Imaginary and real side effects of statins
How Statins treat Cardiovascular diseases
Cardiovascular diseases are the leading cause of death worldwide: today, every third person dies from a heart attack or stroke caused by certain vascular problems. The state of the cardiovascular system is affected, in particular, by the level of cholesterol in the blood: the higher it is, the more cholesterol settles on the walls of blood vessels, narrowing their lumen and impeding blood flow. To combat this problem, statins are used — a special class of drugs that can reduce the level of cholesterol in the blood. Pharmacologist Yuri Kiselyov, Ph.D., associate professor at Oslo Metropolitan University, tells about how they work and what side effects they can cause.
Statins are drugs that are able to reduce the level of cholesterol in the blood, and in particular — the level of low-density lipoproteins, or "bad" cholesterol, which is associated with the development of various cardiovascular diseases — angina pectoris, heart attacks, strokes, atherosclerosis and others. Part of the "bad" cholesterol contained in the body enters the body with food, and about two-thirds is produced by the liver to be further used in cell membranes or for the production of certain hormones, including testosterone and estrogen. Therefore, in order to lower cholesterol levels in the blood, a diet low in animal fat is often not enough: it is also necessary to suppress the production of cholesterol in the liver. This is what statins are used for.
How do they work? When statins suppress the production of cholesterol, the liver begins to lack it, because it itself cannot produce it in the desired volume due to drugs. As a result, liver cells form receptors for "bad" cholesterol on their surface and begin to snatch it from the bloodstream, the cholesterol level in the blood drops, and as a result, the development of atherosclerosis slows down, that is, atherosclerotic plaques that settle on the walls of blood vessels, narrowing their lumen. Statins have other effects, in particular, anti—inflammatory: we know that chronic inflammation in the vascular wall predisposes to the development of atherosclerosis, and statins are able to reduce it. Thus, statins are used to prevent the development of cardiovascular diseases.
Side effects of statins
Like any other medication, statins have undesirable side effects. The most commonly reported effect of statins on the liver and muscle tissue, as well as on the likelihood of developing type 2 diabetes.
Statins are indeed able to affect the level of liver enzymes, but in most patients it either does not increase or increases slightly. It is believed that the rise of enzymes 3 times from the initial level is not significantly dangerous. Studies have shown that serious liver damage on the background of statin therapy is very rare, but just in case, liver enzymes should be measured before starting treatment.
Another group of important undesirable side effects is associated with muscle tissue: patients often note muscle weakness and diffuse, diffuse pain in large muscles, in particular in the thigh muscles. Such effects can range from minor pain to potentially serious problems — for example, rhabdomyolysis. Rhabdomyolysis is a severe lesion of muscle tissue, in which muscle cells begin to disintegrate, releasing muscle protein into the bloodstream, which may later end up in the kidneys and cause severe damage to them. However, rhabdomyolysis as a severe lesion as a result of statin therapy is extremely rare — less than once per 10,000 patient-years, that is, 10,000 patients must take statins for at least a year to have at least one case of rhabdomyolysis. According to recent studies, the actual incidence of rhabdomyolysis is even lower.
Some studies indicate that statins can slightly increase the risk of developing type 2 diabetes, but these are not absolute, but relative estimates. Let's assume that the risk of developing diabetes while taking statins increases by 10% — although this is a rough estimate that has not yet been proven. This does not mean that one in ten people taking statins will develop diabetes: this means that if earlier the patient's risk of developing diabetes until the end of life was 20%, then against the background of taking statins, it is 20% plus one tenth of this value, that is, 22%.
When it comes to side effects, it is important to remember that when prescribing treatment, it is necessary to correlate some risk of side effects with the risk of dying from a heart attack, getting severe heart failure or, for example, acute cerebrovascular accident. If the probability of side effects from taking statins is low, and the probability of death or serious illness is serious, it is better to prescribe statins to exclude the development of serious problems.
Can we trust our feelings?
In 2021, a study of the work of statins was published: it involved about 200 patients who had previously taken statins, but refused them due to side effects. These patients were offered to resume taking the drug, and applications were installed on their phones, where they had to mark their level of distress due to side effects on a scale from 0 to 20 every day.
The patients were divided into three groups: one group received statins for four months without knowing about it; the second group received a placebo; the third group did not take anything. After four months, the groups changed: those who drank statins began to take placebos, etc. During the year, each group took both statins and placebo, and also did not take drugs at all for a certain period of time.
The study showed that the average level of distress in patients who did not take anything was 8 points. The average level of distress in patients who took statins was 16 points, and in patients who took placebo — 15 points. This shows that brain function plays a very important role in our perception: it may be that the patient does not have any real mechanisms for pain while taking statins, but he still feels them. Doctors need to understand that in this case the patient will stop taking statins if he does not receive support, so this situation should be treated with respect. Algorithms have been developed for doctors to work with such patients: for example, you can reduce the dose of statins twice for a certain period, or replace one statin with another, or cancel therapy for a while, and then return to taking the drug starting with low dosages.
Thus, the occurrence of side effects when taking statins is possible, and doctors have ways to work with them — but we should not believe the panic messages that statins will inevitably ruin us and make us disabled. This is not true: statins have revolutionized cardiology medicine, and this has been proven by research.
Portal "Eternal youth" http://vechnayamolodost.ru