Statins: The Whipping Boys of Cardiac Drug Therapy

I’m approaching year 8 of breakfasting on atorvastatin. When my GP first explained to me that I’d be taking the medication for the rest of my life, after being diagnosed with cardiac ischemia and atherosclerosis (coronary artery disease), I protested.

I bargained with him:

“What if I change my diet?”

“What if I go vegan?”

Bargaining is the 3rd of the five stages of grief (Elisabeth Kubler-Ross) and my doctor wasn’t buying it. He explained that most of the cholesterol circulating in my bloodstream was produced in my body (about 80% to 85%), and not from the food I ate and that he wasn’t optimistic about my adhering to such a radical change in diet.

Full disclosure: I knew little about statins at the time. I had no rational reason for my reluctance. I just hadn’t dealt very well with the fact I had a progressive coronary vascular disease. As a long-time marathon runner, it was hard to accept I was suddenly unhealthy. This had never occurred to me before and something I had believed running prevented.

I was wrong.

In year 3 of statins, I tore my left calf muscle. I was running a 10-miler when I felt a sharp pain in my calf about 4 miles in. I stopped, massaged it, and finished the run, limping in for the last 50 yards. As a runner, a typically stoic runner, dwelling on pain was a mental roadblock to performance. I tended to ignore it yet this time it was harder to ignore. The next day my calf was black with bruising and by the end of the week my ankle was swollen, and my foot was black as the blood had migrated down with gravity.

I thought my calf injury was likely a function of age, accident, and stubbornness. I had never thought about statins and their potential side effects until I joined Facebook groups related to my cardiac issues. It was there I learned that statins got blamed for many things, from muscular aches and pains to fatigue, brain fog and bad dreams. Before my enlightenment, I’d always relegated my aches and pains to my running and then forgot about them soon after my run. If it was the statin, I wondered, why are the aches and pains confined to my legs and not any of the many other muscles in my body. Perhaps athletes are more prone to the aches and pains of statins but then I would wager athletes are more prone to aches and pains anyways.

Standard Deviation

I barely passed 2nd-year statistics in university.

My final mark was 50%.

By graduate school, I began to enjoy statistics and research methodology. I ended up being the tutorial assistant for graduate-level advanced multivariate statistics. I made a t-shirt for the final exam I was proctoring which read: “I am a standard deviation” on the front and the formula on the back. (Okay, you had to be there or be a stats nerd.) Working with statistics forces you to look at populations instead of the individual, at the experiences of thousands of people and not just those of one person.

It’s hard to overlook a personal experience in favour of impersonal research findings about populations. When my physician said most people can’t adhere to a radical change in diet, my initial reaction was “I’m different”.

He was referencing the research.

I was referencing my emotions.

He was looking at probabilities and I, like a lottery player, was looking at possibilities. I believe people who say their muscular aches and pains are the result of statins. I also believe the multiple randomized double-blind research studies that report the side effects of statins, in particular the aches and pains, are over-reported and exaggerated in the popular media, to the point of causing real harm. I don’t think those two beliefs are mutually exclusive.

Evidence

If you have the time, I invite you to read a 2016 article from the American College of Cardiology titled: “Summarizing the Current State and Evidence on Efficacy and Safety of Statin Therapy”. I’m not asking you to believe it, just to read it and try it on for size. If you don’t have time to read the article, here are the big take-aways:

1. Statins reduce the likelihood of heart attacks, strokes, and death in people with cardiovascular disease. People like me.
2. There is a risk of muscular injury from statins, but it is extremely low, reversible and its prevalence highly exaggerated in the popular culture. There is NO evidence that statins cause muscle pain or weakness, in the absence of this specific low-likelihood muscle injury just mentioned — people taking a sugar pill and told it is a statin are as likely to report muscle aches and pains as people taking a statin.
3. There are more serious side effects from statins, such as rhabdomyolysis and hepatotoxicity, but these are extremely rare. People with pre-existing risk for diabetes have a higher risk of developing this disease when taking statins, but the benefits of statins still outweigh this risk by reducing their risk of heart attack, stroke, and death, even if diabetes develops. Likewise, statins increase the risk of hemorrhagic stroke (1-2 strokes per 10,000 patients) but their benefits still outweigh this risk.
4. Statins have NOT been demonstrated to affect memory or cognitive function among patients, or to be associated with the development of dementia.
5. The popular myths about the side effects of statins are becoming a public health issue as patients stop taking their prescribed statins and doctors stop prescribing them to avoid arguing with their patients and the opinionated Dr. Google. This is causing unnecessary and premature deaths among people with cardiovascular disease.

As for the deep-state conspiracy theories about physicians and Big Pharma pushing expensive pills over cheaper alternatives, the price of one atorvastatin pill went from costing $5 to 31 cents when it went off-patent. About 86% of prescribed drugs sold in America are generics. Of course, pharmaceutical companies want to make profits, just like diet book authors like Ornish and Esselstyn and supplement salespeople like Dr Sinatra and Gwyneth Paltrow want to make money. Yet somehow these latter medical capitalists get a free pass, from the cynical public and government health regulatory agencies.

Go figure.

Negative Experience?

Sharing your negative experience with a statin may feel like the right thing to do but to what end? It’s your personal story yet, in terms of being informative in another’s decision-making or even applicable, about as helpful as sharing that your grandmother smoked cigarettes all her life and didn’t die from lung cancer.

The research says otherwise.

Helping to spread the myths about statins, based on personal experience or opinions found on internet websites, contributes to other people becoming non-compliant in following their statin regimen and being at risk of dying prematurely.

If you are experiencing muscle aches and pains, and are taking a statin, resist the urge to seek advice from the internet. Instead, reflect on the physical activities in which you’ve recently been engaged, especially any increase in their intensity, and any other changes in your lifestyle, and then talk to your physician. Simply switching to another statin usually does the trick. If you feel you absolutely must share your personal negative experience with statins, don’t forget to say you’re a member of a very small and very exclusive group, and mention all the carefully planned and executed research studies that support that fact.

For my part, I think atorvastatin is impacting my wife’s sense of humour, and she isn’t even the one in our home taking the drug. Please don’t tell her I said that.

Addendum: Here is an interesting article, targeted at physicians to educate them on the myths their patients hold about statins.The Fatal Dangers of Statin Misinformation (escardio.org)

Ted Guloien

Canadian, Athlete and SCA Survivor