3 ms·

Hm, so statins for everyone? What’re the downsides?

by ericd 9mo ago

amanaplanacanal 9mo ago
Possible side effects include muscle damage, liver damage, and type 2 diabetes.
yojo 9mo ago
I’m old enough that my parents/spouse’s parents are all on statins. They all report side-effects, mostly digestive issues. I’ll eat a healthy diet, exercise, and live a life without persistent diarrhea. I’ll take statins if/when they are medically necessary, and no sooner.
brandonb 9mo ago
The main side effects of statins are muscle pain and brain fog (from some statins -- others cross the blood-brain barrier much less). The benefit of statins is to not only lower LDL cholesterol, but also inflammation, which is now actually a stronger risk factor for cardiovascular disease than cholesterol: https://www.empirical.health/blog/inflammation-and-heart-health/ https://www.empirical.health/blog/inflammation-and-heart-hea... Layering PCSK9 inhibitors, ezetimibe, and statins can lower ApoB/LDL cholesterol by 85–90%, which would have been unheard of until recently. On the horizon, drugs in clinical trials lower Lp(a) (the strongest hereditary risk factor for heart disease) by 94%. Currently, there are four RNA-based drugs in trials that effectively silence the gene that makes Lp(a) in liver cells: lepodisiran, olpasiran, pelacarsen, and zerlasiran.
- gabrielsroka 9mo ago
  > About 10% of people develop muscle aches > Concerns about statin effects on the brain, such as cognitive impairment or dementia, are unfounded https://www.health.harvard.edu/heart-health/what-are-the-risks-from-taking-statins https://www.health.harvard.edu/heart-health/what-are-the-ris...
- CalChris 9mo ago
  I had the brain fog. I switched from atorvastatin (dizziness) to pravachol (no dizziness), and then again to higher effective dosage of rosuvastatin (still no dizziness). I went from LDL 152 to LDL 83. But I have high Lp(a) and so I'm prescribed a baby aspirin every other day. This counteracts the Lp(a) clotting effect but doesn't fix its genetic cause. It's a journey.
  - tresdots 9mo ago
    I was recently prescribed rosuvastatin (my first time taking any statin), and I had some very intense brain fog. How would you describe the feeling of what you experienced? The best way I could describe it to my friends and family was that I felt like I lost a quarter of my IQ and slept only 5 hours every night(I was getting great sleep, it just felt that way). It was such a strange feeling. It's a weird feeling to know you're brain just isn't working as it has always worked.
    - CalChris 9mo ago
      I had dizziness from atorvastatin and nothing from Pravachol and Rosuvastatin. The conclusion I draw is that you have to find something that works. But this is uncharted territory. Your docs won't know and you have to kind of force the issue.
- ericd 9mo ago
  Thanks! I've been looking into this a little recently, so thanks for the very timely article and advice. Do you have any info on good ways to nail down personal sources of inflammation relevant to cardio health, or do you think that just general anti-inflammatory diet/habits is the best we can do right now? We were hunting down a source of mold in our house recently due to some blood markers recently, which got me thinking about inflammation sources and cardio health (we found a big patch of mold between our floors and removed it, blood markers immediately improved).
tresdots 9mo ago
My experience with them was a brain fog so bad I could hardly do my engineering job effectively. Quite unfortunate as I've read that side effect isn't very common.
Aurornis 9mo ago
If you’re unlucky enough to have one of the genetic factors that predisposes you to atherosclerosis then it’s going to be statins and maybe PCSK9 inhibitors. For the average person, diet and lifestyle choices could be enough, but adherence can be difficult. Monitoring LDL as an imperfect but useful marker and then introducing low-dose statins on a sliding scale proportions to severity is a good idea. Statins are not completely side effect free (no medication really is) but they’re generally well tolerated. Statin side effects are an interesting area of research because they have a very high nocebo effect rate: People hear so much about statins and their side effects from popular media that when they’re prescribed a statin in older age they start thinking everything is a side effect of the statin. There are some actual known side effects of statins which scale with dose and some of which can be maybe offset by supplements like CoQ10, but the side effects are generally mild. I’d take the side effects over heart disease after watching some older family members struggle and then die due to heart problems.
- KempyKolibri 9mo ago
  Yep - the SAMSON trial suggests that nearly all side effects attributed to statins are actually just nocebo: https://www.jacc.org/doi/10.1016/j.jacc.2021.07.022 https://www.jacc.org/doi/10.1016/j.jacc.2021.07.022

Hm, so statins for everyone? What’re the downsides?

by ericd 9mo ago

Hm, so statins for everyone? What’re the downsides?

amanaplanacanal 9mo ago

Possible side effects include muscle damage, liver damage, and type 2 diabetes.

yojo 9mo ago

I’m old enough that my parents/spouse’s parents are all on statins. They all report side-effects, mostly digestive issues. I’ll eat a healthy diet, exercise, and live a life without persistent diarrhea. I’ll take statins if/when they are medically necessary, and no sooner.

brandonb 9mo ago

The main side effects of statins are muscle pain and brain fog (from some statins -- others cross the blood-brain barrier much less). The benefit of statins is to not only lower LDL cholesterol, but also inflammation, which is now actually a stronger risk factor for cardiovascular disease than cholesterol: https://www.empirical.health/blog/inflammation-and-heart-health/ https://www.empirical.health/blog/inflammation-and-heart-hea... Layering PCSK9 inhibitors, ezetimibe, and statins can lower ApoB/LDL cholesterol by 85–90%, which would have been unheard of until recently. On the horizon, drugs in clinical trials lower Lp(a) (the strongest hereditary risk factor for heart disease) by 94%. Currently, there are four RNA-based drugs in trials that effectively silence the gene that makes Lp(a) in liver cells: lepodisiran, olpasiran, pelacarsen, and zerlasiran.

gabrielsroka 9mo ago
> About 10% of people develop muscle aches > Concerns about statin effects on the brain, such as cognitive impairment or dementia, are unfounded https://www.health.harvard.edu/heart-health/what-are-the-risks-from-taking-statins https://www.health.harvard.edu/heart-health/what-are-the-ris...
CalChris 9mo ago
I had the brain fog. I switched from atorvastatin (dizziness) to pravachol (no dizziness), and then again to higher effective dosage of rosuvastatin (still no dizziness). I went from LDL 152 to LDL 83. But I have high Lp(a) and so I'm prescribed a baby aspirin every other day. This counteracts the Lp(a) clotting effect but doesn't fix its genetic cause. It's a journey.
- tresdots 9mo ago
  I was recently prescribed rosuvastatin (my first time taking any statin), and I had some very intense brain fog. How would you describe the feeling of what you experienced? The best way I could describe it to my friends and family was that I felt like I lost a quarter of my IQ and slept only 5 hours every night(I was getting great sleep, it just felt that way). It was such a strange feeling. It's a weird feeling to know you're brain just isn't working as it has always worked.
  - CalChris 9mo ago
    I had dizziness from atorvastatin and nothing from Pravachol and Rosuvastatin. The conclusion I draw is that you have to find something that works. But this is uncharted territory. Your docs won't know and you have to kind of force the issue.
ericd 9mo ago
Thanks! I've been looking into this a little recently, so thanks for the very timely article and advice. Do you have any info on good ways to nail down personal sources of inflammation relevant to cardio health, or do you think that just general anti-inflammatory diet/habits is the best we can do right now? We were hunting down a source of mold in our house recently due to some blood markers recently, which got me thinking about inflammation sources and cardio health (we found a big patch of mold between our floors and removed it, blood markers immediately improved).

tresdots 9mo ago

My experience with them was a brain fog so bad I could hardly do my engineering job effectively. Quite unfortunate as I've read that side effect isn't very common.

Aurornis 9mo ago

If you’re unlucky enough to have one of the genetic factors that predisposes you to atherosclerosis then it’s going to be statins and maybe PCSK9 inhibitors. For the average person, diet and lifestyle choices could be enough, but adherence can be difficult. Monitoring LDL as an imperfect but useful marker and then introducing low-dose statins on a sliding scale proportions to severity is a good idea. Statins are not completely side effect free (no medication really is) but they’re generally well tolerated. Statin side effects are an interesting area of research because they have a very high nocebo effect rate: People hear so much about statins and their side effects from popular media that when they’re prescribed a statin in older age they start thinking everything is a side effect of the statin. There are some actual known side effects of statins which scale with dose and some of which can be maybe offset by supplements like CoQ10, but the side effects are generally mild. I’d take the side effects over heart disease after watching some older family members struggle and then die due to heart problems.

KempyKolibri 9mo ago
Yep - the SAMSON trial suggests that nearly all side effects attributed to statins are actually just nocebo: https://www.jacc.org/doi/10.1016/j.jacc.2021.07.022 https://www.jacc.org/doi/10.1016/j.jacc.2021.07.022