Debunking Statin Myths

You know high cholesterol is not a good thing. But just how dangerous it can be was driven home in a 2019 study in the Journal of the American Heart Association. Scientists following 3,875 adults for 35 years found that those with long exposure to high LDL cholesterol — often called “bad” cholesterol — had five times the rate of cardiovascular disease and four times the mortality of individuals with optimal LDL levels.

While the best way to lower LDL, which clogs arteries and is a significant cause of heart attack and stroke, is through diet and exercise, statins are the accepted second line of defense. And with good reason, says Nihar Desai, M.D., associate professor of medicine at the Yale School of Medicine in New Haven, Connecticut. “The data to support their use is overwhelming,” he says. “They’re highly effective at reducing the risk of cardiac disease and cardiac events like a heart attack.”

Yet only about 60 percent of people with coronary artery disease and peripheral artery disease, or who have had a stroke, are being prescribed the recommended statin therapy, according to a 2020 study in JAMA Network Open. And only slightly more than half (or 47 million) the adults who could benefit from cholesterol medication are currently taking it, according to the Centers for Disease Control and Prevention.

Some of the hesitation comes from concerns about potential side effects, which many doctors say have been overblown. Here’s a closer look at common concerns with statins like atorvastatin (Lipitor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor) — and when you need to worry, or not.

CONCERN: Statins can have a lot of side effects, including muscle pain, digestive problems and liver damage.

REALITY: Patients who take statins are often told by their doctors to report back if they have muscle problems, which appear in about 5 percent of patients. But awareness of the potential for this symptom and others, like digestive problems, can have its own effect, says Roger S. Blumenthal, M.D., professor of medicine at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore, who explains that what may be at play is a kind of twist on the placebo effect, called the nocebo effect.

A study reported in The New England Journal of Medicine in November 2020 found evidence for this idea. Researchers conducted a blinded trial of statins versus a placebo, or no treatment, among 60 patients who had abandoned statins because they had what they judged to be serious side effects. In patients who discontinued statin therapy because of side effects, 90 percent of the symptoms caused by the statins were also caused by the placebo.

When patients complain of muscle problems, Blumenthal often stops their medication for a bit and then restarts it to see if it is still intolerable. Some patients will do better taking statins every other day, or at a lower dose, he says.

Donald Lloyd-Jones, M.D., chair of the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine in Chicago, says that in general, atorvastatin (Lipitor) and rosuvastatin (Crestor) are among the best-tolerated statins and also have the greatest LDL-lowering effect and best safety profile.

Liver issues are another reported side effect of statins. Lloyd-Jones says that this problem occurs in patients who already have fatty liver, a metabolic disorder that causes fat buildup in the liver. Rarely do patients get earlier, mild liver inflammation from statins, he says.

The U.S. Department of Health and Human Services notes that serious risks are rare with statins, and that studies involving thousands of people show no differences in muscle aches and liver abnormalities between those taking a statin and those on an inactive pill.

CONCERN: Statins cause diabetes.

REALITY: Statins can increase the risk of developing diabetes by about 30 percent in people already at risk for the disease or who have prediabetes, according to a 2017 study in a British medical journal.

“People with normal blood sugar do not develop diabetes because you put them on a statin. These people were going to become diabetic anyway. Maybe we accelerated their diabetes slightly,” says Lloyd-Jones. “We don’t prevent diabetes by withholding statins. We do it with lifestyle changes.”

CONCERN: Statins cause dementia, or cognitive dysfunction.

REALITY: There have been many studies on the use of statin medications to prevent heart attacks that have shown that the statins don’t cause cognitive problems, including dementia. In fact, they have been shown to prevent dementia with long-term use.

In a study reported in Scientific Reports in 2018, researchers found that statin users without baseline cognitive problems had between a 15 and 26 percent reduced risk of developing dementia and mild cognitive dysfunction.

“It’s extremely rare that statins are associated with a change in mental status, quite rare in fact, because statins prevent little strokes that add up to dementia,” says Lloyd-Jones.