Ask the Pharmacist

Q: I’ve been taking my cholesterol medication for a year now and I don’t feel any different than before I started it. I also see lots of negative posts about these drugs on the Internet; I’m thinking about not taking it anymore. How can you advise me?

A: Cholesterol drugs are the class of drugs that Canadians are least likely to take the way they have been instructed to, for a variety of reasons.

The most commonly-prescribed group of cholesterol drugs is called the “statins.” A statin can work wonderfully, and yet you’ll feel not one iota better. If you were you to Google “statin,” you would undoubtedly be asked to join any number of class action suits south of the border.

That being said, statin drugs, despite their bad name, save lives and are very safe on the whole. In fact, statins are so effective, they prevent one cardiovascular event (e.g. stroke, heart attack) in every 50 people who take these drugs for five years even when they are currently completely healthy and do not have any need to be prescribed them.

In those who really need them (i.e. those with high cholesterol, diabetics, previous heart attack), they work dramatically better than that. For those who do have cardiovascular disease, they have been shown to eliminate one cardiovascular event for every 20 people who take them for five years.

Perhaps even more encouraging, the higher the risk the individual has of having a heart attack, the better the statins seem to work. And, while every drug (along with every activity you choose to participate in, such as hockey, driving on Highway 401, drinking alcohol) comes with some degree of risk, the downsides of statins have been largely overblown.

Previous concerns regarding their potential to increase your risk of cancer and dementia, have been since disproven and the initial concerns about liver disease, while valid, are such that they occur in only a fraction of a per cent.

There is real evidence that taking a statin can elevate your blood sugars and increase the chances that you may someday become a diabetic, but like most negative news stories, the hype seems to outweigh the real story.

The increase in blood sugars for most people is around 0.3 per cent. Diabetes is diagnosed at a value of seven or more which gives you some idea of how small an increase this is. It’s not zero, as we would prefer, but it weighs far less heavier than the dietary choices we often make.

As for increasing the risk of diabetes, different studies have found conflicting incidences but the numbers seem to hover around one additional case of diabetes created for every 255 people treated with a statin for a period of four years. When this is compared to an almost 50-per-cent reduction in the rates of heart attacks, strokes and other cardiovascular events in this same group of patients, it is nonsensical to not take a statin when you are at high risk of a heart event due to a fear of diabetes.

Despite these concerns, the most common reason people quit taking a statin is the muscle pain that some patients experience. When statins were first introduced on the market, a lot of attention was paid to muscle pain as this is a possible symptom of rhabdomyolysis, a condition which can permanently damage your kidneys.

While statins are linked to this serious condition, we now believe that this occurs only in one out of every 23,000 people who take a statin. This is not to belittle those who quit their cholesterol drug when they suffer from this pain. It can, in some, be quite intense and even disabling which makes it significant even if it is not going to put you in the hospital.

It occurs in about 30 per cent of statin users and usually starts in the first four to six weeks of starting the drug. It tends to occur in large muscle groups (e.g. across the shoulders, the back and the legs) bilaterally (i.e. both sides) and can be experienced as pain, stiffness, weakness, tenderness, cramps or fatigue. Should you experience this, rather than quitting the drugs forever, there are a number of strategies which can be engaged and will allow most people to be able to still take a statin.

These strategies include possibly stopping the drug for two to four weeks to see if the symptoms improve and then coming back with the same drug at a lower dose or changing to a different member of the class that might be less inclined to cause these effects (such as pravastatin or fluvastatin).

There are a number of other helpful suggestions that could be tried as well should these fail, with the overall point being that these drugs are proven life-savers and we should not readily discard them for fish oils (as much as we like them) or niacin at the first sign of a challenge.

It is perfectly fine to be skeptical of Big Pharma and there is no doubt that we, as a health care community, sometimes can be accurately accused of over-prescribing drugs. However, the case for statins is very strong in those who are at risk of a heart attack and they should be more leery than many of us appear to be, before they scrap the idea of taking these drugs until it is too late.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts