Side effects of stopping statins

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Side Effects of Stopping Statins: An Overview

Introduction to Statin Discontinuation

Statins are widely prescribed to lower cholesterol and reduce the risk of cardiovascular events. However, many patients discontinue their use due to side effects, which can lead to increased cardiovascular risks 26. Understanding the side effects associated with stopping statins is crucial for both patients and healthcare providers.

Common Reasons for Statin Discontinuation

Statin-Associated Muscle Symptoms (SAMS)

One of the primary reasons for discontinuing statins is the development of muscle-related side effects, known as statin-associated muscle symptoms (SAMS). These symptoms include muscle pain, weakness, and in severe cases, rhabdomyolysis, a potentially fatal condition 59. SAMS can affect up to 30% of patients, depending on the population and the specific statin used .

Nocebo Effect

Interestingly, many symptoms reported by patients on statins may not be directly caused by the drug itself but rather by the nocebo effect, where negative expectations lead to perceived side effects. Studies have shown that symptom intensity and relief are similar between statin and placebo groups, indicating that many reported side effects may not be pharmacologically induced 17.

Side Effects After Stopping Statins

Cardiovascular Risks

Discontinuing statins can lead to a significant increase in cardiovascular risks, particularly in patients with high-risk profiles for atherosclerotic cardiovascular disease (ASCVD). This is because statins play a crucial role in both primary and secondary prevention of cardiovascular events 26.

Muscle Symptoms

While stopping statins can alleviate muscle symptoms in some patients, the relief is often similar to that experienced by those stopping a placebo, suggesting that the symptoms may not always be directly caused by the statins 17. However, in cases of severe muscle symptoms like rhabdomyolysis, stopping statins usually leads to a full recovery .

Other Potential Side Effects

Diabetes Mellitus

Statins have been associated with a modest increase in the risk of new-onset diabetes mellitus. This risk is particularly higher in individuals with pre-existing conditions like metabolic syndrome or prediabetes 78. However, the cardiovascular benefits of statins generally outweigh this risk.

Liver Function

Statins can cause asymptomatic increases in liver transaminases, but these are not typically associated with clinically significant liver disease. Stopping statins usually reverses these changes without long-term consequences 38.

Conclusion

Stopping statins can lead to a range of side effects, primarily due to the underlying conditions they were prescribed to manage. While muscle symptoms and the nocebo effect are common reasons for discontinuation, the increased risk of cardiovascular events and the potential for new-onset diabetes highlight the importance of careful management and patient education. Clinicians should weigh the benefits and risks of statin therapy and consider alternative strategies for patients who experience significant side effects.

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Most relevant research papers on this topic

Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment

The majority of symptoms caused by statin tablets were nocebo, meaning they were not pharmacologically induced and should not be interpreted as pharmacological causation.

RCTVery Rigorous JournalHighly Cited

2021·

107citations

·J. Howard et al.

Side effects of statins-from pathophysiology and epidemiology to diagnostic and therapeutic implications.

Statins are generally safe but may increase the risk of diabetes and liver issues, and alternative strategies are needed to prevent atherosclerotic cardiovascular disease.

Literature ReviewRigorous JournalHighly Cited

2022·

88citations

·M. Ruscica et al.

The safety of statins in clinical practice

Statins are effective cholesterol-lowering drugs with rare adverse effects on muscle and liver, but their widespread use can significantly reduce cardiovascular disease risk.

Rigorous JournalHighly Cited

2007·

788citations

·J. Armitage

The STatin Adverse Treatment Experience Survey: Experience of patients reporting side effects of statin therapy.

The STatin Adverse Treatment Experience survey highlights the importance of patients' adverse experiences with statins and how symptom and impact scores affect decisions to continue or discontinue therapy.

Observational Study

2019·

42citations

·T. Jacobson et al.

Statin-Associated Side Effects.

Statins are well-tolerated but may cause rare side effects like statin-associated muscle symptoms, diabetes mellitus, and central nervous system complaints.

Very Rigorous JournalHighly Cited

2016·

555citations

·P. Thompson et al.

Statin Toxicity: Mechanistic Insights and Clinical Implications

Statin toxicity, mainly muscle symptoms, is a major cause of discontinuation and nonadherence, highlighting the need for identification of high-risk individuals and alternative treatment strategies.

Rigorous JournalHighly Cited

2019·

339citations

·N. Ward et al.

What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice

Only a small minority of symptoms reported on statins are genuinely caused by the drug, with only 1 in 5 new-onset diabetes cases being genuinely caused by statins.

Highly Cited

2014·

198citations

·J. Finegold et al.

Adverse effects of statin therapy: perception vs. the evidence – focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract

Long-term statin therapy is remarkably safe with a low risk of clinically relevant adverse effects, outweighing the risk of adverse effects.

Systematic ReviewHighly Cited

2018·

284citations

·F. Mach et al.

Mechanisms of statin-associated skeletal muscle-associated symptoms.

Statins may cause muscle symptoms like fatigue, weakness, and pain due to mitochondrial dysfunction and impaired Akt/mTOR pathway.

Rigorous JournalHighly Cited

2020·

103citations

·J. Bouitbir et al.

Muscle- and skeletal-related side-effects of statins: tip of the iceberg?

Statins can cause muscle-related side-effects, with the incidence of myopathy ranging from 1.5% to 10%, and discontinuing use is the only effective treatment.

Highly Cited

2016·

71citations

·J. Auer et al.

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