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Statins and side effects
An essay on statins and side effects
Module
Medicine (A100)
63 Documents
Students shared 63 documents in this course
University
University of Nottingham
Academic year: 2020/2021
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Notre Dame Catholic Sixth Form College
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Statins and side effects
Statins are a group of medicines that can help lower the level of low-density lipoprotein
(LDL) cholesterol in the blood. Patients may be offered statins if they have been diagnosed
with cardiovascular disease or if they are at high risk of developing it. As CVD is the highest
cause of death in the world (BHF, 2020), a drug that can prevent or slow its progression is of
great benefit to the public as 1 in every 50 people who take the medicine for 5 years will
avoid a serious event, such as a heart attack or stroke (NHS, 2020), however this relies on
patient adherence which isn’t always achieved.
Statin-associated muscle symptoms are the most common type of side effect by statins as
well as the main reason for discontinuation of therapy, which includes myalgia (pain and
weakness in muscles), affecting 5-10% of statin users (Thompson et al., 2016). Till recently
the cause of statin associated muscle symptoms wasn’t clear however a recent study has
found that statins triggered loss of the modulator protein from the calcium channels in the
sarcoplasmic reticulum of muscles. This caused a Ca2+ leak which can trigger statin
myopathy in only the individuals who are susceptible, explaining why only a low percentage
experience this (Lotteau et al., 2019). The biggest takeaway from this study is that they found
moderate exercise prevents statin myopathy from being triggered. Encouraging patients to
make this lifestyle change while on statins will cause a reduction in LDL as well as prevent
any adverse muscle effects of this life saving medication. This will decrease the number of
patients discontinuing treatment therefore decreasing mortality.
Statins have been associated with high blood sugar levels and risk of developing type 2
diabetes, although direct causality hasn’t yet been proved (Aiman et al., 2014). A meta-
analysis found that statin use is associated with a 12% increase in risk of type 2 diabetes and
theorised that this could be due to genetic variation in the gene encoding HMGCR protein
(Swerdlow et al., 2015). However, the authors note that findings should not alter guidance on
prescription of statins and suggest that lifestyle changes such as exercise should be
emphasised.
Research has also shown that the side effects associated with statins could be a “nocebo
effect”. It found that people taking statins were more likely to report side effects if they knew
they were taking the drug and in double blinded RCT, rates of reported side effects were
similar or lower for the people taking statins. For example, muscle pain was reported by
2% in people taking statins and in 2% taking a placebo (Gupta et al., 2017). The results
show that there isn’t a causal relationship between the side effects and the use of statins, and
that the claims may be exaggerated.
These side effects can affect patient adherence – leading them to discontinuing treatments or
refusing it in the first place.
References
NHS. (2020). Statins. [online] Available at: nhs/conditions/statins [Accessed 28 October
2020].
Thompson, P., Panza, G., Zaleski, A. and Taylor, B. (2016). Statin-Associated Side Effects. Journal of
the American College of Cardiology, [online] 67(20), pp–2410. Available at:
sciencedirect/science/article/pii/S0735109716016922 [Accessed 28 October 2020].
Lotteau, S., Ivarsson, N., Yang, Z., Restagno, D., Colyer, J., Hopkins, P., Weightman, A., Himori, K.,
Yamada, T., Bruton, J., Steele, D., Westerblad, H. and Calaghan, S. (2019). A Mechanism for Statin-
Induced Susceptibility to Myopathy. JACC: Basic to Translational Science, [online] 4(4), pp–523.
Available at: sciencedirect/science/article/pii/S2452302X19301317 [Accessed 28
October 2020].
BHF. (2020). Heart & Circulatory Disease Statistics 2020. [online] Available at:
bhf.org/what-we-do/our-research/heart-statistics/heart-statistics-publications/
cardiovascular-disease-statistics-2020 [Accessed 28 October 2020].
Aiman, U., Najmi, A. and Khan, R. (2014). Statin induced diabetes and its clinical implications. Journal
of Pharmacology & Pharmacotherapeutics, [online] 5(3), pp–185. Available at:
ncbi.nlm.nih/pmc/articles/PMC4156828/ [Accessed 28 October 2020].
Swerdlow, D., Preiss, D., Kuchenbaecker, K., Holmes, M., Engmann, J.E., Shah, T., Sofat, R.,
Stender, S., Johnson, P.C., Scott, R., Leusink, M., Verweij, N., Sharp, S., Guo, Y., Giambartolomei,
C., Chung, C., Peasey, A., Amuzu, A., Li, K., Palmen, J., Howard, P., Cooper, J., Drenos, F., Li, Y.,
Lowe, G., Gallacher, J., Stewart, M.C., Tzoulaki, I., Buxbaum, S., A, D. van der, Forouhi, N.,
Onland-Moret, N., Schouw, Y. van der, Schnabel, R., Hubacek, J., Kubinova, R., Baceviciene,
M., Tamosiunas, A., Pajak, A., Topor-Madry, R., Stepaniak, U., Malyutina, S., Baldassarre, D., Sennblad,
B., Tremoli, E., Faire, U. de, Veglia, F., Ford, I., Jukema, J., Westendorp, R.G., Borst, G. de, Jong,
P. de, Algra, A., Spiering, W., Zee, A.H. der, Klungel, O., Boer, A. de, Doevendans, P., Eaton,
C., Robinson, J., Duggan, D., Kjekshus, J., Downs, J., Gotto, A., Keech, A., Marchioli, R.,
Tognoni, G., Sever, P., Poulter, N., Waters, D., Pedersen, T., Amarenco, P., Nakamura, H.,
McMurray, J.J., Lewsey, J., Chasman, D., Ridker, P., Maggioni, A., Tavazzi, L., Ray, K.,
Seshasai, S.R., Manson, J., Price, J., Whincup, P., Morris, R., Lawlor, D., Smith, G., Ben-
Shlomo, Y., Schreiner, P., Fornage, M., Siscovick, D., Cushman, M., Kumari, M., Wareham, N.,
Verschuren, W.M., Redline, S., Patel, S., Whittaker, J., Hamsten, A., Delaney, J., Dale, C.,
Gaunt, T., Wong, A., Kuh, D., Hardy, R., Kathiresan, S., Castillo, B., Harst, P. van der, Brunner, E.,
Tybjaerg-Hansen, A., Marmot, M., Krauss, R., Tsai, M., Coresh, J., Hoogeveen, R., Psaty, B.,
Lange, L., Hakonarson, H., Dudbridge, F., Humphries, S., Talmud, P., Kivimäki, M., Timpson, N.,
Langenberg, C., Asselbergs, F., Voevoda, M., Bobak, M., Pikhart, H., Wilson, J., Reiner, A.,
Keating, B., Hingorani, A. and Sattar, N. (2015). HMG-coenzyme A reductase inhibition, type 2
diabetes, and bodyweight: evidence from genetic analysis and randomised trials. The Lancet, [online]
385(9965), pp–361. Available at: thelancet/journals/lancet/article/PIIS0140-
6736(14)61183-1/fulltext [Accessed 28 Oct. 2020].
Gupta, A., Thompson, D., Whitehouse, A., Collier, T., Dahlof, B., Poulter, N., Collins, R., Sever, P. and
ASCOT Investigators (2017). Adverse events associated with unblinded, but not with blinded, statin
therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a
randomised double-blind placebo-controlled trial and its non-randomised non-blind extension
phase. Lancet (London, England), [online] 389(10088), pp–2481. Available at:
ncbi.nlm.nih/pubmed/28476288 [Accessed 28 Oct. 2020].
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Statins and side effects
Module: Medicine (A100)
63 Documents
Students shared 63 documents in this course
University: University of Nottingham
Was this document helpful?
Statins and side effects
Statins are a group of medicines that can help lower the level of low-density lipoprotein
(LDL) cholesterol in the blood. Patients may be offered statins if they have been diagnosed
with cardiovascular disease or if they are at high risk of developing it. As CVD is the highest
cause of death in the world (BHF, 2020), a drug that can prevent or slow its progression is of
great benefit to the public as 1 in every 50 people who take the medicine for 5 years will
avoid a serious event, such as a heart attack or stroke (NHS, 2020), however this relies on
patient adherence which isn’t always achieved.
Statin-associated muscle symptoms are the most common type of side effect by statins as
well as the main reason for discontinuation of therapy, which includes myalgia (pain and
weakness in muscles), affecting 5-10% of statin users (Thompson et al., 2016). Till recently
the cause of statin associated muscle symptoms wasn’t clear however a recent study has
found that statins triggered loss of the modulator protein from the calcium channels in the
sarcoplasmic reticulum of muscles. This caused a Ca2+ leak which can trigger statin
myopathy in only the individuals who are susceptible, explaining why only a low percentage
experience this (Lotteau et al., 2019). The biggest takeaway from this study is that they found
moderate exercise prevents statin myopathy from being triggered. Encouraging patients to
make this lifestyle change while on statins will cause a reduction in LDL as well as prevent
any adverse muscle effects of this life saving medication. This will decrease the number of
patients discontinuing treatment therefore decreasing mortality.
Statins have been associated with high blood sugar levels and risk of developing type 2
diabetes, although direct causality hasn’t yet been proved (Aiman et al., 2014). A meta-
analysis found that statin use is associated with a 12% increase in risk of type 2 diabetes and
theorised that this could be due to genetic variation in the gene encoding HMGCR protein
(Swerdlow et al., 2015). However, the authors note that findings should not alter guidance on
prescription of statins and suggest that lifestyle changes such as exercise should be
emphasised.
Research has also shown that the side effects associated with statins could be a “nocebo
effect”. It found that people taking statins were more likely to report side effects if they knew
they were taking the drug and in double blinded RCT, rates of reported side effects were
similar or lower for the people taking statins. For example, muscle pain was reported by
2.03% in people taking statins and in 2% taking a placebo (Gupta et al., 2017). The results
show that there isn’t a causal relationship between the side effects and the use of statins, and
that the claims may be exaggerated.
These side effects can affect patient adherence – leading them to discontinuing treatments or
refusing it in the first place.
