Statins & CRP
In addition to lowering cholesterol, statins slow down the buildup of fatty plaque in the arteries of the heart ( atherosclerosis) and they lower levels of C-reactive protein (CRP).33, 34 High CRP is a sign of inflammation, the body's response to injury, and it is linked to a higher risk of heart disease. The aptly titled REVERSAL study found that heart disease patients who lowered their CRP levels the most with statins showed signs of reversing the fatty plaque buildup in the arteries of their hearts.35 The results were not analyzed separately for women but other studies have shown that statins lower CRP in women.
For people who have had a heart attack, lowering CRP reduces the risk of dying from heart disease or having another heart attack. In one study of nearly 4,000 heart attack patients (22% were women), those who lowered their CRP below 2 milligrams per liter (mg/L) were less likely to die or have another heart attack than those with higher CRP levels even if their LDL (bad) cholesterol did not fall below the target 70 mg/dL.36 The patients who lowered both LDL and CRP to target levels fared best. The results were not confirmed separately in women. Overall, intensive statin therapy (80 mg atorvastatin) lowered CRP and LDL cholesterol more than regular dose statin (40 mg pravastatin); however, there was a wide variation in how individual patients responded to these drugs. Previous research shows that statins do not lower CRP levels in some people.37, 38
It is not clear whether lowering CRP with statins has similar benefits in men and women who have not had a heart attack, but ongoing studies may provide an answer.39 Meanwhile, you are unlikely to be prescribed a statin for high CRP alone.
Muscle-related Side Effects
Overall statins are safe medications. The main side effects are muscle pain or weakness. This can be serious if there are signs that the muscle is breaking down -- your doctor will do tests to see if this is the case. In rare cases, this can develop into rhabdomyolysis, a potentially fatal condition in which muscle cells break down and release their contents into the bloodstream. Signs of rhabdomyolysis include muscle pain, swelling, or weakness, usually affecting the back or lower calves. Fever, nausea, dark urine, and a general feeling of discomfort may also occur. If you are taking statins and experience any of these symptoms, you should contact your healthcare provider immediately. The risk of muscle problems is higher if you are taking fibrates (another type of cholesterol-lowering drug) along with statins, and women have a higher risk than men when using both fibrates and statins.40 Medications for other conditions can also increase your risk for muscle-related side effects including cyclosporine, and certain antibiotics (such as erythromycin) or antifungals (such as itraconazole [Diflucan]). It is important that you always tell your doctor what other medications you are taking.
Rhabdomyolysis occurs in approximately 1 patient out of every 100,000 treated with statins, and accounts for less than 1 death per million statin prescriptions.41 However, some of the newer, more potent statins have a higher risk of this potentially fatal side effect. Cerivastatin (Baycol) was banned in the US in August 2001 after being linked to 31 such deaths. According to FDA figures, the incidence of rhabdomyolysis was 10 to 50 times higher for cerivastatin compared with other statins.41 The risks were higher at higher doses, and when cerivastatin was combined with the fibrate gemfibrozil (Lopid). Below are some factors that increase the risk of experiencing muscle problems when taking statins:
- Older age especially over 80 years, and older women more than older men
Small body frame and frailty
Diabetic-related kidney problems
Taking multiple medications
Drinking large quantities of grapefruit juice (more than 1 quart/day)
Rosuvastatin Side Effects & Dosing
Rosuvastatin (Crestor) is the most potent statin currently on the market. It was approved by the FDA in August 2003 at doses of 5 to 40 mg. Very high dose (80 mg) rosuvastatin was not approved by the FDA because it has a relatively high risk of the potentially fatal muscle-wasting side effect (rhabdomyolysis).42 A consumer group asked that rosuvastatin be banned after reports of this side effect with the approved doses.43 The FDA denied the request for a ban stating that Crestor does not pose a greater risk of muscle problems or rhabdomyolysis than the other statins when prescribed correctly. The FDA asked the manufacturers to revise the label for rosuvastatin to emphasize the increased risk at higher doses and in certain groups of patients including those taking fibrates. Specifically, patients taking the fibrate gemfibrozil (Lopid) should not take more than 10 mg of rosuvastatin, and the 40 mg dose should only be used in people who have already tried the 20 mg dose but their LDL cholesterol is still too high.44 Because studies show that Asians and Asian-Americans absorb almost twice as much of this drug into their blood than Caucasians (potentially increasing their risk for side effects), the FDA recommend a 5 mg starting dose for people of this race. Blood levels of rosuvastatin do not seem to differ between Caucasian, African American,,or Hispanic people.
Liver-related Side Effects
The other main side effect seen with statins is liver damage.45 Before you are prescribed a statin, your doctor will test your liver enzymes. These tests will be repeated at 12 weeks and then twice a year assuming no problems are found. If the blood tests show signs of liver damage, you will be taken off the statin; this usually resolves the problem.
Can statins prevent Alzheimer's Disease & Dementia?
Fatty plaque buildup in the arteries of the brain and neck play a role in the development of dementia and Alzheimer's disease (AD), and cholesterol is linked to the plaques found in the brains of people with AD. This led to theories that statins could help lower the risk of mental decline and AD. However, research shows that very low cholesterol levels appears to increase the risk of mental decline,46 and it is not clear whether statins have any affect (positive, negative) on mental function.
Some of the research so far suggests that statins reduce the risk of cognitive decline;47, 48 in other studies, people taking statins experienced increased memory loss.49 Small trials suggest that statins may slightly lower attention and mental speed.50, 51
It is also unclear whether statins affect Alzheimer's disease.52 The Cache County study followed more than 5,000 elderly residents (65 years or older) and saw no difference in the rates of dementia or AD between statin users and nonusers.53 Two large studies on the heart health benefits of statins have not shown any significant impact (either negative or positive) on mental function or dementia.14, 54 The National Institues of Health (NIH) is sponsoring a large study on statins, mental function, and behavior that should shed more light on this issue.55
Do statins increase the risk of cancer
No. Studies from the early 1990s suggested—but did not prove—a link between low cholesterol and a higher risk of dying from cancer.56 54, 57 However, the Heart Protection Study, which included 20,000 people (25% were women), found that those taking simvastatin had no increased risk of cancer.58 In addition, researchers combined the results of studies using various statins and found no increased risk of cancer for people who took statins for 5 years.54, 59, 60 It has also been shown that taking statins for 10 years does not increase your risk of cancer either.61 Now there is even a suggestion that taking statins may protect against some cancers, including colorectal cancer; however, this needs to be investigated more.62
Is red yeast rice the same as a statin?
Red yeast rice is rice that is fermented with red yeast and used in Chinese cooking and herbal medicine. Red yeast rice is sold by many names, including the dietary supplements Cholestin and HypoCol, which claim to lower cholesterol. These preparations may contain a chemical (mevinolin) that is identical to the cholesterol-lowering drug lovastatin (Mevacor). In1998, the FDA banned Cholestin, deeming it an unapproved drug rather than a dietary supplement.63 In August 2007, the FDA warned customers to avoid red yeast rice products promoted on the internet because they could lead to severe muscle problems and kidney problems and interfere with other medications.64 Dietary supplements are not allowed to make claims to treat or cure disease. Drug manufacturers must prove to the FDA that their products are safe and effective before they can be sold in the US. Dietary supplements are not subject to such approval and there are no guarantees that they contain the ingredients listed on the label or that they have the promised effects. In small studies Cholestin has been shown to lower LDL (bad) cholesterol.65 An analysis of 10 commercially available red yeast rice products found that some did not contain any cholesterol-lowering ingredients.66 You should talk to your doctor before taking any dietary supplements. High cholesterol is a major risk factor for heart disease that should be treated with scientifically proven strategies (lifestyle changes and approved medications when necessary).