Widely used to combat cholesterol, statins are now frequently prescribed to people at risk of cardiovascular disease. However, some “serious side effects” can occur, warns the United Kingdom’s public health system (NHS). Here are the ones to be aware of.
Statins: how to use them correctly?
Statins are medications prescribed to lower “bad” LDL cholesterol and reduce the risk of cardiovascular events such as stroke or heart attack. Concretely, they inhibit the functioning of hydroxy-methyl-coenzyme A reductase (HMG Co A), an enzyme which controls the synthesis of cholesterol by liver cells. In general, this treatment is taken once a day, on medical advice.
However, even if statins constitute the reference drug treatment for isolated hypercholesterolemia, the patient must first adopt hygienic and dietary measures. Only if this lifestyle change fails will statin treatment be indicated.
Concerning the dosage, the dose prescribed in France depends on the patient’s level of cardiovascular risk and the desired objective (percentage of reduction in LDL cholesterol). It can range from 5 to 60 mg per day. Of the available statins, simvastatin and atorvastatin are generally considered the most effective.
“Abroad, things differ. In the UK for example, where their use follows NICE recommendations in people at cardiovascular risk, with the aim of maintaining non-HDL cholesterol below 2.5 mmol/L. The dose often starts at between 10 and 40 mg (e.g. atorvastatin), then can be increased every 4 weeks, up to a maximum of 80 mg if necessary,” remarks the medical director of True Medical, who invites everyone to never take (or stop) this drug treatment “without having discussed it with his doctor.
Taking statins: symptoms to watch out for
According to the NHS, the type of statin taken can greatly influence the side effects you experience. However, regardless of the treatment used, it is essential to consult a doctor quickly if any of the following symptoms appear:
- Unusual muscle pain;
- A significant weakness;
- A pink or red rash (especially on the palms or soles of the feet);
- Yellowing of the skin or eyes accompanied by dark urine;
- Intense abdominal pain;
- A persistent cough associated with shortness of breath or weight loss.
“These signs can indicate serious problems such as rhabdomyolysis, liver damage, pancreatitis or lung damage. More common side effects, such as headache, nausea or digestive problems, are generally mild, but if they persist, medical advice is recommended,” recommends Dr Gérald Kierzek.
In the columns of The Mirror newspaper, NHS also confirms the existence of these serious side effects, requiring emergency treatment.
However, whatever your symptoms, “never stop your treatment alone, without medical advice”, insists the medical director of True Medical.
In France, how is surveillance carried out?
The effectiveness of the treatment is assessed by a lipid profile approximately twelve weeks after the start of treatment.
“Subsequently, a new lipid profile is carried out 8 to 12 weeks after each dosage adjustment, until the target values are reached. confides the medical director.
Concerning myalgia, that is to say muscle pain – which represents the most common side effect of statins – monitoring is mainly clinical, and the measurement of muscle enzymes (CPK) is not systematic.
“It is reserved for risky situations such as the presence of muscle pain, moderate to severe kidney failure, hypothyroidism, a personal or family history of genetic muscle disease, alcohol abuse or age over 70 years. Stopping statins is recommended when muscle enzymes exceed 5 times normal, away from intense physical effort,” specifies the emergency doctor.
As for hepatic (liver) monitoring, it is carried out before the start of treatment, then eight to twelve weeks after initiating treatment – or after any increase in the dose. Then, an annual check is carried out if an enzyme produced by the liver (ALT, for “alanine aminotransferase”) remains below three times normal.
“If exceeded, it is necessary to stop treatment or reduce the dose, then check liver enzymes 4 to 6 weeks later,” concludes Dr Gérald Kierzek.