Safety of statins

Abstract

Statins are an established class of drugs with proven efficacy in cardiovascular risk reduction. The concern over statin safety was first raised with the revelation of myopathy and rhabdomyolysis with the use of now withdrawn cerivastatin. Enhanced understanding of the mechanisms behind adverse effects of statins including an insight into the pharmacokinetic properties have minimised fear of statin use among clinicians. Studies reveal that occurrence of myopathy and rhabdomyolysis are rare 1/100000 patient-years. The risk of myopathy/rhabdomyolysis varies between statins due to varying pharmacokinetic profiles. This explains the differing abilities of statins to adverse effects and drug interaction potentials that precipitate adverse effects. Higher dose of rosuvastatin (80 mg/day) was associated with proteinuria and hematuria while lower doses were devoid of such effects. Awareness of drugs interacting with statins and knowledge of certain combinations such as statin and fibrates together with monitoring of altered creatine kinase activity may greatly minimise associated adverse effects. Statins also asymptomatically raise levels of hepatic transaminases but are not correlated with hepatotoxicity. Statins are safe and well tolerated including more recent potent statins such as, rosuvastatin. The benefits of intensive statin use in cardiovascular risk reduction greatly outweigh risks. The present review discusses underlying causes of statin-associated adverse effects including management in high risk groups.

Neutral Endopeptidase-Resistant C-Type Natriuretic Peptide Variant Represents a New Therapeutic Approach for Treatment of Fibroblast Growth Factor Receptor 3–Related Dwarfism

“…The effect beyond 14 days on final growth (6-8 weeks) was not assessed in this study. The mechanism is unclear but could be due to altering membrane dynamics, which may not be a good strategy given the frequency of known side effects of statins as well as the potential developmental consequences (Evans and Rees, 2002;Maji et al, 2013).…”

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“…Reduction of hypercholesterolemia has been associated with improvement of coronary artery disease and intensive interventions, including diet, exercise, and use of hypolipidemics and antiinflammatory drugs, are recommended. However, some patients need safer therapeutic alternatives because they cannot tolerate the adverse effects of these drugs 41 .…”

Cannabinoids, the Heart of the Matter

“…Moreover, they are well‐tolerated by most patients, but can have dose‐dependent muscle‐related adverse effects (myopathy) where the levels of plasma creatine kinase are 10 times higher than normal 28. This condition goes along with pain, tenderness, weakness, and restriction in mobility 28, 29. The human monoclonal antibody, alirocumab, inhibiting proprotein convertase subtilisin‐kexin type 9 (PCSK9), was found to decrease LDL levels in patients by 62% when added to a statin therapy 30…”