Hazards May Diminish the Benefits of Statin Use

Authors of a recent paper reviewed the available literature on the adverse effects caused by the use of the statin class of cholesterol reducing drugs and suggested that damage caused to mitochondria may have been the underlying reason for statin-related problems.

Investigators at the University of California, San Diego (La Jolla, USA) examined results from more than 900 studies that described statin (HMG-CoA reductase inhibitors) side effects. They found that the majority of adverse effects were linked to muscle injury with rhabdomyolysis being the most serious complication.

Side effects were found to increase with statin potency, often through inhibition of the mitochondrial cytochrome P450 3A4 system. Additional risk factors for the development of statin side effects were those linked to mitochondrial or metabolic vulnerability, such as metabolic syndrome factors, thyroid disease, and genetic mutations linked to mitochondrial dysfunction.

The review, which appeared in the December 2008 online edition of the American Journal of Cardiovascular Drugs, found that many physicians were unaware not only of the possibility of muscle damage but also of other statin side effects such as cognitive loss, neuropathy, pancreatic and hepatic dysfunction, and sexual dysfunction.

"Physician awareness of such side effects is reportedly low," said first author Dr. Beatrice Golomb, associate professor of medicine at the University of California, San Diego. "Being vigilant for adverse effects in their patients is necessary in order for doctors to provide informed treatment decisions and improved patient care. Muscle problems are the best known of statin drugs' adverse side effects, but cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported. The risk of adverse effects goes up as age goes up, and this helps explain why statins' benefits have not been found to exceed their risks in those over 70 or 75 years old, even those with heart disease."

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