Each year, doctors write somewhere around 200 million prescriptions for a single class of medications: statins.
Lauded for their cholesterol-lowering ability, statins have become a staple in the medicine cabinets of countless American adults. Nearly 45 percent of people age 60 years and older are on some form of statin; a category that includes: atorvastatin (Lipitor), pravastatin (Pravachol), simvastatin (Zocor) and lovastatin (Altoprev, Mevacor).
The potential benefits of these drugs are thought to be so great that some medical experts have even proposed that all adults should be prescribed statins in mid-life, regardless of their risk for, or history of, heart disease. Not only can statins help prevent cardiovascular disease, their use has also been linked to lower levels of inflammation, a condition linked a host of undesirable diseases including, diabetes, Parkinson's disease, Alzheimer's disease and cancer.
"Cardiovascular disease is the number one cause of death in the U.S., and among elderly Americans," says Eliot Brinton, M.D., Director of Atherometabolic Research at the Utah Foundation for Biomedical Research and President of the Utah Lipid Center. "Statins remain the very best preventive treatment for cardiovascular disease, both for those who have experienced a cardiovascular event (i.e. heart attack, stroke) and those who haven't."
Popular meds not without controversy
Despite their advantages, statins have gotten a bad rap in recent years. Their effectiveness has come into question, particularly among the elderly population, and the frequency of undesirable side effects have had a devastating effect on statin medication adherence.
According to Brinton, over half of adults who are prescribed statins will stop taking the drug within the first year, often without telling their physician. Citing findings from a recent nationwide survey conducted by the National Lipid Association, Brinton says 62 percent of people who discontinued their statin medication claimed they stopped because they didn't want to deal with the side effects of the drug.
About 20 percent of people on statin medication experienced a negative event while taking statins, according to new research from Brigham and Women's Hospital. The most prevalent problems were myopathy and myalgia—essentially muscle pain and weakness. These side effects were severe enough to compel many individuals in the study to stop taking statins altogether; a move that doctors consistently urge their patients not to make.
Biologically, statins can interfere with a person's metabolism and muscle functioning. But Brinton admits not much is known about why certain people appear to be more intolerant of these medications than others, or how to predict which individuals will have a negative reaction to the drugs.
What doctors do know is that some statins are more easily tolerated than others. So, even if a person doesn't do well on one type of statin, that doesn't mean they have to avoid the entire class of cholesterol-lowering medications altogether. And overall, the preventive benefits of statins appear to outweigh the potential drawbacks.
What you need to know about statins
Sifting through the mixed bag of information surrounding statin medication can be tricky for elders and their caregivers.
If you or a loved one is currently taking (or considering taking) statin medication, here are seven important things to keep in mind:
- Statin dosing is difficult: Finding the right dose of statin medication for a particular individual can be a challenge. While statins have been proven to be effective in people who are middle-aged as well as those who are elderly, older adults are likely to respond better to lower doses of the drug. "For many older individuals, high-dose statins are not a good idea," Brinton says.
- Mobility problems may occur: One of the most common complaints from those on statins is that they cause muscle weakness, pain and fatigue. If these issues are truly caused by statin medication, they won't be able to be alleviated by using over-the-counter pain medications such as Advil or Tylenol. These side effects can be especially dangerous for aging adults, as they can increase the risk of falls in elderly people. Brinton suggests caregivers remain on the lookout for signs of weakness and trouble balancing in their aging loved one. If such problems arise, the elder's doctor should be notified so steps can be taken to remedy the problem.
- Benefits of statins can't be felt: One of the challenges of getting people to stick with statins, according to Brinton, is that the benefits of the drugs are basically invisible to the person taking them. Because an individual can't feel the drugs working in their body, they may be more likely to stop taking them if they experience an adverse reaction. Brinton says that a person should never stop taking any prescription medication without first notifying their doctor.
- Drug interactions aren't uncommon: A recent investigation of more than 10,000 statin users found that 84 percent were taking at least one other medication (either prescription or over-the-counter) that had the potential to affect the effectiveness of the statin. Commonly-prescribed medications that may negatively interact with statins include: gemfibrozil (Lopid), antidepressants such as nefazodone (Serzone, Nefadar), amiodarone (Cordarone), cyclosporine (Sandimmune) and certain antibiotics containing clarithromycin and erythromycin.
- Diabetes risk may increase: An analysis by the Harvard Medical School, and published in the journal Circulation, found that individuals taking statin medications experienced a nine percent increase in their overall risk for developing diabetes than those not taking the drugs. While acknowledging the link, Brinton feels that it's "largely overblown." He points out that some statins have actually been shown to reduce diabetes risk and may even help diabetic women better control their blood sugar levels. Indeed, high cholesterol, the health condition that statins are designed to treat, is one of the top diabetes risk factors.
- Cognitive issues can arise: New statements on statin prescription bottles now make reference to the fact that some people have reportedly developed symptoms of memory loss and confusion while taking the drugs. Brinton says the wording on this issue is vague because the research findings are vague—there's no definitive data that directly links statins with cognitive issues. However, he does make a point to mention that any change in a person's cognition that occurs soon after they've started a new prescription should be reported to their doctor.
- Not every elder needs statins: Because statins are meant as a preventive measure, Brinton feels that people who are nearing the end of their lives do not necessarily need to keep taking these medications. "Certain individuals may accumulate enough disability from other issues that intervention to prevent cardiovascular disease is no longer necessary," he says. As an elder nears the end of their life, statins can be included on the list of medications that could possibly be tapered off to make them more comfortable.
Ultimately, successful administration of statins (and any prescription medication, for that matter) hinges on ongoing, honest communication between a doctor and their patient (or their caregiver).
Brinton urges caregivers to avoid assuming their loved one's doctor knows all of the different drugs they are on. He says caregivers play a "crucial role" in making sure an elder's doctor knows which medications (both over-the-counter, and prescription) that their aging loved one is taking.