According to the Centers for Disease Control (CDC), more than 38 million Americans take a single class of medications: statins. Lauded for their ability to lower “bad” cholesterol and help prevent heart attacks and strokes, statins have become a staple in the medicine cabinets of countless Americans who are at higher risk for cardiovascular disease. Nearly 45 percent of people age 60 and older are on some form of statin, such as 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 suggested 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, but their use has also been linked to lower levels of inflammation, a condition linked to a host of other health issues, 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,” explains Eliot Brinton, MD, 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 like a heart attack or stroke and those who haven't.”
The Controversy Surrounding Cholesterol-Lowering Drugs
Despite their advantages, statins have gotten a bad rap in recent years. Their effectiveness has come into question, particularly for the elderly population, and the frequency of undesirable side effects has had a devastating effect on statin medication adherence.
According to Dr. Brinton, over half of adults who are prescribed statins will stop taking the drug within the first year, often without telling their physicians. Citing findings from a nationwide survey conducted by the National Lipid Association (NLA), Dr. Brinton says 62 percent of people who discontinued their statin medication claimed they stopped because they didn't want to deal with the bothersome side effects.
The American College of Cardiology estimates that statin drugs are well-tolerated by approximately 85 to 90 percent of patients, but a significant percentage stop taking the medication as directed—a move that doctors consistently urge their patients not to make. The most prevalent side effects of statin use are myalgia and myopathy (muscle pain and weakness).
Biologically, statins can interfere with a person's metabolism and muscle function. However, Dr. Brinton admits little is known about why certain people appear to be more tolerant of these medications than others, or how to predict which individuals will experience adverse reactions 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 drugs. Overall, the preventive benefits of statins appear to outweigh the potential drawbacks.
Facts About Statin Use
Sifting through the mixed information surrounding statin medication can be tricky for elders and their caregivers. If you or a loved one is currently taking (or considering taking) a statin, here are seven important things to keep in mind:
- Statin dosing is difficult. Finding the right dose of statin medication can be a challenge. While these medications have been proven effective in middle-aged people and seniors, older adults are likely to respond better to lower doses of the drug. “For many elders, high-dose statins are not a good idea,” Dr. Brinton states.
- 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 statins, then over-the-counter pain medications like Advil or Tylenol won’t provide relief. Side effects that impact mobility and activity levels can be especially dangerous for aging adults because they can contribute to falls. Dr. Brinton suggests caregivers remain on the lookout for signs of weakness and changes in balance and coordination in their aging loved ones. If such problems arise, the elder's doctor should be notified immediately so steps can be taken to remedy the problem.
- The benefits of statins can't be felt. “One of the factors in low adherence to statin therapy is that the benefits of the drugs are basically invisible to the person taking them,” explains Dr. Brinton. Because an individual can't feel the drugs working in their body, they may be more likely to stop taking them if they experience even a minor adverse reaction. Dr. Brinton seriously discourages patients from stopping any prescribed medication without first notifying their doctor.
- Drug interactions aren't uncommon. A study 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 could potentially alter 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. It is crucial that every member of a person’s medical care team has a complete list of all prescription and over-the-counter medications, vitamins and supplements they take to minimize the risk of interactions.
- Diabetes risk may increase. An analysis by the Harvard Medical School published in the journal Circulation found that individuals taking statin medications experienced a nine percent increase in their overall risk for developing diabetes. While Dr. Brinton acknowledges this link, he 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. Statin prescription bottles now feature labels disclosing that some people may develop symptoms of memory loss and confusion while taking the drugs. Dr. Brinton says the wording on this issue is vague just like the medical research findings on the topic. There's no definitive data that directly links statins with cognitive decline. However, Dr. Brinton confirms that any change in a person's cognition occurring soon after they've started a new prescription should be reported to their doctor immediately.
- Not every elder needs statins. Because statins are intended for use as a preventive measure, Dr. 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 are one of many drugs that can 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 doctors and their patients (or their caregivers).