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Review Shows Statins Safe, Effective

Risks of Side Effects Very Low for Most Patients
By
WebMD Health News
Reviewed by Louise Chang, MD

doctors

June 6, 2007 -- The benefits of taking cholesterol-lowering statin drugs far outweigh the potential risks for the vast majority of patients with heart and vascular disease, a new review of the research suggests.

Longtime statin researcher Jane Armitage, MD, of the University of Oxford, found the incidence of serious side effects to be very rare in patients taking standard doses of the drugs, although the risks rose with higher doses.

She estimated the risk for myopathy (muscle symptoms such as pain or weakness) to be less than one in 10,000 for patients on standard doses of the drugs.

Her analysis is published in the latest online issue of The Lancet.

“These are very safe drugs, overall, and they are very effective for lowering stroke and heart attack risk,” she tells WebMD.

Best-Selling Drugs

In just two decades, statins have become the world’s best-selling class of drug, with sales of Pfizer’s Lipitor alone approaching $13 billion last year. Other statins include Zocor, Mevacor, Pravachol, Lescol, and the newest statin, Crestor.

Another statin, sold as Baycol, was removed from the market in 2001 when its use was linked to an unacceptably high incidence of serious muscle damage.

Patients taking the statins on the market today are routinely warned that muscle pain or weakness can be a side effect of the drug, and Armitage says many erroneously attribute routine muscle issues to its use.

Muscle pain is one of the main reasons patients cite for abandoning statin therapy.

When Armitage reviewed studies comparing statin users with patients with similar characteristics who were not taking the drugs, she found no evidence of an increase in muscle pain and weakness in the former group.

"When you look at the objective evidence there is very little to suggest that muscle pain is a common problem with statins,” she says.

She adds that there is even less evidence linking standard doses of the cholesterol-lowering drugs now in use to a life-threatening liver disease caused by muscle breakdown.

Standard doses were considered those that typically reduce low-density lipoprotein (LDL), or bad, cholesterol levels by 30% to 45% -- 10 milligrams to 20 milligrams daily for Lipitor, 40 milligrams to 80 milligrams for Lescol, 40 milligrams for Mevacor, 40 milligrams for Pravachol, 10 milligrams for Crestor, and 20 milligrams to 40 milligrams for Zocor.

Treatment with statins is known to raise levels of potentially problematic liver enzymes in some patients, but that has not been clearly linked with liver failure, American Heart Association spokesman Gerald Fletcher, MD, tells WebMD.

A preventive cardiologist at the Mayo Clinic in Jacksonville, Fla., Fletcher was among a group of cardiovascular disease experts who conducted a separate review of the research assessing statin safety, published two months ago in the American Journal of Cardiology.

Like Armitage, Fletcher’s group found little evidence of risk in the published studies.

“The side effects and complications with these drugs are so rare, they are miniscule,” he says. “But the potential benefits are great for people with any kind of vascular disease, whether or not they have had a heart attack or stroke.”

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Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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