WIDELY used statin drugs are the most effective drugs for preventing heart attacks and strokes - since they can lower low-density (LDL, “bad”) cholesterol by upwards of 50 percent - but statins can cause side effects significant enough to prompt some patients to stop taking them, says the June 2014 issue of the Cleveland Clinic Men’s Health Advisor.

However, a Cleveland Clinic study suggests that many individuals who are statin-intolerant can find a cholesterol-lowering strategy that agrees with them - but patients and their physicians need to rule out potential causes of statin side effects and persevere in finding the right treatment regimen, adds the health letter.

Leslie Cho, M.D., co-section head of Preventive Cardiology and Cardiac Rehabilitation at Cleveland Clinic, says, “For many patients, taking a statin is a matter of living longer and having fewer heart attacks and strokes.”

While most patients tolerate statins well, 10 to 15 percent develop side effects, including muscle aches and stiffness, indigestion, headache and liver abnormalities.

The September 2013 issue of the American Heart Journal published study led by Dr. Cho and colleagues who reviewed data on 1,605 patients referred to the Cleveland Clinic Section of Preventive Cardiology because of intolerance to two or more statins.

The researches gave the patients a statin once a week and then administered varying doses and dosing schedules to determine what they could tolerate.

Results showed: Overall, more than 72 percent of the patients who were previously statin-intolerant were able to resume statin therapy, often -

a) with the help of dosing adjustments,

b) switching to a different medication in the statin class, or

c) by means of intermittent therapy - taking drugs every other day, or as infrequently as once a week. However, most of the patients were able to return to a daily statin regimen.

The study also found that while the patients who resumed daily statin therapy achieved greater LDL reductions than those on intermittent therapy, both groups experienced greater LDL reductions and were more likely to achieve LDL goals compared to those who discontinued statin use.

Dr. Cho estimates that complete statin intolerance (inability to take any statin) affects less than 5 percent of statin users - in many cases, there’s an underlying reason, including:

• A number of treatable medical conditions, such as thyroid dysfunction, kidney or liver problems, or severe Vitamin D deficiency.

• Several medications can affect how your body processes statins and contribute to intolerance: for instance, certain antibiotics, some blood pressure medications and certain drugs used to treat irregular heart rhythms.

• The choice of statin may affect your likelihood of intolerance: for instance, pravastatin (Pravachol) and rosuvastatin (Crestor) do not affect muscle tissue as much as other statins, such as atorvastatin (Lipitor) or simvastatin (Zocor), Dr. Cho explains.

For those who absolutely cannot tolerate statins, as well as many patients on intermittent statin dosing, other cholesterol-lowering medications may be necessary to reduce LDL, says Dr. Cho - these alternatives include:

a) ezetimibe (Zetia),

b) niacin, or

c) drugs known as bile acid sequestrants (Colestid and Welchol).

If you experience statin side effects, the health letter suggests you should:

• Take your statin exactly as prescribed - do not stop taking your medication without first consulting with your physician.

• Promptly report any statin-related side effects to your doctor, and explore novel statin regimens that work for you.

• Be patient. It may take time to find the cholesterol-lowering regimen that you can tolerate.

• If you are on statin therapy, follow your doctor’s recommendations for follow-up cholesterol and liver function tests.

• If you’ve had muscle symptoms, a lower dose of rosuvastatin (2.5 or 5 mg, three times a week) or atorvastatin (5 mg, three times a week) may improve your cholesterol without side effects.

In conclusion, Dr. Cho advises, “Patients have to work with their physicians. The goal of therapy is not to be on no medicine...the goal should be preventing cardiovascular events.”

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