of statins might have resulted in the under-utilisation among those who are at increased risk of cardiovascular events. It is therefore important to always seek medical advice from doctors or reliable sources to address any concerns.
1 Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670-1681. doi:10.1016/S0140-6736(10)61350-5.
2 Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet. 2017 Jun 24;389(10088):2473-2481. doi: 10.1016/S0140-6736(17)31075-9.
3 Effect of statins on kidney disease outcomes: a systematic review and meta-analysis. Am J Kidney Dis 2016; 67: 881–92.
4 Testing cognitive function in elderly populations: the PROSPER study. PROspective Study of Pravastatin in the Elderly at Risk. J Neurol Neurosurg Psychiatry 2002; 73: 385–89.
5 Pravastatin and cognitive function in the elderly. Results of the PROSPER study. J Neurol 2010; 257: 85–90.
6 Randomized controlled trial of atorvastatin in mild to moderate Alzheimer disease: LEADe. Neurology 2010; 74: 956–64.
7 Effect of a Dietary Portfolio of Cholesterol-Lowering Foods Given at 2 Levels of Intensity of Dietary Advice on Serum Lipids in Hyperlipidemia: A Randomized Controlled Trial. JAMA. 2011;306(8):831-839. doi:10.1001/jama.2011.1202.
This article is from Murmurs Issue 34 (May – Aug 2019) and contributed by
Dr Ho Jien Sze, Consultant from
Department of Cardiology,
National Heart Centre Singapore (NHCS). Click here to read the full issue.