As cheap statins arrive, why fret about lifestyle?

Skipped follow-up tests
Another concern with greater statin use is inadequate follow-up testing. The medications have few side effects but about 1 to 2 percent of people taking them develop liver abnormalities that could lead to liver damage. Periodic blood tests should be done during the first year on the drugs, and then annually, to check for markers that indicate the problem, but many doctors don’t order the follow-up tests.

A more serious but rare side effect is muscle damage called rhabdomyolosis, which was the factor behind the withdrawal of Baycol, a statin drug, in 2001.

Doctors should be asking about muscle weakness, a possible indication of the problem, but too many don’t, says Dr. Sidney Wolfe, head of the Public Citizen Health Research Group, an advocacy organization in Washington, D.C.

About 50 to 100 cases of the muscle condition are reported each year, says Wolfe, and the actual number is likely much higher. If doctors asked about muscle weakness in the early stages of statin treatment, they could lower the dose or stop the drug in affected patients, often before anyone progressed to muscle damage, he says.

Not a cure-all
Perhaps most worrisome is that, over time, people who get great results with statins may not see the need for them anymore, says Avorn.

He says many patients, especially those taking statins preventively with no symptoms of heart disease, stop them after awhile.

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A study on close to 9,000 patients published last year in the American Journal of Health-System Pharmacy found that compliance with statin therapy decreased significantly over time, with only 21 percent of patients still taking the drugs three years after they were prescribed, even though experts say that most patients on statin therapy will have to stay on the drugs throughout their lives.

That's another reason why lifestyle change is key, even if statin therapy brings down a patient's cholesterol levels, according to Avorn.

"Worst case," he says, "is patients stop the drugs, their doctors are unaware and [those] patients don’t exercise or diet either.’’

Fran Kritz is a health care writer based in Silver Spring, Md.

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