Welcome to another video where medical topics are made easy.
Today we’re going to talk about the side effects of statins.
Statins are a class of medications used to help lower cholesterol.
The drug names end in “statin”, and you can see some examples shown on your screen along
with some of the brand names to help you recognize them.
I came up with a simple mnemonic to help you remember the main side effects of statins.
The mnemonic is “LIPITOR” which is a commonly prescribed statin, and this will make it easier
to remember the side effects.
We’re going to use this mnemonic throughout the video, so make sure to watch until the end.
The timestamps for each side effect can be found in the description below.
As always, the notes and images for the video will be linked down below where you can find
more information on this topic.
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So turn on the captions down below and read along, and let’s get right into it!
As mentioned before, statins are a class of medications that help lower cholesterol.
But where does cholesterol come from?
Some of the cholesterol in our body comes from the food we eat,
but most of our body’s cholesterol is actually produced by the liver.
When our cholesterol levels are high,
we can try to decrease our cholesterol with lifestyle modifications such as improving
our diet, exercising, losing weight, quitting smoking, among other things.
But sometimes our cholesterol levels remain high even with lifestyle modifications, and
that’s where statins can help.
Statins block cholesterol synthesis in the liver. In other words, statins block the liver
from producing cholesterol.
Specifically, statins inhibit HMG-CoA reductase, which is an enzyme involved in cholesterol
synthesis.
Since the liver is not making as much cholesterol, it takes cholesterol out of the blood because
it needs it to make bile.
So statins help decrease cholesterol levels by blocking cholesterol synthesis in the liver,
and by the liver taking up cholesterol out of the blood so it can be used to make bile.
While statins are great medications for many people and are effective in lowering cholesterol
levels, like any medication, they can have side effects.
Let’s go through those side effects now.
Again, we’re going to use the mnemonic “LIPITOR” to walk through each of the main side effects,
starting with the effects on the liver.
But first a few things to keep in mind as we go through the video.
It’s important to know people tolerate different statins differently, and they tolerate different
doses differently.
Just because someone has a side effect doesn’t mean you will too, and most people taking
statins have no side effects at all.
Some symptoms may be due to other factors and may not actually be a side effect of the statin.
So it’s important to discuss any side effects, along with risks and benefits of statins
with your provider as statins are very effective in lowering cholesterol and reducing the risk
of cardiovascular disease.
The benefits of statins usually outweigh the low likelihood of an adverse event for most
people, so do not stop taking your statin medication without talking to your provider first.
This video is for educational purposes only to learn about some of the reported side effects.
It’s not intended to scare anyone away from statins, because again statins are beneficial
medications for many people. So discuss your situation with your provider.
The first side effect using the “LIPITOR” mnemonic is the “L”
which stands for “Liver Effects".
This is because statins can cause side effects to the liver.
The most common one being elevated liver enzymes, which can be measured on a blood test.
The main liver enzymes affected are AST and ALT,
which is why your provider may run a blood test to check these levels before starting
a statin, and they may periodically check them depending on your situation.
AST and ALT are enzymes normally found in the liver, and they help with the function
of the liver.
The elevation in liver enzymes is thought to be due to leakage of the enzymes into the
bloodstream rather than actual damage to the liver, although in rare cases statins can
cause inflammation or injury to the liver as well.
As AST and ALT leak into the bloodstream, this will cause high levels to be detected
on a blood test.
AST and ALT are called transaminases, so the elevation of these enzymes is called transaminitis.
Elevated liver enzymes are usually temporary without symptoms, and it typically occurs
when first starting a statin.
In many cases the increase in liver enzymes will fall back to a normal range on their
own without having to stop the statin.
If the elevated liver enzymes don't improve on their own,
then they typically resolve by decreasing the statin dose or temporarily stopping the
medication.
Once the liver enzymes are back to normal, many people can restart their statin medication
without the liver enzymes increasing again.
The potential for developing elevated liver enzymes is typically dose-dependent,
meaning the higher the dose of statin you take, the greater the risk of elevated liver
enzymes.
Other contributing risk factors are preexisting hepatitis or inflammation of the liver, older
age, and other chronic illnesses.
The next side effect is the first “I” in “LIPITOR”
which stands for “Increased Blood Sugar”.
Normally the pancreas produces and secretes a hormone called insulin.
After insulin is secreted by the pancreas, it binds to insulin receptors on cells,
which allows for cells to take up glucose from the blood.
As glucose in the bloodstream enters the cells,
the cells use the glucose as a form of energy to help the cell function.
The use of statins may decrease insulin secretion from the pancreas,
and they could make cells less sensitive to insulin.
As a result, cells will have a harder time taking up glucose from the blood,
which may lead to an increase in blood sugar.
Having said that,
the benefit of reducing cardiovascular disease, such as strokes and heart attacks using a statin
typically far outweighs the smaller risk of developing a mild increase in blood sugar
even in those who already have diabetes.
The risks and benefits of statins vary from person to person, so it’s always good to
discuss with your provider.
The next side effect is the “P” in “LIPITOR” which stands for “Pain”,
primarily muscle pain but has also been reported in joints too.
Some individuals may experience muscle pain, tenderness, cramps, spasms, or weakness.
Muscle pain may be bilateral and symmetrical.
Symptoms involve the skeletal muscles and not cardiac or smooth muscles.
This side effect has been shown to be dose-dependent as well, meaning the higher the dose the greater
the potential risk of developing muscle pain.
Symptoms are typically reversible with discontinuation of the statin.
Some studies have shown people to report muscle pain when they were actually taking a placebo
instead, so muscle pain from statins may not be as common as reported.
Again it's important to discuss any concerns with your provider.
The next side effect is another “I” which stands for “Impaired Memory”.
Some people have reported mild memory loss and confusion while taking a statin, but there’s
not much supportive data to suggest that statins are the cause.
The side effect is often labeled as “non-serious and reversible”.
Next we have the “T” which stands for “Tiredness” as some people have reported
increased fatigue while taking a statin.
Next we have the “O” which stands for “Other”.
This is the “catch-all” category to include other mild side effects like headaches and
nausea.
And finally, we have the “R” in “LIPITOR” which stands for “Rhabdomyolysis”.
Rhabdomyolysis is a rare side effect, characterized by the breakdown of skeletal muscle.
As mentioned before, statins can cause muscle side effects including muscle pain and tenderness.
Rhabdomyolysis is the severe form of that.
Symptoms may include muscle pain or weakness, and dark urine.
Creatine kinase (CK) is an enzyme found in muscle cells that help muscle cells function.
When muscle cells breakdown, creatine kinase is released into the bloodstream and can be
measured in the blood, and this can be a marker for muscle damage.
Myoglobin is a protein found in muscles cells.
When muscles breakdown, myoglobin is also released into the bloodstream and excreted
in the urine.
This can cause the urine to appear dark and can be measured in the urine as well.
This could also be a sign of rhabdomyolysis.
Possible risk factors for developing rhabdomyolysis include taking high doses of statins, advanced
age, diabetes, taking certain medications with a statin, among others.
Complications of rhabdomyolysis include electrolyte abnormalities like high potassium levels,
kidney injury, and arrhythmias to name a few.
Hopefully this helped you better understand the side effects of statins.
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As always, you can find all of the notes and pictures for this video on the website linked
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Thanks for watching and hope you check out future videos.