Despite the proven benefits of the cholesterol-lowering statin medications in reducing future cardiovascular events such as heart attacks and strokes, particularly in those with known cardiovascular disease, many patients remain reluctant to take these medications due to potential perceived side effects. In complying with current cardiology guidelines, I encourage all patients with known vascular disease, including those who have adopted a heart-healthy, plant-based lifestyle to take a statin. Dr. Robert Vogel recently presented data which should help to ease the minds of the many patients concerned about potential statin side-effects.(6)
One potential side-effect of statins is the possibility that they may cause confusion or memory loss. In fact, in 2012, the FDA mandated that all statins carry the warning that this is a potential consequence which can be reversed upon discontinuation of the medication. To address this, Dr. Vogel references a data from Johns Hopkins where they reviewed 16 randomized trials and population studies which demonstrated no short-term adverse consequences on cognitive endpoints. In fact, eight long-term studies showed a 29% reduction in new-onset dementia in those taking statins. (1). Another large analysis of 27 studies showed no evidence of increased dementia or objective cognitive impairment. (2) In this same report, the incidence of cognitive-related adverse events was found to be only 1.9 cases per 1 million statin prescriptions, no different from common blood pressure and blood-thinning medications.
The most commonly experienced side effect attributed to statins is muscle aches, or myalgias. A study was performed to evaluate this effect by randomizing 420 people to either a high-dose statin or a placebo (sugar pill). The incidence of myalgias was 9.4% in those taking statins, roughly 5% higher than those taking placebo. So the true incidence of significant muscle aches is around 1 in 20 patients, a much lower number than anticipated by most patients who have disproportionately heard this complaint expressed by friends or family members.(3)
Many patients also fear that starting a statin will cause them to have diabetes. An analysis of 13 trials involving over 90,000 patients who were followed for over four years on average found that only one additional new case of diabetes developed for every 255 patients treated with statin therapy. The benefit of statins in reducing adverse cardiovascular events far outweighs this small risk.(4)
Finally, there is some concern that statins might increase the risk of hemorrhagic strokes. These strokes result from bleeding into the brain, and account for less than 10% of all strokes. Roughly 90% of strokes are ischemic strokes. These are caused by a blockage of blood flow to the brain due to a narrowed blood vessel or a blood clot. In a trial involving nearly 5,000 patients who had a recent stroke, high dose statin therapy dramatically reduced recurrent ischemic strokes but slightly increased the risk of hemorrhagic strokes from 1.4% to 2.3%. Patients whose initial stroke was hemorrhagic and those with very high blood pressures were at particularly high risk for having a hemorrhagic stroke on high dose statin therapy.(5) Despite causing a slight increase in hemorrhagic strokes, is important to keep in mind that statins were extremely effective at reducing ischemic strokes which affect the majority of people. Once again, the large benefit of statins in those with a prior stroke outweighs the small risk.
Although statins do indeed have some side effects, large clinical trials confirm that these are much less likely than anticipated based on anecdotal stories. Without exception, the benefit of statins in those with proven cardiovascular disease is undeniable, and far outweighs any risk. Although those leading a healthy lifestyle may experience less of a relative benefit from statins than what was observed in clinical trials, they still have an important role in this population.
- Mayo Clin Proc. 2013 Nov;88(11)1213-21
- Ann Intern Med. 2013 Nov 19;159(10):688-97
- Circulation. 2013 Jan 1;127(1):96-103
- Lancet. 2010 Feb 27;375(9716):735-42
- Neurology. 2008 Jun 10;70(24):2364-70
- Cardiology News. 2018 March;16(3):1,15