Statin adverse side effects vs risk of stroke and heart attack: how to balance the risks?Ruslan Dorfman, PhD, MBA
Statins have long being used for reducing the risk of heart attack and stroke in patients at high risk of cardiovascular disease, particularly in obese and Type 2 Diabetes patients. Clinical trials have demonstrated the positive role of statins in risk reduction that extended well beyond the associated reduction of cholesterol levels, therefore, many physicians prescribe statins even for patients with normal or slightly elevated cholesterol levels, increasing the incidences of statin-induced pain and myopathy. Every fifth patient on statin reports severe muscle pain and weakness, and 5% of people are at high risk of statin-induced myopathy that can result in kidney failure.
So, the question is how to balance the risk of adverse side effects? Should patients avoid statins?
The answer is simple: genetic test can identify patients with high risk of adverse side effects to statins. These patients can benefit from alternative treatments.
Current clinical practices for stroke treatment aim to reduce the risk and severity of heart attacks and strokes, as well as prevention of a secondary stroke, by aggressive pharmacological interventions. These interventions mitigate the key risk factors such as atrial fibrillation, diabetes, hypertension, and hyperlipidemia. Nearly all stroke patients receive four classes of medications for continual stroke prevention:
- Antiplatelet control: Aspirin or clopidogrel.
- Continuous anticoagulant treatment: primarily warfarin for patients with atrial fibrillation (10-15% of all stroke patients).
- Hypertension control: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, administered to a vast majority of patients due to additional benefits of these drugs.
- Statins: primarily as anti-inflammatory agents and for the control of hyperlipidemia, prescribed to the majority of stroke patients.
However, not all statins have the same effect! Some statins, such as pravastatin and simvastatin, are known to cause severe muscle and bone pain more frequently than others; the risk of pain and kidney failure increases in a dose dependent manner.
Atrovastatin (Lipitor) is favored by physicians for its higher potency and lower risk for causing pain while Rouvastatin (Crestor) does not cross the bloodbrain barrier and is thought to be a lower risk for statin-induced dementia, as well as muscle pain. The PRIMO study reported that 5.1% of patients on Fluvastatin XL experience muscle pain vs 18% of simvastatin users.
Specific variations in the SLCO1B1 gene have been implicated in patients’ responses to statins. The SLCO1B1 transporter (uptakes) transports statins from the gastrointestinal tract and genetic variants alter drug uptake, resulting in differing drug responses. For instance, SLCO1B1 variants block the uptake of flavonoids present in grapefruit juice as well as statins.
The rs4149056 p.Val174Ala variant in SLCO1B1 were shown to be associated with simvastatin-induced myopathy and people who carry two alleles (CC genotype) are at 20 fold increased risk of statin-induced myopathy than people who do not carry this variant.
Testing for SLCO1B1 variants for new patients can significantly reduce the incidence of simvastatin-induced myopathy by allowing people to switch to alternative cholesterol controlling strategies through diet and naturopathic medicine. For example,red rice is known to have very potent cholesterol lowering effect; while grapefruit juice which is contraindicated for people on statins has cholesterol lowering effect when taken with food. Strict adherence to diet is not easy and statins could be the easy solution, but statins are certainly not for everybody.
Geneyouin offers you the opportunity to check how you can (will) react to statins as well as other 60 medications in one affordable test, so you know your options and take control of your health.