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Posted: 12:37 PM Nov 4, 2006
Statin Options
Softening the side effects Statin drugs are very effective at lowering cholesterol but the medications can have serious side effects.
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Statin drugs are very effective at lowering cholesterol but the medications can have serious side effects, including muscle and liver damage, memory problems and fatigue.
At first, Marilyn Cronan was afraid that her multiple sclerosis was getting worse.
“I had such horrible leg cramps," she says. "Occasionally, my fingers would be like this and I would have to pull them.”
It turns out that the symptoms weren’t from MS, but side-effects from a statin drug she was taking to lower her cholesterol.
Marilyn says, “I refuse to take it anymore.”
That doesn’t surprise Dr. Jay Cohen.
He says, "More than half of the people who are put on statin drugs quit within a few years, up to 75%, and these are from studies.”
In his new book, Cohen writes that the dose recommended by drug companies and typically prescribed by doctors can be too strong.
Dr. Cohen says, "You might do well, just as well with one-fourth the medication than someone else who needs a higher dose.”
Ask your doctor about alternatives like a milder statin or a lower dose.
“You can say, 'I want to start very low and we’ll test it out and if it doesn’t, if it’s not sufficient, then we’ll inch up higher, but I don’t want to take the full dose that you’re recommending because of my sensitivity.'”
Ask your doctor if natural remedies and a healthier lifestyle can be just as effective.
Dr. Cohen says, "It’s about informed consent: knowing all the choices from low dose, to high dose, to a natural alternative, to diet, and how to put it all together in an approach that the patient’s comfortable with.”
Marilyn switched to the supplement niacin to improve her cholesterol.
She says, "It’s been less than six months since I had it checked and they were very happy with it, the doctor was.”
Dr. Cohen notes in his book that starting doses of statins are increasing, sometimes from 10 or 20 milligrams to 40. He argues that two milligrams might be enough for some people.
Fast Facts:
Cholesterol
Cholesterol is a waxy substance found in cells. It is used by the body to make hormones, bile acids and vitamin D. The body makes all the cholesterol it needs. We also get cholesterol from some of the foods we eat.
Cholesterol circulates in the bloodstream in the form of tiny packages, called lipoproteins. There are two main types. Low density lipoproteins (LDLs) carry cholesterol to the tissues. High density lipoproteins (HDLs) take cholesterol from the body to the liver for elimination.
When there is too much cholesterol in the blood, the excess gets deposited along the walls of the arteries. Over time, the fatty deposits combine with other substances in the blood to form plaque. The plaque can build and narrow the inside of the vessel, impeding the flow of blood through the area. If the plaque deposit breaks open (ruptures), a clot can form that may completely block the flow of blood in the affected portion of the artery. In the heart, a blockage can cause a heart attack. In the brain, it’s a stroke.
Cholesterol Levels
The higher cholesterol levels are, the greater the risk for plaque build up and eventual heart attack or stroke. High LDL levels are also considered bad because they can cause more cholesterol to be deposited onto the arterial walls (this is why LDL is sometimes referred to as the “bad” cholesterol). On the other hand, higher HDL levels are associated with decreased risks because HDL cholesterol gets rid of excess LDL and may protect against heart disease.
The National Heart, Lung and Blood Institute currently recommend a total cholesterol of less than 200 mg/dL of blood. Borderline high total cholesterol levels are 200-239 mg/dL. High cholesterol is 240 mg/dL or higher. Ideal LDL cholesterol is less than 100 mg/dL. An LDL of 130-150 mg/dL is borderline high and 190mg/dL or above is high. HDL cholesterol should be 60 mg/dL or above.
According to the American Heart Association, nearly 100 million American adults have at least borderline high total cholesterol. Roughly 65 million have high cholesterol. Family history, a diet high in saturated fat and being overweight increase the risk of having high cholesterol.
Lowering Cholesterol with Statins
Since elevated cholesterol levels are associated with an increased risk of heart attack and stroke, health experts advise Americans to aim for normal cholesterol levels. In patients with high cholesterol, a ten percent reduction in total cholesterol reduces the risk of heart disease by 30 percent.
Some patients are able to decrease their cholesterol levels through diet, weight loss and increased physical activity. When those steps aren’t effective enough, doctors may recommend medications. An important group of drugs for cholesterol reduction are statins. Statins inhibit an enzyme that controls the rate of cholesterol production in the body. The drugs are especially useful for lowering LDL levels. Currently, six statins are approved by the FDA: atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) and simvastatin (Zocor®).
In general, statins can reduce LDL cholesterol levels by 20 to 55 percent. However, the medications can cause side effects. The most common side effects associated with statin drugs are diarrhea, nausea, constipation, stomach pain or cramps, muscle aches, headache, skin rash, vision problems and sleep problems/extreme tiredness. Statins are also rarely associated with an increased risk for two serious problems – elevated liver enzymes (an indication of problems with liver function) and statin myopathy (muscle pain and tenderness caused by breakdown of muscle cells).
Alternatives to Statins
Some patients who are taking statins are not fully aware of the side effects or risks associated with the medication. Physicians may not understand that not all patients need high doses of statins. And some patients may be able to effectively lower their cholesterol levels with other types of medications.
Jay Cohen, M.D., a Psychopharmacologist, has written a book to help consumers understand the importance of cholesterol reduction, benefits and risks of statins and other treatments that may be helpful. His book is called, What You Need to Know About Statin Drugs & Their Natural Alternatives.
Cohen says patients should find out how far they need to lower their cholesterol. Those who need only a modest amount of cholesterol reduction may be able to take lower doses of statins. This step is important because every patient responds differently to statins. Some people will experience significant cholesterol reduction with a lower dose, while others may not see any benefits at all. Since the risk of side effects increases with higher doses, Cohen recommends starting out with lower doses of statins and gradually increasing the level if further reduction is necessary.
Cohen also says patients should ask their physician about natural alternatives to statins, like red yeast rice, intermediate acting niacin, plant sterols and policosanol. These supplements work well for lowering cholesterol in some people. They are much less expensive and generally safer than statin medications.
Cohen does not argue against the use of statins. He says statin users who are gaining good control over their cholesterol and don’t have any side effects may not want to make any changes in their treatment. Cohen also stresses that some people really need statins. Patients with very high cholesterol levels, a strong family history of heart disease, a personal history of major heart disease or other important risk factors may still need to take statins.
Web Resources
For general information on cholesterol, statins and cholesterol-lowering medications:
