![]() This disorder likely only develops in individuals with an existing genetic susceptibility, but its severity and need for immediate treatment with immunosuppressants highlight the importance of familiarity with this disorder.Īnother side effect associated with statin usage is new-onset diabetes. Statins have also been shown to be environmental triggers for anti-HMG-CoA reductase necrotizing autoimmune myositis, a rare disorder characterized by severe muscle cell death caused by an autoimmune response against the enzyme that statins target. The "nocebo" effect occurs when a patient who has been told that a drug has a particular side effect reports that side effect even when they are actually taking a placebo instead of the drug this effect has been demonstrated to occur with statin-related muscle symptoms in several clinical studies, most notably the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and in Goal Achievement After Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects-3 (GAUSS-3). Since patients who take statins are often asked to watch out for muscle problems, the clinical incidence of muscle complaints is likely higher than its true value. However, in routine practice, much of the symptomatic adverse events attributed to statin therapy represent misattribution, as demonstrated by placebo-controlled trials. For patients on standard statin doses, symptomatic adverse events like muscle pain and weakness may occur in 50-100 patients per 10,000 treated over five years. The mechanism of statin-induced myopathy is not completely understood and may be caused by decreased synthesis of mevalonic acid from statin use leading to decreased energy generation, which may lead to muscle injury. Creatine kinase, an essential enzyme for muscle function, is a marker for muscle damage when found in elevated levels in the blood. Statin-induced myopathy is typically defined as muscle pain, weakness and/or cramps with blood creatine kinase (CK) levels at least ten times the normal upper limit. The broad range in rates reflects differences in study populations and is likely in part caused as well by differing categorizations for muscle symptoms. The most common complaints with statin use are muscle-related, with reported rates ranging widely between 0.3 to 33%. Three of the most common concerns include muscle-related issues, new-onset diabetes and increased incidence of hemorrhagic stroke. However, there are a few side effects that tend to raise concern among patients when considering the need for one these medications. In general, statins are very well tolerated and about 85-90% of patients report no side effects. Statins clearly help to lower the risk for future ASCVD events in patients at risk. The number of events prevented will continue to grow past five years since statin therapy further reduces ASCVD risk during each year it continues to be taken. An ~80 mg/dL (2 mmol/L) reduction over five years with low-cost statin therapy appears to prevent a major vascular event in about 500 out of 10,000 patients who have not yet had a vascular event (primary prevention) and 1,000 out of 10,000 patients who already have ASCVD (secondary prevention). The Cholesterol Treatment Trialists' (CTT) meta-analysis using 27 large-scale trials demonstrated that each ~40 mg/dL (1 mmol/L) reduction in LDL-C with statin therapy decreases risk of major vascular events by ~25% each year after the first year there was a more modest 10-12% reduction in the first year. Robust data show that reducing LDL-C through statin therapy leads to a reduction of ASCVD risk. Patients with high cholesterol develop plaque in their blood vessels, which can limit blood flow and lead to ASCVD events. ![]() With the decline of smoking, LDL-C control has become an even more important way to decrease the risk for ASCVD events (heart attacks and strokes). ![]() ![]() Since 1900, ASCVD has been the leading cause of death every year in the US (except for 1918, the year of the influenza pandemic). Since lovastatin was first approved in 1987 in the US, statins have become the leading pharmacologic treatment for high LDL-C and non-HDL-C. Statins are a class of drug that inhibit one of the first steps in cholesterol synthesis, in turn upregulating LDL receptors and lowering LDL-C generally by 25-50%. High low-density lipoprotein cholesterol (LDL-C) is one of the most common modifiable risk factors for atherosclerotic cardiovascular disease (ASCVD), affecting 78 million US adults (37% of the American adult population) in 2011-2012 according to the Centers for Disease Control and Prevention. ![]()
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