Patients weigh benefits, risks of statins

WASHINGTON — They are the most prescribed drugs in America, but an estimated 15 million to 20 million people who could benefit from cholesterol-lowering statins aren’t taking them.

“The most common reason, typically, is people being afraid about side effects,” says Dr. Tariq Haddad, director of research at Virginia Heart, the largest cardiology practice in the region.

The most common side effects are muscle and joint aches, which affect about 5 percent of patients on statins. On very rare occasions, muscle problems can develop or the medication can produce an increase in liver enzymes or blood sugar.

Some critics of statins have also charged that they result in cognitive problems, but Haddad is unconvinced. “It’s a very debatable issue because there is really not any good data to show that statins cause this,” he explains.

The bottom line is that any patient considering going on a statin needs to weigh the pluses and minuses, and have a heart-to-heart conversation with his or her doctor.

“It requires a real patient-physician relationship with a real discussion about the risk and benefits,” says Haddad, noting that dialogue is part of the guidelines for anyone considering statins by the American Heart Association and the American College of Cardiology.

The guidelines for statin use specify four categories of patients: those who already have cardiovascular disease; diabetics; people with very high LDL — or bad — cholesterol numbers, and those who are considered at high risk due to a variety of factors.

Some of these patients, particularly those whose high cholesterol is genetic, may appear healthy and decide that, since they are not showing visible signs of illness, a statin is not necessary.

“It’s a lot easier to have denial when you feel just fine, but your arteries may not look fine,” Haddad says.

He says some patients need a high-dose statin, which can cut bad cholesterol levels almost in half. Others, whose risk is lower, do just fine on a smaller dose that reduces LDL cholesterol by about a quarter.

But those benefits are not universal. Roughly 15 percent to 20 percent of patients do not see any significant cholesterol lowering from statins. For them, a new class of drugs offers hope.

These medications are called PCSK9 inhibitors. They work by blocking a particular enzyme that allows LDL cholesterol to circulate in the blood.

“They are a class of medicines that can drop cholesterol down to levels that we have never seen,” says Haddad, who adds: “This is one of the cutting-edge areas that is going to be very exciting down the road.”

These drugs, however, are extraordinarily expensive. The annual cost is likely to range between $7,000 and $12,000 per patient. According to Consumer Reports, generic statins cost about $12 a month or less, while brand-name medications can cost more than $500 a month.

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