Bisher AKIL, MD

Posts Tagged ‘Lipids’

Not all statins are equal

In General Health, Heart on September 13, 2013 at 7:57 pm

Because statins lower the incidence of adverse cardiovascular and cerebrovascular events — even in low-risk patients — they are used broadly. Statins’ reported adverse effects include myalgias (muscle pain) , myopathy(muscle disease), rhabdomyolysis (muscle damage / breakdown), transaminitis (elevated liver enzymes) , and diabetes mellitus. In a meta-analysis of 135 randomized trials (247,000 participants) that involved seven statins (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin [Crestor], simvastatin, and pitavastatin [Livalo]), investigators evaluated adverse effects associated with statins overall and individually. The overall rate of statin discontinuation owing to adverse effects was low (6%) for all statins combined. Statins as a class caused no more medication discontinuations, myalgias, creatinine kinase elevations, myopathy, rhabdomyolysis, or cancer than placebo. However, statins significantly increased relative risk for transaminase elevations (by 50%; baseline incidence, 1%) and diabetes (by 9%) compared with placebo. Simvastatin( Zocor)  and pravastatin(Pravachol)  were associated with best overall tolerability and lowest discontinuation rates. Compared with controls, atorvastatin( Lipitor) and rosuvastatin (Crestor)  were associated with the highest discontinuation rate because of adverse events; whereas atorvastatin (lipitor) and fluvastatin( LesCol)  were associated with higher risks for transaminase elevations (odds ratios, 2.6 and 5.2, respectively). Higher doses of all statins were associated with higher risk for transaminase elevations. Although low doses of simvastatin (Zocor) appeared to be safest, daily doses >40 mg significantly raised risk for creatinine kinase elevation (OR, 4.1) and transaminase elevation (OR, 2.8).

Appeared in NEJM Journal Watch

Source: Naci H et al. Comparative tolerability and harms of individual statins: A study-level network meta-analysis of 246 955 participants from 135 randomized, controlled trials. Circ Cardiovasc Qual Outcomes 2013 Jul; 6:390. –

Comments: Useful analysis; choosing the safest statin is exceedingly important, particularly when we have significant side effects such as diabetes and elevated liver enzymes, and muscle problems. Unfortunately, we are often obligated to use other than the safest statins to achieve the desired effect on lipids, leading to the choice of the lesser of the two evils; this is certainly a discussion to have with the PCP _BA