Statin drugs for cholesterol, side effects, benefits, risks and danger, natural alternatives by Ray Sahelian, M.D.
 

Statins, a commonly prescribed class of lipid-lowering drugs that include Lipitor, Zocor and Crestor, are among the most widely prescribed drugs in the United States, with more than $12 billion in annual sales and tens of millions of patients. However, many doctors and their patients do not realize the potential serious side effects from statin use. Doctors are prescribing these drugs too casually, not recognizing the potential dangers. Furthermore, there is no proof that patients taking statin drugs will live longer. See my discussions in the March and November 2008 newsletters. Therefore, why should a doctor prescribe such an expensive and potentially harmful drug when there is no proof of increased lifespan? Plus, there are many natural ways to lower cholesterol levels that are much safer.
   The medical community, and the drug companies keep pounding the consumer and physicians with promotional material that cholesterol must be lowered with statin drugs. However, natural supplements and functional foods are also good options to lower cholesterol levels. See cholesterol for a thorough discussion. Many patients on statins may need to take a CoQ10 supplement to counteract the myopathy that occurs from statin drug use.
   Although it is clear that statin drugs such as Lipitor and Zocor do lower cholesterol levels, it is not clear whether they improve overall longevity. What's the point of having lower cholesterol levels, and perhaps even a lower rate of stroke or heart attack if the death rate remains the same, i. e., dying from other causes as a result of the damage done by the statin drugs? Many people suffer quite unpleasant and dangerous statin drug side effects including muscle / body aches and liver damage. Are there safer alternatives to statin drugs? Is fish oil just as good for heart health as these drugs? Many doctors focus on cholesterol levels as if this was the most important factor in cardiovascular health not realizing that there are many other important factors that influence heart disease. Doctors prescribe statin drugs and are content when cholesterol levels are reduced thinking that they have done well for their patients. But are doctors overlooking other factors? I know many people who take statin drugs and have muscle aches as a side effect which reduces their activity level, thus reducing the strength of their heart.

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Statin side effect
Side effects of statins include damage to muscle tissue, harm to kidneys, elevated liver function tests, depletion of CoQ10, and slight damage to brain cells leading to mild impairment of mental function. Those taking statins may consider also supplementing with 30 or 50 mg of CoQ10 two or three days a week. See additional nerve and muscle statin side effects on this neuromuscular page.
   The most common statin side effect is muscle damage, next common statin side effect is liver damage. Changes in liver function occur in some  people and blood test monitoring may be required.  Muscle symptoms are a very common side effect with statin drugs. “Myopathy," involving actual damage to muscle tissue, can be very serious. For this reason, if you develop a statin side effect as new muscle pain, weakness, or tenderness you should inform your doctor immediately. Very rarely, if myopathy occurs and the drugs are not stopped, a very dangerous condition, called “rhabdomyolysis”, can occur that can sometimes be fatal. Myopathy and rhabdomyolysis are more common if people are on other cholesterol lowering drugs, particularly niacin or gemfibrozil (or other “fibrates”), as well as a statin. Certain other classes of drugs in combination with statins can also increase the risk of problems.
   Neuropathy may be another statin side effect. Neuropathy is well recognized and reported more and more often. Statins can also trigger underlying neuromuscular conditions. With time, we are likely to find other statin side effects, and this should make doctors cautious in being overly zealous in prescribing statin drugs to patients who may not really need them. Muscle pain as a statin side effect is much more common than most doctors realize.
   Statin drug use is not associated with a reduced risk of colorectal cancer.
   Statin drug use may be associated with an increased risk for prostate cancer, particularly in those who are obese. American Journal of Epidemiology, August 1, 2008.
   Lab experiments indicate that statin drugs reduce the ability of progenitor muscle cells to multiply and then repair and regenerate damaged muscles.

 

Statin drugs and certain heart medications can cause muscle damage
The Food and Drug Administration said in August 2008 doctors should use extra care when prescribing the statin Zocor, generic Zocor, or Vytorin to patients who are also taking amiodarone, a heart rhythm drug marketed as Cordarone or Pacerone. The danger is higher for patients taking more than 20 milligrams a day of the cholesterol drugs. The generic name for the statin cholesterol medication is simvastatin.

 

Statin drugs and eye muscle damage
Even at normal doses, statin drugs may cause rare instances of eye muscle disorders such as ophthalmoplegia, diplopia and ptosis. Drs. F. W. Fraunfelder and Amanda B. Richards, from the Casey Eye Institute, Oregon Health & Science University, Portland, evaluated reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, and the Food and Drug Administration. A total of 256 case reports of diplopia, ptosis, or ophthalmoplegia associated with statins were identified in the databases. The average time to occurrence of the adverse drug reaction was 8 months. Among the 256 case reports, 62 patients stopped the statin and the diplopia or ptosis resolved. Sixteen case reports indicate that the statin was started again and the diplopia or ptosis reoccurred. Drs. F. W. Fraunfelder and Amanda B. Richards think that the problem is due to a localized myositis in the extraocular muscles just as statins can cause myositis in other skeletal muscles in the body. Ophthalmology 2008;115:2282-2285.

 

Statin drugs and stroke risk
The use of cholesterol-lowering statin drugs, such as Lipitor (atorvastatin) and Zocor (simvastatin), may raise the risk of brain hemorrhage in patients who have experienced a recent stroke or a transient ischemic attack (TIA). Is this risk outweighed by the ability of these statin drugs to lower the overall risk of a second stroke and other serious events, such as heart attack?

 

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Statins and mortality
Primary Prevention of Cardiovascular Diseases With Statin Therapy: A Meta-analysis of Randomized Controlled Trials.
Arch Intern Med. 2006 Nov 27;166(21):2307-13. Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK. Department of Medicine, University of Toronto, Toronto, Ontario.
While the role of hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) in secondary prevention of cardiovascular (CV) events and mortality is established, their value for primary prevention is less clear. To clarify the role of statins for patients without cardiovascular disease, we performed a meta-analysis of randomized controlled trials (RCTs). Seven trials with 42 848 patients were included. Ninety percent had no history of CV disease. Mean follow-up was 4.3 years. Statin therapy reduced the RR of major coronary events, major cerebrovascular events, and revascularizations by 29%, 14%, and 33%, respectively. Statins produced a nonsignificant 22% RR reduction in coronary heart disease mortality. No significant reduction in overall mortality or increases in cancer or levels of liver enzymes or creatine kinase were observed. In patients without cardiovascular disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality.
   Dr. Sahelian comments: Statins are currently the most widely prescribed drugs in many countries. There are hundreds of thousands of doctors in the USA, and many more in the rest of the world, who prescribe statin drugs to their patients and have been doing so for the past decade or so. Most of these doctors are well meaning and do think they are helping their patients. But, unfortunately, they have been misguided by the drug companies and by the medical journals they read and trust. These medical journals have repeatedly reinforced the notion that lowering cholesterol is a good thing. I don't dispute the fact that studies show those with high cholesterol levels have a higher rate of cardiovascular conditions. However, I do dispute the fact that lowering cholesterol with statin drugs is a good thing when there are natural options available..
     This is what a CNN article says: Statins are prescribed to lower excessive levels of artery-clogging "bad" cholesterol and to lessen inflammation in blood vessels. But the latest study casts doubt on the benefits of prescribing statins to prevent cardiovascular disease in individuals with healthy cholesterol levels. While statins lessen the risk of heart attacks and strokes in people already at risk because of heart disease or high cholesterol, routine use of such drugs by otherwise healthy adults produces such limited benefits that it may not be cost-effective. For example, an analysis of seven previous trials involving nearly 43,000 adults aged 55 to 75 found that the average adult had a nearly 6 percent chance of suffering a heart attack or stroke over a 4 year period, compared with a 4 percent risk among those who took statins. Therefore, 60 patients would need to be treated for an average of 4 years to prevent one major coronary event," the study's author, Dr. Paaladinesh Thavendiranathan of the University of Toronto, wrote in the article. To prevent a single stroke, 268 people would need to undergo statin treatment, and to prevent one nonfatal heart attack 61 would have to take the drugs, he added. Moreover, statin use did not improve the overall risk of dying from cardiovascular disease or from other causes.

    Most of you realize by now that doctors and the medical establishment do not know it all and are fallible. (Just to be clear, I don't claim to know it all, either, but I do my best to keep an open mind and accept the use of drugs or supplements if they work.) For decades doctors prescribed hormone replacement therapy for women in high doses and a few years ago we found out that this treatment increased breast cancer rates. It is quite possible that we may in the next few years discover that the widespread use of statin therapy was not such a good idea after all. I do not deny the possibility that there are certain patients that may be helped by statins. However, statins are overused and misused. Too many people are focusing too heavily on blood cholesterol levels as opposed to looking at the effects of these drugs on the whole body. If you have an extremely high cholesterol level, then a statin drug could lower it, but would this result in you living longer? I don't know if anyone can promise this to you in great confidence. If you have a mild to moderate cholesterol elevation, and your doctor has you on a statin drug, then it is legitimate to question your doctor. Ask your doctor to show you studies or prove to you that the use of statin drugs for mild to moderate cholesterol elevation leads to a longer lifespan. If he or she can't, then why is the statin drug being prescribed? There are a number of steps one can take to improve cardiovascular health without drugs, and I list some of them at this site. See heart disease. Statin cholesterol drugs do not appear to lower the risk of colorectal cancer.

 

November 2008 - Will taking the statin drug Crestor reduce your inflammatory markers and heart attack rate?
Here is a basic summary of a November 2008 study funded by AstraZeneca, the maker of Crestor (rosuvastatin):
   About 18,000 healthy men and women with normal cholesterol levels but with elevated levels of "high-sensitivity C-reactive protein" or hs-CRP -- a marker that indicates inflammation in the body -- took 20 milligrams of Crestor a day and were compared to a group taking a placebo pill. Designed to last up to five years, the study was stopped after less than two years because endpoints were apparently met. According to the statistical interpretations, participants taking Crestor reduced their risk of heart attack, stroke and death compared with those taking the placebo pills. LDL cholesterol levels and hs-CRP levels were reduced by Crestor. Interestingly, at the time the study was stopped, it appeared that those who were taking Crestor were starting to have higher blood sugar levels. You would think the study would have continued to see if diabetes would set in after a few more months or years of use.
   Hardly any news organizations reported the potential downside of taking this drug, flaws in the study, or misinterpretation of the results. The rate of muscle aches and liver damage by statins is much higher in clinical practice than what is reported in studies. There may also be potential mental decline from the use of statins. I still have not seen any studies where the use of statins in those who have low or moderate cholesterol elevation has led to a decrease in overall mortality. it is quite possible that a statin drug can reduce cholesterol levels, reduce CRP levels, reduce the risk of heart attack and stroke, yet lead to a shorter lifespan. How could this happen you ask? This could be due to several factors including muscle damage that leads a patient doing less exercise, mental decline leading to a higher rate of dementia, lower mood or depression leading to a higher rate of suicides, liver damage, kidney damage, and other unknown and potentially serious side effects that could harm the body.
  A DOCTOR I CAN RESPECT. Fortunately, the website of ABC News had an article by Dr. Nortin Hadler which reviewed the flaws of the study. Dr. Nortin Hadler is professor of medicine at the University of North Carolina at Chapel Hill. If your doctor advises you to take Crestor or another statin drug as a consequence of the results of this study, you MUST read this article and you MUST request that your doctor read it, too. The reduction in heart attack or stroke was minimal, almost insignificant, not as high as the news media made it seem. Plus, the cost of Crestor, blood tests, and doctor visits can be several thousand dollars a year. Practically speaking our health care system, particularly during these tough economic times, cannot afford this heavy cost for minimal gain, it any gain at all. See the link at the top of this page for a November newsletter article that provides a link to an ABC news website article.
   The headlines by news organizations are sometimes misleading. If you are a regular reader of my newsletter you are aware that I have warned you not to trust headlines and to be critical of what you read or hear. The media is not sophisticated enough to understand and interpret studies. They often believe and regurgitate whatever the drug companies tell them.
   As a medical doctor who has studied natural ways to decrease inflammation and heart disease, it saddens me that more natural and safer approaches are not discussed or promoted as aggressively as studies involving expensive and unsafe medications. There are so many natural ways to reduce cholesterol, heart disease and inflammation including fish oils, psyllium and other natural fibers, and potentially the addition of spices such as curcumin, ginger, etc.

 

Q.  I am writing from Australia. Earlier this year my Dr prescribed Crestor for me. The next morning I had side effects of swollen lips and tongue. As it was a public holiday I could not see my Dr and went to see my pharmacist. For 5 minutes he tried to sell me every kind of laxative and micro-enema. What? I finally shouted at him to listen to me and not his cash register. The best advice I could get was to see my Dr the next day. I did. He is a very good Dr but all of a sudden he treated me rudely and did not continue treatment he said he would do. My blood pressure was 200/110, he said I was sitting there waiting for a stroke. One of my carotid arteries is 60% blocked. He said he would bring my B/P to 120/80. After the Crestor business he lost all interest and now I am still waiting for a stroke. What happened to medicine? How can a Dr be so childish?

 

Q.  I was very interested to read your article about Crestor in your newsletter. I was coming round to the conclusion that I might usefully begin using this statin medication product, albeit I was looking at "Lipitor / atorvastatin". My cholesterol levels are typically a little higher than they should be and I was beginning to think "why not use a statin drug?". You touched on the other aspect of statins that interests me, but not in the way I expected. You suggested the potential for mental decline, whereas many articles I've read recently suggest statins may have a beneficial effect on the formation of the plaques in the brain that cause Alzheimer's disease, as any web search for 'statins + alzheimers' will show. Have you any more information on this aspect? Thanks for your very informative newsletter.

 

Why was this the headline of an article as opposed to "Statin use does not improve mortality"?
 Statins Reduce Risk of Heart Attack and Stroke in Those Without Heart Disease
CHICAGO, IL -- November 28, 2006 -- Among individuals without cardiovascular disease, taking statins regularly may reduce the risk of major heart and cerebrovascular events such as heart attack and stroke but not coronary heart disease or overall death, according to a meta-analysis of previously published studies, reported in the November 27 issue of Archives of Internal Medicine, one of the JAMA Archives journals. Statins have been shown to reduce death and other negative outcomes associated with heart and cerebrovascular disease among those who already have these conditions, according to background information in the article. It is less clear whether these medications benefit those without cardiovascular disease. Current national treatment guidelines recommend the use of statins in these patients based on their cardiovascular risk profile and LDL-C or "bad cholesterol" level. For patients without cardiovascular disease and with normal LDL-C levels, statins are recommended only for individuals with diabetes or with two or more other cardiac risk factors that raise their 10-year risk of a heart attack or other heart event to at least 10%. Paaladinesh Thavendiranathan, MD, MSc, University of Toronto, Ontario, and colleagues analyzed the results of seven previously published clinical trials that assessed the benefits of statins in a total of 42,848 patients, 90% of whom had no history of cardiovascular disease. In each study, patients were randomly assigned to receive either statins or another form of care and were followed for at least one year, at least 100 major cardiovascular events occurred and 80% or more of the participants did not have cardiovascular disease. In total, 21,409 patients in the trials took statins and 21,439 were assigned to placebo. The average follow-up period for the studies ranged from 3.2 to 5.2 years; average age of the participants ranged from 55.1 to 75.4 years; and the proportion of men included ranged from 42% to 100%. In patients on statin therapy, there were 924 major coronary events such as heart attack compared with 1,219 among those in control groups -- a 29% reduction in risk. Major cerebrovascular events, including stroke, occurred in 440 patients taking statins and 517 controls, a 14% lower risk. Statin treatment was also associated with a 31.7% reduction in risk for non-fatal heart attacks and a 33% reduction in the number of revascularization procedures, which restore blood flow and include angioplasty and bypass surgery. There were no statistically significant differences between the statin and control groups in the rates of patients who died from cardiovascular disease or from all causes. Assuming that individuals not taking statins have a 5.7% chance of having a major heart event over a 4.3-year period, statins can reduce that risk to 4%, the authors write. "Therefore, 60 patients would need to be treated for an average of 4.3 years to prevent one major coronary event." Similarly, 268 patients would need to be treated to prevent one stroke or other major cerebrovascular event; 61 to prevent one non-fatal heart attack; and 93 to prevent one revascularization procedure. Statins are expensive and other therapies also may work to reduce risk, the authors conclude. "Therefore, even though universal lipid-lowering therapy appears attractive, especially in an intermediate-risk primary prevention population, further studies are needed to clarify the cost-effectiveness of therapy in this group." SOURCE: American Medical Association
 

Statins, diet and cholesterol
Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants.
Am J Clin Nutr. 2005 Feb;81(2):380-7. Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Canada.
3-Hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors reduce serum cholesterol and are increasingly advocated in primary prevention to achieve reductions in LDL cholesterol. Newer dietary approaches combining cholesterol-lowering foods may offer another option, but these approaches have not been compared directly with statins in the same persons. The objective was to compare, in the same subjects, the cholesterol-lowering potential of a dietary portfolio with that of a statin. Thirty-four hyperlipidemic participants underwent all three 1-mo treatments in random order as outpatients: a very-low-saturated-fat diet (control diet), the same diet plus 20 mg lovastatin (statin diet), and a diet high in plant sterols (1.0 g/1000 kcal), soy-protein foods (including soy milks and soy burgers, 21.4 g/1000 kcal), almonds (14 g/1000 kcal), and viscous fibers from oats, barley, psyllium, and the vegetables okra and eggplant (10 g/1000 kcal) (portfolio diets). LDL-cholesterol concentrations decreased by 8%, 33%, and 29% after 4 wk of the control, statin, and portfolio diets, respectively. Although the absolute difference between the statin and the portfolio treatments was significant at 4 wk, 9 participants (26%) achieved their lowest LDL-cholesterol concentrations with the portfolio diet. Moreover, the statin and the portfolio diets did not differ significantly in their ability to reduce LDL cholesterol below the 3.4-mmol/L primary prevention cutoff. Dietary combinations may not differ in potency from first-generation statins in achieving current lipid goals for primary prevention. They may, therefore, bridge the treatment gap between current therapeutic diets and newer statins.

 

Statin and flavonoid combination
Combination therapy of statin with flavonoids rich extract from chokeberry fruits enhanced reduction in cardiovascular risk markers in patients after myocardial infraction (MI).
Atherosclerosis. 2007 Feb 20; Naruszewicz M, Laniewska I, Millo B, Dluzniewski M. Department of Pharmacognosy and Molecular Basis of Phythotherapy, Medical University of Warsaw, Ul. Banacha 1, Warszawa, Poland; Center for Atherosclerosis Research, Pomeranian Medical University Szczecin, Poland.
Recent studies have shown, that chronic flavonoids treatment improves vascular function and cardiovascular remodeling by decreasing superoxide anion production as well as by increasing NO realize from endothelial cells. A progressive decrease in systolic blood pressure and reduction of low-density lipoprotein oxidation (Ox-LDL) has also been reported. However, none of these studies were done in patient with coronary artery disease treated with statins. This was a double-blind, placebo-controlled, parallel trial. Forty-four patients (11 women and 33 men, mean age 66 years) who survived myocardial infraction and have received statin therapy for at least 6 months (80% dose of 40mg/day simvastatin) were included in the study. The subjects were randomised to receive either 3x 85mg/day of chokeberry flavonoid extract (Aronia melanocarpa E) or placebo for a period of 6 weeks. The study extract was a commercially-available product of the following declared composition: anthocyans (about 25%), polymeric procyanidines (about 50%) and phenolic acids (about 9%). Compared to placebo, flavonoids significantly reduced serum 8-isoprostans and Ox-LDL levels, as well as hsCRP and MCP-1. In view of the fact that chokeberry flavonoids reduce the severity of inflammation, regardless of statins, they can be used clinically for secondary prevention of ischaemic heart disease.
 

Statins and Neuromuscular Disease

Statins may unmask neuromuscular disease. Patients with asymptomatic neuromuscular disorders may have their condition precipitated by statin use, according to investigators from the University of Athens Medical School. Dr. Panagiota Manta and colleagues describe four such cases in the July 24th, 2006 issue of the Archives of Internal Medicine. 

Case 1 was a 46-year-old man with a history of hypertension and diabetes mellitus who was prescribed pravastatin for hypercholesterolemia. Three months later, he complained of fatigue, muscle pain and stiffness. Serum creatine kinase levels were persistently elevated. Genetic testing revealed myotonic dystrophy.

Case 2 was a 62-year-old man with a history of MI and diabetes. Hypercholesterolemia was treated with simvastatin. Creatine kinase levels became persistently elevated. He was eventually diagnosed with McArdle disease.

Case 3 was a 51-year-old man with hypertension and hypercholesterolemia who was hospitalized with acute rhabdomyolytis after taking atorvastatin for 18 months. He was diagnosed with mitochondrial myopathy.

Case 4 case was a 58-year-old man with a history of hypertension, hyperuricemia and coronary artery disease. He began treatment with pravastatin. Shortly after a dose increase, he developed muscle twitching, muscle cramps and difficulty walking. He was eventually diagnosed with Kennedy disease.
 

Unrecognized side effect of statin treatment: unilateral blepharoptosis.
Ophthal Plast Reconstr Surg. 2006 May-Jun;22(3):222-4. Ankara University, School of Medicine, Department of Cardiology, Turkey.
A 43-year-old man receiving statin monotherapy (10 mg atorvastatin) for hypercholesterolemia had unilateral blepharoptosis as the result of isolated myositis of the levator muscle. Statin -induced myositis in the levator muscle should be considered in the differential diagnosis of acquired unilateral blepharoptosis of unknown cause.

 

Statin drugs and Alzheimer's disease
The cholesterol-lowering benefits of statin drugs, such as Zocor and Mevacor, do not prevent Alzheimer's disease or slow the cognitive decline in the elderly. Neurology, January 16th online, 2008.

 

Statin drugs and eye disorders
Statin drugs, even at normal doses may cause rare instances of eye muscle disorders such as ophthalmoplegia, diplopia and ptosis. Drs. F. W. Fraunfelder and Amanda B. Richards, from the Casey Eye Institute, Oregon Health & Science University, Portland, collected reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, and the Food and Drug Administration. A total of 256 case reports of diplopia, ptosis, or ophthalmoplegia associated with statins were identified in the databases. The average time to occurrence of the adverse drug reaction was 8 months. Among the 256 case reports, 62 patients discontinued the statin and the diplopia or ptosis resolved. Sixteen case reports indicate that the statin was started again and the diplopia or ptosis reoccurred. Drs. F. W. Fraunfelder and Amanda B. Richards think that the problem is due to a localized myositis in the extraocular muscles just as statins can cause myositis in other skeletal muscles in the body. Ophthalmology 2008;115:2282-2285.

 

Statins and Parkinson's disease, is there a link?
January 2007 - There may be a link between Parkinson's disease and low levels of low density lipoprotein (LDL), the "bad" cholesterol. Researchers at the University of North Carolina are planning clinical trials involving thousands of people to see whether statin drugs, which lower low LDL levels, might actually trigger Parkinson's in some people. Other research has for several years suggested that people with abnormally low levels of LDL might be at higher risk of Parkinson's disease. Xuemei Huang and colleagues found that patients with low levels of LDL cholesterol are at least 3 times more likely to develop Parkinson's disease than those with higher LDL levels. Reporting in the journal Chemistry & Industry, the investigators said they plan a bigger study of patients taking statins, the biggest-selling drugs in the world. "I am very concerned, which is why I am planning a 16,000-patient prospective study to examine the possible role of statins," Huang said in a statement.
 

Names of statin drugs
BAYCOL- cerivastatin - pulled off market in Aug 2001 for rhabdomyolisis (excessive muscle breakdown) and deaths.

CRESTOR-- rosuvastatin -- causes more muscle and kidney damage than the other statins. AstraZeneca's cholesterol-lowering drug Crestor has more than twice the side effects of rival statin drugs, including deaths. Adverse effects include muscle damage known as rhabdomyolysis; proteinuria or protein in the urine; nephropathy, a reduced ability of the kidneys to filter toxins from the blood; and kidney failure.
   There are potential benefits, though, with Crestor. Crestor has been shown to partially reverse the build-up of plaque in coronary arteries which can lead to a heart attack or stroke. AstraZeneca Plc's Crestor, in a two-year study of 507 patients, showed that intensive treatment reduced plaque volume by 7 percent to 9 percent. Crestor also reduced levels of LDL, or "bad," cholesterol by more than 53 percent and raised levels of HDL, or "good," cholesterol by nearly 15 percent.

LESCOL- fluvastatin
   July 2006 - Novartis Pharmaceuticals has announced labeling changes to LESCOL ® (fluvastatin sodium) Capsules and LESCOL ® XL (fluvastatin sodium) Extended-Release Tablets prescribing information: LESCOL and LESCOL XL are now indicated as an adjunct to diet to reduce total cholesterol (total-C), LDL-C, and Apo B levels in adolescent boys, and adolescent girls who are at least one year postmenarche, 10 to 16 years of age, with heterozygous familial hypercholesterolemia whose response to dietary restriction has not been adequate and in whom the following findings are present: LDL-C remains ³190 mg/dL or LDL-C remains ³160 mg/dL, and there is either a positive family history of premature cardiovascular disease or two or more other cardiovascular disease risk factors are present. LESCOL XL may now be taken at any time of the day.

LIPITOR is the product brand name for atorvastatin - The popular cholesterol-reducing drug Lipitor made by Pfizer does not prevent obstruction of the heart valve that leads to the aorta, the body's largest artery, according to June 2005 findings published in The New England Journal of Medicine. In a study conducted to determine whether the cholesterol drug, also known by its generic name atorvastatin, did more than just reduce cholesterol, doctors found that Lipitor failed to prevent obstructions that can keep the heart from pumping blood adequately. The condition, known as calcified aortic stenosis, occurs when a key heart valve narrows or becomes blocked, preventing the heart from pumping blood properly and can manifest itself in spite of reductions of cholesterol levels.
     Pfizer is doing research with a drug that supposedly will help increase HDL cholesterol. The name of this drug is torcetrapib.

MEVACOR- lovastatin


PRAVACHOL- pravastatin - Pravachol is the brand name. Pravastatin is the generic name. Pravachol is a statin drug used to decrease LDL cholesterol and triglyceride levels and increase the HDL cholesterol (the "good" cholesterol) level. Pravachol is also prescribed to reduce coronary heart disease events and deaths due to heart attack or stroke.


ZOCOR is the product name for the statin drug simvastatin - in June, 2006, a generic version of Zocor (simvastatin), a drug to treat elevated cholesterol and other fatty substances in the blood such as triglycerides was approved. In the United States, Zocor is the second most widely prescribed drug in the "statin" category of cholesterol-lowering medicines.
   While both simvastatin and pravastatin help lower levels of low-density lipoprotein (LDL), simvastatin is lipophilic, meaning it is soluble in fats, while pravastatin is hydrophilic, meaning it is soluble in water. Because simvastatin is fat soluble, it can more easily penetrate cell membranes, making its way across the blood-brain barrier. Simvastatin statin use is associated with insomnia or sleep problems.
 

Grapefruit and statin drugs
Scientists at Hebrew University in Jerusalem divided 57 men and women who had recently undergone coronary bypass surgery and whose blood cholesterol remained high despite treatment with statin drugs into three groups. One group ate a single serving of red grapefruit every day; another ate a serving of white grapefruit and the third group had none. Otherwise, all three groups ate an ordinary balanced diet. At the end of 30 days, the researchers found that the grapefruit eaters—especially those eating red grapefruit—had significant decreases in cholesterol, while the abstainers did not. What it Means: Combining grapefruit and statins to treat stubbornly high cholesterol levels is an experimental remedy that should be done only under close medical supervision. Grapefruit contains antioxidant chemicals, which may be responsible in part for the effect. But grapefruit also increases the body's absorption of statins, which is why the drugs usually come with warnings not to eat grapefruit or drink grapefruit juice. Too high a level of statins in the blood can lead to serious muscle damage.
     Does taking certain cholesterol-lowering drugs at the same time as grapefruit juice increase the risk of potentially life-threatening muscle toxicity? The risk appears to be greatest with Merck & Co Inc's Zocor, or simvastatin, which went on sale without prescription in Britain, and Pfizer Inc's Lipitor. The problem occurs because grapefruit contains a chemical that inactivates a liver enzyme involved in drug metabolism. As a result, regular consumption of grapefruit juice can lead to excessively high levels of statins in the blood. The risk of serious muscle problems also increases when these cholesterol pills, or statins, are taken along with some other drugs, including HIV protease inhibitors.

 

Statins and Cognitive Function
The cholesterol-lowering drugs statins do not appear to lower the risk of dementia or Alzheimer's disease, except possibly in cases of early-onset Alzheimer's disease. This runs counter to reports indicating that statins do, in fact, reduce the risk of dementia and Alzheimer's disease.
   Statin drugs, such as Lipitor or Zocor, widely used for lowering cholesterol, may slightly impair brain function and perhaps harm brain cells. Doctors have known for quite some time that these drugs cause muscle tissue damage and lower CoQ10 levels in the blood. How statins interfere with optimal brain function is not clear, but my best guess is due to interference with cholesterol metabolism. Cholesterol is involved in the formation of pregnenolone and other hormones in the brain. These hormones are crucial for memory. There's still so much we don't know about the long term risks of statins. I only recommend their use in cases of very high cholesterol levels where natural remedies have failed. Besides, even though lowering cholesterol is important, too much emphasis has been placed on cholesterol reduction as opposed to reducing the whole inflammatory process that leads to clogging of vessels with plaques.

 

Statins and cognitive function in the elderly: the Cardiovascular Health Study.
Neurology. 2005 November. Bernick C, Katz R, Smith NL, Rapp S, Bhadelia R, Carlson M, Kuller L; Cardiovascular Health Study Collaborative Research Group. Department of Medicine, University of Nevada School of Medicine, Las Vegas, NV 89102, USA.
To examine the association of statin drug use on cognitive and MRI change in older adults. Participants in the Cardiovascular Health Study, a longitudinal study of people age 65 or older, were classified into three groups determined by whether they were taking statin drugs on a continuous basis, intermittently, or not at all. The untreated group was further divided into categories based on National Cholesterol Education Program recommendations for lipid-lowering treatment. Statin drug use was associated with a slight reduction in cognitive decline in an elderly population. This relationship could not be completely explained by the effect of statins on lowering of serum cholesterol.
 

Dementia
Statin drugs do not prevent Alzheimer's disease or dementia according to Dr. Bernadette McGuinness from Queen's University Belfast, Belfast, UK. Cochrane Database of Systematic Reviews 2009.

 

Statins and cancer
Statin drugs do not appear to prevent cancer. The results of a study, published in the journal Epidemiology, do not support an association between statin use and the occurrence of 10 different cancer types, including the four most common in the US -- lung, breast, colon and prostate cancer. Epidemiology March 2007.

 

Statins and risk of cancer: A systematic review and metaanalysis.
Int J Cancer. 2006 Nov 27; Faculty of Medicine and Dentistry, University of Bristol, Bristol, United Kingdom.
We conducted a systematic review of the association between HMG-CoA reductase inhibitor ( statin ) use and cancer risk. Thirty-eight individual studies (26 randomized trials involving 103,573 participants and 12 observational studies with 826,854 participants) were included. Median follow-up was 3.6 and 6.2 years for trials and observational studies, respectively. In metaanalyses of randomized trials, there was no evidence that statin therapy was associated with incidence of all-cancers or the following site-specific cancers: breast, prostate, colorectum, lung, genito-urinary, melanoma; or gastric. There was no evidence of differential effects by length of follow-up, statin type (lipophilic vs. lipophobic) or potency. Trial results were generally consistent with observational studies. We conclude that statin use is not associated with short-term cancer risk, but longer-latency effects remain possible.
   Dr. Sahelian comments: It takes sometimes at least 10 years to determine whether the use of a drug or substance leads to a higher cancer rate. The followup of 3 to 6 years of statin treatment tells us little.

 

Statins and breast cancer
Women who use statin drugs to lower their cholesterol are probably no more likely to develop breast cancer than women who do not use the statins although this is not for certain yet since different studies have shown different results.

 

Statins and colon cancer
Contrary to findings from lab research and epidemiologic evidence, results of a new large study show no reduction in the overall risk of colorectal cancer among people who take a "statin" drug such as Lipitor or Zocor for their hearts. As reported in the Journal of the National Cancer Institute, the researchers compared statin use among 1809 patients with colorectal cancer and 1809 similar but cancer-free "controls." Taking statins regularly for 3 months or longer had no apparent effect on the overall risk of colorectal cancer. Moreover, no consistent trends in statin dosage or duration of use were seen. However, statin users were only half as likely to have advanced (stage IV) colorectal cancer as were nonusers. The new findings strongly suggest that statins are not useful for preventing colorectal cancer. Journal of the National Cancer Institute, January 3, 2007.

Statins and fibrates
Today’s top-selling statins could be risky when taken with other drugs called fibrates by older people with diabetes. Fibrates alone can be dangerous. These drugs lower triglycerides and often are taken by diabetics.

 

When to take statins
Doctors should use "good" (HDL) cholesterol levels to determine which elderly patients are most likely to benefit from statin therapy. Statin therapy may be indicated if the HDL level falls below 40 mg/dL or if the ratio between "bad" (LDL) cholesterol and HDL is greater than 3.3. With higher HDL levels, little benefit is achieved with statin therapy. Statin drugs should be used if diet and natural supplements have not been successful in lowering very high cholesterol levels.

 

Are statins necessary after an acute MI?
The introduction of statins within 14 days of the onset of acute coronary syndromes (ACS) does not reduce the risk of MI, stroke, or death during the first 4 months of treatment. Therefore, it may be a good idea to hold off for a few weeks after an MI and then decide the need for statins or natural supplements based on dietary changes and cholesterol levels.
   However, another study disputes this. High-dose therapy with statins was shown to reduce the risk of cardiovascular events by about 20% when initiated within 2 weeks of hospitalization for acute coronary syndrome (ACS), according to a meta-analysis. The decreased risk appears to be independent of the statin's efficacy in reducing LDL-cholesterol levels, researchers report in the September 25 issue of the Archives of Internal Medicine. The team, at Walter Reed Army Medical Center in Washington, DC, led by Dr. Eddie Hulten, searched medical literature for randomized trials comparing early, intensive statin within 14 days of hospitalization for ACS, with a control arm. "Intensive therapy" was defined as a medication regimen begun at a higher dose than usual, as recommended by the National Cholesterol Education Panel guidelines. The investigators identified 13 statin trials reported between 1974 and 2005, with a total of 17,963 subjects. Median duration of follow-up was 6 months (range 1 to 48 months). Intensive statin therapy was compared with placebo, placebo for 4 months followed by a lower dose of statin, a lower dose of statin alone, or usual care. Statins included atorvastatin 20 or 80 mg, pravastatin 40 mg, fluvastatin 80 mg, and simvastatin 80 mg. The meta-analysis showed that the benefit began to accrue after 4 months of treatment. There was significant reduction in overall cardiovascular events (hazard ratio, 0.76), which persisted through 24 months (hazard ratio 0.81). The most effective regimen was atorvastatin 80 mg. Statin side effects included cases of rhabdomyolysis among patients taking high-dose simvastatin, and hepatitis.
   Dr. Sahelian comments: I wonder if adding cheap and safe supplements, such as fish oils and psyllium, may have shown a similar benefit. Plus, it is possible that the studies that were included in the meta-analysis were biased in order to present a benefit from statin treatment. When big money is involved, science can bend. Archives Internal Medicine 2006;166:1814-1821.

 

Statins and the elderly
Although statins may lower mortality in heart attack sufferers who are between 65 and 80 years old, they may not be effective in older patients. Journal of the American Geriatrics Society, March 2006.

 

Statins and CoQ10

Considerations for supplementing with coenzyme Q10 during statin therapy.
Ann Pharmacother. 2006 Feb;40(2):290-4. Epub 2006 Jan 31. Levy HB, Kohlhaas HK. HbL PharmaConsulting, St. Louis, MO
To review the literature concerning the effects of statin use on coenzyme (Co) Q10 concentrations and explain the rationale behind considering CoQ10 supplementation. A MEDLINE search was conducted through January 2006. Search terms included ubiquinone, coenzyme Q10, HMG-CoA reductase inhibitors, statins, myotoxicity, and clinical trials. Statin therapy reduces blood CoQ10 concentrations. Studies exploring how this affects the development of myotoxicity have been small and dissimilar, thus limiting the ability to draw strong conclusions. Isolated studies suggested that statins induce mitochondrial dysfunction, but the clinical implications of this effect are limited. Limited data suggest that patients with familial hypercholesterolemia, heart failure, or who are over 65 years of age might represent at-risk populations who would benefit from CoQ10 supplementation.

 

Protective effect of coenzyme Q10 in simvastatin and gemfibrozil statin induced rhabdomyolysis in rats.
Indian J Exp Biol. 2005 Oct;43(10):845-8.
Administration of the statins simvastatin (80 mg/kg, po. evening dose) and gemfibrozil (600 mg/kg, po twice) for 30 days produced significant decrease in the level of reduced glutathione, superoxide dismutase, catalase and increase in the level of lipid peroxidation and various serum parameters (creatine phosphokinase, lactate dehydrogenase, serum glutamate oxaloacetate transaminase, creatinine, urea and blood urea nitrogen). This suggested involvement of statin treatment in oxidative stress in rhabdomyolysis. Increase in the level of reduced glutathione, superoxide dismutase, catalase and decrease in the level of lipid peroxidation and serum parameters after administration of antioxidant CoQ10 (10 mg/kg.ip) proved the protective effect of CoQ10 in rhabdomyolysis. See also benefit CoQ10.

 

Statins and hepatitis virus
Statins, which are typically used as anti-cholesterol medications, can inhibit the replication of the hepatitis C virus (HCV). These findings are published in the July 2006 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). The standard treatment for hepatitis C is a combination therapy of interferon and ribavirin, which is only effective in about 55 percent of patients. The remaining 45 percent face a threat of the disease progressing to cirrhosis and liver cancer. Based on recent reports that one statin, lovastatin, inhibits HCV replication, researchers led by Masanori Ikeda of Okayama University in Japan, tested other statins in search of a more effective anti-HCV therapy. Using the OR6 cell culture assay system, they evaluated the anti-HCV activities of five statins: atorvastatin, fluvastatin, lovastatin, pravastatin and simvastatin. When the statins were tested alone, all except pravastatin inhibited HCV replication. Fluvastatin had the strongest effect. Atorvastatin and simvastatin had moderate effects while lovastatin had a weak effect. While pravastatin exhibited no anti-HCV activity, it did work as an inhibitor for HMG-CoA reductase, suggesting that the anti-HCV activities of the other stains are not due to the direct inhibition of HMG-CoA. The researchers determined that the anti-HCV activities of statins were not related to cytotoxicity, meaning they did not kill the host cell. Additional experiments also suggested that, "the statins possess the ability to inhibit the replication of HCV RNA via a specific antiviral mechanism.

 

Statin use and anesthesia
People who experience myalgia after taking statins (HMG-CoA reductase inhibitors) may have impaired calcium homeostasis, which could mean they're at risk for malignant hyperthermia if they're exposed to halogenated anesthetics and other agents. In the August 15th issue of Arthritis and Rheumatism, Dr. David Bendahan of Faculte de Medecine de la Timone, Marseilles and colleagues comment that statins may cause myotoxic effects. To investigate possible skeletal-muscle related mechanisms, the researchers studied 11 patients with increased creatine kinase levels and myalgias after statin treatment. None of the patients or their family members had a history of adverse reactions to volatile anesthetics. Nine patients underwent muscle biopsies, and in vitro halothane and caffeine contracture tests were conducted on the specimens. The results were abnormal in seven of the patients, indicating impaired calcium homeostasis. Moreover, results were positive for both halothane and caffeine in two patients demonstrating that they were susceptible to malignant hyperthermia. Given these findings, the researchers advise that "statin treatment must be administered with caution to patients with a known susceptibility to malignant hyperthermia." Dr. Bendahan says creatine kinase assays should be performed before the initiation of any statin treatment. Arthritis Rheum 2006;55:551-557.

 

Research on statin drugs and alternatives
Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia
American Journal of Clinical Nutrition, Vol. 83, No. 3, 582-591, March 2006
Cholesterol-lowering foods may be more effective when consumed as combinations rather than as single foods. Our aims were to determine the effectiveness of consuming a combination of cholesterol-lowering foods (dietary portfolio) under real-world conditions and to compare these results with published data from the same participants who had undergone 4-wk metabolic studies to compare the same dietary portfolio with the effects of a statin medication. For 12 months, 66 hyperlipidemic participants were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal), and almonds (23 g/1000 kcal). Fifty-five participants completed the 1-y study. The 1-y data were also compared with published results on 29 of the participants who had also undergone separate 1-mo metabolic trials of a diet and a statin. Results: At 3 mo and 1 y, mean (±SE) LDL-cholesterol reductions appeared stable at 14 and 13, respectively. These reductions were less than those observed after the 1-mo metabolic diet and statin trials. Nevertheless, 31% of the participants had LDL-cholesterol reductions of >20% at 1 y. The LDL-cholesterol reductions in this group were not significantly different from those seen after their respective metabolically controlled portfolio or statin treatments. More than 30% of motivated participants who ate the dietary portfolio of cholesterol-lowering foods under real-world conditions were able to lower LDL-cholesterol concentrations >20%, which was not significantly different from their response to a first-generation statin taken under metabolically controlled conditions.

 

Statin drugs damage mitochondria
The mitochondria are structures in cells that make adenosine triphosphate, or ATP, which helps power cells. Statins lower ATP levels and interfere with the mitochondria. Three statin drugs (fluvastatin, lovastatin and simvastatin) produce strong decreases in cellular ATP levels and mitochondrial) activity. Fluvastatin is sold by Novartis under the brand name Lescol, lovastatin is sold under the brand name Mevacor, and simvastatin is sold as Zocor. Three others -- atorvastatin, made by Pfizer under the brand name Lipitor, pravastatin, sold as Pravachol, made by Bristol Myers Squibb and rosuvastatin, sold under the Crestor brand name by AstraZeneca -- have little effect on mitochondria.
Other drugs that are similar to statins in their activity in mitochondria include propranolol, amoxapine, cyclobenzaprine, griseofulvin, pentamidine, paclitaxel, propafenone, ethaverine, trimeprazine and amitriptyline.

 

Statin drug questions
Q. Is it okay to take serrapeptase enzyme or nattokinase enzymes the same day as statin drugs?
   A. This is a good question. I don't know, but my first impression is to be cautious and not to combine statins and these proteolytic enzymes.

 

Q. Thanks for this writeup in your August 2006 newsletter regarding statin use and muscle damage. In your opinion, would the same be true for red yeast rice which has statin -like properties?
   A. Red yeast rice has many substances in it, one of them being similar to a statin drug. Plus, different red yeast rice supplements on the market may have different compositions. it is difficult to say whether red yeast rice causes muscle damage. We have not had this reported to us yet, but we keep an open mind.

 

Q.  I am new to your medical newsletter and I like what I read.. you can add me to the list of leg muscle pain taking the statin Lipitor. i took this statin medication for 2 yrs and stopped 3 months ago.

 

Q. I am a medical doctor. I was placed on Crestor after my cholesterol became elevated. I had also become diabetic -- both after being on many medications for various illnesses. I developed so-called diabetic peripheral neuropathy. I say "so called" because there was a possibility I had plantar fasciitis, and I insisted that all other possible causes of the neuropathy be ruled out. Internists and neurologists insisted that the statin Crestor was not a possible cause. I subsequently "googled" "statins and peripheral neuropathy"...Needless to say, much was found. I insisted that I be taken off the Crestor, and received PT for possible plantar fasciitis. During this time, I wrote Dr. Lam at his web site, asking if red yeast rice, as a "natural" statin, could also cause peripheral neuropathy. He replied, "Yes". He suggested alternatives, which I cannot remember at this time. I am writing out of concern that perhaps the red yeast rice could cause similar problems as the pharmaceutical statins. Also wondering if CoQ10 supplementation might also be necessary for the red yeast rice!
   A. I have not seen any research regarding the role of red yeast rice and muscle tissue damage.

 

Q. Dr. Sahelian, I've been following your advice and even though I'm 75, my health has been improving. In Jan 2001, a cardiologist rushed me into heart surgery and then prescribed statin drugs, one of which caused me to cough 24 hours a day, I got off of it, then heard it was taken off the market due to causing deaths The statin drug was Baycol manufactured by Bayer. Thank you for your reliable information. My friend's husband is 60 and has had heart surgery, has diabetes, and is in terrible health; I've forwarded your information to her in hopes it will be as much help to her has it has to me.

 

Q. Are there special risks associated with discontinuing statin use, as opposed to not starting it in the first place. I've noticed a lot of muscle fatigue in my legs since starting to take Lovastatin ( Mevacor ), although I hadn't previously associated the pain with the drug as a statin side effect. I stopped taking the lovastatin and the pain in my legs went away immediately! Now I need to figure out if I should take it every other day, once a week, or not at all . .
   A. There have not been any problems mentioned in the medical literature with abrupt discontinuation of statin drugs, you could consider at first using it every other day after discussing with your doctor until you implement natural ways for cholesterol reduction. I think statin drugs are being overused and are less safe than doctors think.
      Q. I'm thinking that I'll get more exercise without taking this statin drug, since the pain was keeping me away from dancing and other activity that would exercise my joints- I was assuming it was arthritis-related, and that I should reduce stress on my joints to prevent it from getting worse! I could live with high cholesterol levels- it was never something I was particularly concerned about in the past. I'm amazed that the information on statin drug use and muscle aches hasn't gotten wider exposure- I've mentioned it to a few friends who also said they had cut down or discontinued cholesterol medication!

 

Q. This is my Kaiser general internist's (tee hee) reply to the message I sent him - a quote from your newsletter. "Those of you who are regular readers of my newsletter http://www.raysahelian.com (he makes sense about enough
stuff that I'm forwarding you a comment of his) have heard me repeatedly say that, even though statin drugs such as
Lipitor and Zocor reduce cholesterol levels, there is no proof that statin drugs help people live longer. A recent medical journal article appears to validate my viewpoint. Fortunately, this journal article from Archives of Internal Medicine, November 27, 2006 got picked up by the news media. The CNN.com headline said, " Study doubts benefits of universal statin drug use." The CNN article begins, "Cholesterol-regulating statin drugs slightly lower the risk of heart attack and stroke in people with no history of cardiovascular disease but may do little to reduce their risk of death." My doctor replied, This is not a good statin study; the author's themselves in the conclusion of it note that they did not break the subjects into groups with varying levels of risk. Other statin studies show a clear benefit for diabetics. Also, this study only addresses primary prevention (ie those people who have never had a stroke or heart attack); the authors note that these people benefit from statins. Lastly, while the death rate was not decreased, the risk of heart attack and stroke was. I think most people would not like to have a nonfatal heart attack or stroke. So I don't think this statin study really changes anybodies recommendations about statins.
   A. Perhaps future research will further clarify the statin controversy, but for the time being it is the doctor's duty to provide proof that a 1000 or 2000 dollar a year statin drug will be of significant benefit to the patient and enhance lifespan and quality of life with few side effects before haphazardly prescribing it. I'm not sure dying of other causes besides a stroke or heart attack is any more pleasant.  Your doctor's answer does not seem rational.


Q. I just finished reading your article on the infamous statin drugs! My cholesterol always hovered around the 180 mark which is fine by all the standards, and my LDL, bad cholesterol, was always around 100, again ok, and my triglycerides hovered around the upper range at150 - 160 or so!...About 6 months ago, I started taking flush free niacin (over the counter!) to see what would happen to my cholesterol levels, added 2 grams of fish oil, and a garlic supplement!. I DID "NOT" CHANGE MY DIET!!...To the astonishment of both my Dr. and to myself last week, the following results came back. TOTAL CHOLESTEROL, 138, LDL, 86, TRIGLYCERIDES, 90..... My HDL, well, I've always had a bit of a problem with that being around 36 or so and have tried everything, went to 40....My point being that one should explore 'every possible option' before putting the dangerous statins into their systems. Additionally, statins deplete the body of CoQ10. Doctors don't tell you to supplement with CoQ10 if you are on a statin drug. My best to you,. Chuck Kelley, llcarlos48@yahoo.com. You may use my name if you wish, and I have 'documentation' if you wish also.
 

Q. I am a retired drug rep. My cardiologist could not believe my lipid profile without the use of statins. I take 1 tbls. of pharmaceutical grade fish oil each day. My triglycerides dropped by 40%!
 

Q. After 7 months of various statin protocols I completely stopped in March 06 due to extensive pain in the thighs and calfs and started a daily regiment of 2400mg of red yeast rice. The muscular discomfort has slowly decreased. Last month I added 200mg of Co Q10 to my daily regimen. The lingering muscular discomfort has gone. I credit CoQ10 for the relief. I wish to continue CoQ10 along with the Red Yeast Rice and would appreciate your comments, recommended dosage and frequency.
   A. There is no standard nutritional regimen that will apply to everyone. As a rule, the best option is to use the lowest amount of supplements that work. Personally, I prefer to use less than 60 mg of CoQ10 a day, and there have been cases of muscle aches with red yeast rice hence the lowest amount that works in reducing cholesterol.

 

Q. I really am glad to see that someone is writing the TRUTH about statin drugs. I was diagnosed with high cholesterol, at age 25, that was 20 years ago. One of the cardiologist that I worked with at the time, told me that my condition was most likely genetic. He left it up to me as to whether or not to take meds for the condition. I opted not to, despite my cholesterol of 285, because I felt uneasy about the liver implications. The last time I had my cholesterol checked, was a couple of years ago and it was 308. It has stayed in that range for the past ten years. One doctor prescribed statin Lipitor, which I did NOT take; I never filled the prescription! However, the information went on my chart, and now I am self-employed, and honest, and due to the fact that this statin drug was prescribed, I have been denied health insurance. I wonder how many people realize that once they begin taking statin drugs that they are considered a "high risk" for heart attack or bypass surgery? Do they know that if they ever attempt to obtain private insurance, they can be denied based on this "high risk" categorization? To dispute this presumption of CAD, I had a an echo-cardiogram and a treadmill test. My echo was good, and I did exceptionally well on the treadmill test; better than 70% of women my age (or so I was told). Even with this information, I still cannot get health insurance! Because of this, and my desire to lower my cholesterol, I recently started taking policosanol and I am hoping to see a drop in my cholesterol. I will keep you posted. I may drop dead tomorrow of a massive MI, however, at least I will not have died a slow painful death from my liver being destroyed because of statin drugs!  I know people, who despite taking statin drugs, still had to have stents or bypass surgery, or died.

 

Q. I am suffering from a severe case of rhabdomyolysis caused by statin drugs which were used to lower my cholesterol.

 

Q.  I've had high cholesterol all of my life , some 240 plus and last year increased to the 270 plus level. I've tried all diets, supplements to no effect. Doctor had me on simvastatin 40 MG but I just felt ill , weak and poor balance on them and only took them a couple of weeks before quitting. This I did for three different times. I obtained a copy of Dr Duane Graveline book, Statin Drugs Side Effects; The last thirty days I have been taking 6 to 10 grams of vitamin C and equal amounts of Omega 3 Fish Oil. The reason the amounts vary is that I forget to take them at times. I had a checkup at the VA clinic yesterday and cholesterol has dropped to 221, some 50 points. This has been the lowest I have ever had. I had took the last statin in Nov. last year. I expect the level to drop more. The ratios are out but hopefully they will improved in the future. I has a Carotid Artery screening a couple of months ago and Plaque build up was rated mild / moderate range which is "insignificant", so I must be doing something right. Also I am 67 years old.

 

Q. I have been diagnosed with cfids chronic fatigue and immune dysfunction syndrome since 2001. I am 55 years old now, I suffer greatly. My doctor doesn't know what to do for me. I take tramadol everyday. After I do any physical work, about 5 hours later my entire body (muscles) are killing me...I am getting worse ...Just before I came down with this I was put on pravachol statin drug for high cholesterol, I then had muscle weakness and my doctor took me off of it. To this day we wonder if this was a pravachol side effect that did this to me. I can't take this, the body pain is awful.
   A. It's difficult for us to say whether the pravachol statin drug was the cause, but it is a possibility. Statin drugs can unmask neuromuscular diseases. See the link towards the top of the page regarding neuromuscular damage and conditions that statin drugs may induce or aggravate.

 

Q. I have read recommendations that the appropriate dosage of CoQ10 for those who are on statin drugs is 300 mg. Is this true?
   A. We don't know for sure what the right CoQ10 dosage would be for those on statin drugs, but 300 mg is too high and can cause side effects. For now, we prefer 30 to 50 mg a few times a week.

 

Q. I have had several patients report to me that they have developed tremors after taking statins to lower cholesterol; and these tremors persist even after stopping the statins. They also report their doctors say this is a possible side effect. I have not seen this statin drug side effect reported in any literature I've read. Do you have any knowledge of this statin side effect?
   A. I have not come across in any medical journal publication tremors as a side effect of stating drug use. However, I have come across two patients who thought the use of statin drugs caused tremors. I await further studies and case reports before having more confidence in this possible statin drug side effect.

 

Q. I was prescribed a statin drug about a week ago (Simvastatin which is generic Zocor). I am having muscle cramps, diarrhea, and stomach cramps every morning. I just threw the prescription in the trash today after using for 6 days. My total cholesterol is 253, LDL is 179. Triglycerides are OK at 122, and HDL at 50. I take fish oil - 1200 mg, CoQ10 - 50 mg, and alpha lipoic acid -100 mg. daily in addition to a multivitamin and chondroitin / glucosamine plus MSM.

 

Q. Thanks for your recent news letter on statin drugs. With the article on statins I had to write with my experience. The VA put me on simvastatin 40 mg a day. I don't like to take any drugs and find that I'm very susceptible to any drug. I found a article by a Dr Duane Graveline, and purchased his book "Statin Drugs Side Effects and the misguided war on cholesterol" I took 6 grams of vitamin C and a equal amount of Omega 3 fish oil per day. In 60 days my cholesterol dropped from 270 to 220. Don't have the ratios handy. I've since threw my statins away. Dr Duane Graveline maintains that most people are deficient in Vitamin C.
   A.  Thanks for the feedback. I was not aware of a book by Dr Duane Graveline, "Statin Drugs Side Effects and the misguided war on cholesterol."

 

Q. I am a doctor. My wife, 67, never smoked, no alcohol, very active physically (non stop gardening and ceramicist who hunks and throws clay up to 10kg at a a time) was started on 20mg Pravastatin ten weeks ago for high cholesterol / LDL. Two weeks ago she felt sensitivity at upper right abdomen; unabated for 7 days. Then weakness / loss of appetite/ reduced drinking during a day. Early that day a GP muttered about Gall bladder after consulting current diagnosis software: she proposed ultrasound; queue, 4 weeks. Later in day, weaker and weaker, no temp. yet, back to a different GP (same practice). He was concerned: to ER. Passed out sitting! amylase already 3300 + temp (37.4)! Statin stopped immediately; no food, no statin, pain stopped in 15 hours. Four days in ward; starvation, iv water/salts - ie wide metabolic 'rest'. After four days amylase down to 100. Liver function fine apart from elevated LDH; slight rise in blood urea / also normal after 4 days; ultrasound was negative as also CT, no sign of biliary deposits problem. Other exclusions: hepatitis etc etc. As in 20-30% of cases of pancreatitis, the doctors have no suggestions. After 3 days back home wife seems herself, eating carefully; we hope that this is first/last time My comments: Statins can have very wide 'light' effects over a range of systems. So damage can be slight but slow, unnoticed till the cart tips suddenly. This is a particularly dangerous kind of situation. My wife is lucky - we hope ....; another week to diagnosis and the pancreatitis could have led to permanent pancreatic damage (at least cartilage and muscle effects are noticeable). Not only is the public very unaware of the danger to the pancreas, but it seems most GPs too! This is unacceptable. Is the FDA unaware too? Thanks for keeping an eye out for an unsatisfactorily protected public.

 

My husband cannot take prescription statins due to severe muscle weakness. What would be a good substitute? His numbers are high. I wonder if red yeast rice would have the same affect of muscle weakness as statins?
    It's possible that some red yeast rice products could cause muscle pain or weakness, but there are many other natural supplements that are useful in those with high cholesterol levels.

 

Several years ago I participated in a long term study of lovastatin (almost 6 years). Was monitored frequently and had no problems. After the study was completed I discontinued the statin. When tested a couple of years later cholesterol was up again (240). After reading about potential problems with statins, I wanted to try the more natural supplement way. I began taking red yeast rice and fish oil daily as advocated by N3 Oceanic (Rescue 1250) and others. This worked as well as the lovastatin with no problems. At some point a couple of years ago the government found that there was some lovastatin in the red yeast rice and that was why it was helping keep cholesterol down. Of course they enjoined the companies from marketing the product. I tried the new product for over a year and it did not help my cholesterol problem. A MD started me on Zocor 20 mg which I quickly cut in half as I wanted to try the lowest dose possible. On next visit with him, lab results showed I was getting lower than I wanted to be (140s). Presently I take 10 mg Zocor on 3 days per week and 5 mg 3 days. None on 1 day. I am doing fine at this level(170s). I guess the point of this is that the presently constructed red yeast rice doesn't work for everyone and the low dosing of Zocor can be effective. I have continued with the fish oil all along. Enjoy your newsletters.
 

 

This statin medication page was last updated June 2009.