Are statins good or bad?

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Are statins good or bad?

30 Jan 2004

Data on fractures promising, but concern about adverse cognitive effects

increasing.

Launching what the Wall Street Journal yesterday said could be a year of ³a

statin backlash,² researchers write in the current issue of the Archives of

Internal Medicine about a growing body of evidence that these drugs

interfere with patients¹ cognition.

However, in the same issue of Archives, another article describes the drugs¹

promising but not quite proven effects on fracture rates.

³There are reasons to think both favorable and adverse effects of statins

and low cholesterol on cognition may pertain; the balance of these factors

requires further elucidation,² writes a research group that is studying

cognitive effects of statins.

³A substantial body of literature links low cholesterol level to aggressive

behavior; statin randomized trials have not supported a connection, but they

have not been designed to address this issue. A limited number of reports

suggest a connection between reduced cholesterol level and reduced serotonin

level, but more information is needed with serotonin measures that are

practical for clinical use. Whether lipophilic and hydrophilic statins

differ in their impact should be assessed.²

The NIH-funded trial described in this Archives article, the UCSD Statin

Study, is underway, with results due out this spring, according to

yesterday¹s Wall Street Journal.

³A number of critics believe drug companies have vastly understated side

effects caused by statins‹particularly muscle pains and memory problems,²

wrote reporter Tara ­Pope in her coverage of the biggest medical

milestones likely this year.

³If, as expected, the research shows a higher rate of cognitive side effects

than previously reported, doctors may finally start paying closer attention

to the aches and pains of patients who use the drugs.²

All the news is not bad for statins, however. Attempting to sort divergent

evidence about whether use of statins is linked to fewer fractures, authors

used meta-analysis to combine data from observational and cardiovascular

studies.

Their conclusion is that the use of these agents provides ³a consistent and

clinically meaningful but nonsignificant reduction in hip and vertebral

fractures in 4 prospective observational studies of older women,² one that

is not seen in women taking nonstatin lipid-lowering agents.

They add, ³When these results were quantitatively combined with other

studies of statin use and fracture, we observed a significant reduction in

hip and nonspine fracture risk among statin users. These findings build on

the recent reports that statins increase bone formation in rodents and

suggest that statins may be useful agents for osteoporosis. Clinical trials

are needed to test the ability of potent statins to prevent fracture.²