Study Shows Statin-Intolerant Patients May Have Options
A Cleveland Clinic study finds that changes in dosage or frequency of medication use may make the difference.
If you have experienced muscle aches or other side effects from taking statins, a Cleveland Clinic study suggests that you may be able to tolerate the cholesterol-lowering medications with some simple changes in treatment.
A study led by Leslie Cho, MD, co-Section Head of Preventive Cardiology and Rehabilitation in the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic, found that 72.5 percent of patients who were previously reported to be intolerant to two or more statins were able to tolerate statins when their regimen was carefully restarted.
“Statins make people with heart disease live longer and have fewer cardiac events,” Dr. Cho says. “They also prevent heart attacks and death in patients who do not have heart disease. Thus, it is crucial that if they can tolerate it that patients stay on statin therapy.”
Dr. Cho adds that if you experience side effects from statins, it’s important to find out why as soon as possible. “Sometimes it has to do with other medications or the type of statin that they are on,” she explains.
Statin Therapy Basics
Statins’ primary purpose is to lower LDL (“bad”) cholesterol in the body. The medications are among the most-prescribed drugs in the world, and are generally well tolerated by most patients.
Several types of statins are available, and doses come in sizes ranging from 5 mg to 80 mg. Dr. Cho notes that statins have been shown to reduce cholesterol levels by as much as 20 to 40 percent at the lowest dose level.
“We tend to use statins that are more specific, such as rosuvastatin or pravastatin, and we tend to start once a week and then titrate up,” Dr. Cho explains. “The higher the dose, the more issues they can have, so it is best to start low.”
The higher your LDL, however, the higher dosage you’ll probably be prescribed at the outset. But a high dosage taken daily is more likely to cause side effects, such as muscle pain or liver dysfunction. An estimated 10 to 15 percent of statin users report side effects, the most common of which are muscle pain and/or weakness.
Overcoming Side Effects
Dr. Cho’s study found that, among patients who experienced side effects and appeared to be statin-intolerant, 63.2 percent of them were able to go back on a daily statin regimen. Usually, restarting statin therapy involved switching to a different drug in that class of medications or lowering the dose.
In addition, 9.3 percent of formerly statin-intolerant patients found success on intermittent therapy, which usually involved taking the drugs every other day or even once a week. Dr. Cho says that it was especially encouraging to see that even patients in the intermittent treatment group experienced significant benefits from statin therapy.
“Our study shows that patients who have experienced statin intolerance should, under the close care of their physician, continue to try other drugs in this class because there is a very good chance that they will eventually be able to tolerate long-term use of a statin and benefit from its cholesterol-lowering effects,” Dr. Cho says. “Even if patients cannot tolerate a daily dose of a statin, it’s possible to see a significant reduction in cholesterol levels from taking the drug less often, even as infrequently as once a week.”