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New Information on Statins

Friday, October 29, 2010 // Uncategorized

10/9/2008 12:00:00 AM

Statins, a class of cholesterol lowering medications, have been shown to reduce heart attacks in people at risk for cardiovascular disease.  Recently, some patients have heard that statins are associated with an increase risk of ALS, Amyotrophic Lateral Sclerosis, Lou Gehrig’s Disease.
The following may allay some of those fears.

No Increased Risk for ALS with Statins, FDA Says
Statins likely do not pose increased risk for developing amyotrophic lateral sclerosis (ALS), according to an FDA analysis published online in Pharmacoepidemiology and Drug Safety. <br>From 1991 to 2006, the agency received 57 reports of ALS in U.S. patients taking statins, triggering the analysis. However, using population estimates and pharmacy records, the researchers determined that this number was similar to that expected. And, after examining data from 41 controlled clinical trials, they found that ALS incidence rates were 4.2 per 100,000 person-years in patients taking statins versus 5.0 per 100,000 person-years in those on placebo.

Although the authors say they could not rule out the possibility that statins may reveal or exacerbate muscle weakness associated with ALS, they conclude that “the weight of evidence … argues against the possibility that treatment with statins initiates this neurodegenerative disorder.” <br>The FDA says it’s expecting further data, but in the meantime, practice patterns shouldn’t be changed. <br>Pharmacoepidemiology and Drug Safety article (Free abstract; full text requires subscription) <br>FDA news release (Free)

In addition to preventing heart attacks, there has been an interest that statins may help preserve cognitive function.  Studies supporting this hypothesis are few.  Here is one recent study that supports it.

Statins Associated with Less Cognitive Decline
Elderly people on statins showed a lower rate of cognitive decline than those not taking them, according to a prospective observational study in Neurology. <br>Researchers followed a population-based cohort over 5 years, examining the participants’ medicine cabinets for prescription drug use and measuring their cognitive status annually. The cohort comprised nearly 1700 Mexican American subjects, all over age 60, roughly a quarter of whom took statins at some time during the study. <br>By the end of the study, those who’d taken statins were about half as likely to have developed either dementia or cognitive impairment without dementia as others in the cohort. <br>The authors point out that there have been no primary prevention trials of statins for dementia. Writing in Journal Watch Cardiology, Joel M. Gore says that such studies are needed “before statins are routinely deployed to prevent cognitive decline.” <br>Neurology article (Free abstract; full text requires subscription) <br> <br>Related Journal Watch link(s): <br>Journal Watch Cardiology summary (Free)

Statins are unlikely to have serious side effects.  The most common is muscle aches which go away if one discontinues the medication.  Taking CoEnzyme Q 10 may ameliorate this.  Serious muscle inflammation is uncommon.  People often voice a concern about liver toxicity.  If there is a problem with liver toxicity, it usually occurs in the first weeks to months after beginning the medication.  if it is mild, the medication may be continued and often the abnormal  tests normalize.  Unless there is significant persistent elevation, they may be continued.  Once a person is stable on a statin, checking the blood once a year is usually sufficient.

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