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Cholesterol Drug Use Raises Questions About Side Effects
Some of the most popular drugs in the country lower cholesterol and dramatically reduce heart-attack risk. But
what else do they do? As new government cholesterol standards could triple the number of
people taking the drugs to 36 million, doctors and patients want more-solid information on the side effects. The
class of drugs known as statins includes blockbuster brands Lipitor, Zocor and Pravachol, among others.
Like all powerful drugs, statins have side effects. The problem is that some of the alleged side effects, such as
muscle aches and memory loss, also are common complaints.
"Most people taking these drugs are older people," says New York physician Paul J. Rosch, professor of
medicine and psychiatry at New York Medical College, whose wife developed weakness and temporary
memory loss after taking a statin. "They think, 'Gee, I'm just having a senior moment,' and it's something
doctors don't ask about." Confusing the issue is the fact that most of the memory-loss evidence is anecdotal.
Little independent research has been done on the topic. And most physicians believe the benefits of statins far
outweigh any risks or side effects.
Drug makers flatly dispute the notion that statins contribute to memory problems and some, ironically, are even
studying the use of statins to treat Alzheimer's. "There's a lot of evidence that statins improve memory function
and no good evidence that it affects memory function" in a negative way, says Rob Scott, vice president of the
cardiovascular and metabolic group at Pfizer, maker of Lipitor.
A spokesman for Merck, maker of Zocor, said the drug "has a proven safety and tolerability record" and
prevents coronary deaths. The University of California at San Diego is in the midst of an independent study
assessing statin side effects, good and bad. The study, funded by $4.4 million from the National Institutes of
Health, ultimately will follow 1,000 patients taking either Zocor, Pravachol or a placebo. All the results are
blinded, so doctors don't know whether a complaining patient is taking a drug or a placebo. Some patients have
quit the study because of irritability, clouded thinking or pain. Beatrice A. Golomb, the UCSD assistant
professor of medicine leading the study, says common complaints from patients taking statins include being
unable to remember the name of a grandchild, walking into a room and forgetting why you are there, or starting
a sentence and being unable to finish. Some complain of personality changes or irritability. "Because these are
the most widely prescribed class of drugs in the United States, we need to be sure we understand the full
spectrum of effects," says Dr. Golomb.
What is known about statins is that they can dramatically lower cholesterol, and that may be the problem when
it comes to side effects. Although cholesterol has been vilified as a culprit in heart disease, it is also the most
common organic molecule in the brain. Some researchers theorize that blocking cholesterol production, as
statins do, interferes with the brain's performance and causes muddled thinking and memory loss.
Drug makers say the real risk factors of memory problems are heart disease and stroke.
Muscle pain is an undisputed side effect of statins, although estimates on the incidence range from 5% to 30%.
One statin, Baycol, was pulled from the market last year after being linked to 100 deaths from a rare muscle-
wasting condition called rhabdomyolysis.
However, the type of aching muscle pain most patients report isn't believed to be life-threatening. Paul S.
Phillips, director of interventional cardiology at Scripps Mercy Hospital in San Diego, says
his research shows that some of the muscle problems associated with statin therapy aren't detected by the typical
enzyme screening method doctors use, and therefore are dismissed as signs of aging. In his study, neither
doctors nor the patients involved knew whether a statin or placebo was given, but the majority began feeling pain when they started back on the real drug. "They could tell every time within three weeks of being on the statin therapy," says Dr. Phillips, who presented the findings at an international cholesterol drug meeting in New York last September and is seeking NIH funding for further study. "These drugs unquestionably save lives, but these muscle toxicities are poorly studied." Nobody recommends that patients with muscle pain or memory problems stop taking statins on their own. They should, however, discuss their concerns with their doctor. Some patients experience fewer side effects if the dose is lowered or the brand is changed. Other doctors recommend taking the supplement coenzyme Q10 as a way to counteract memory problems. "You take these fragile elderly people, knock their cholesterol in half and deplete them of this essential nutrient and it makes sense they're going to have trouble," says Peter Langsjoen, a Tyler, Texas, cardiologist. "I think we're going to see some real trouble if we're not careful." Source: The Wall Street Journal
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