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Statins: beyond cholesterol

The widely used drugs show potential to aid the heart, strengthen the bones and even keep Alzheimer's at bay.

June 23, 2003|Peter Jaret | Special to The Times

When his doctor first suggested he start taking one of the cholesterol-lowering drugs called statins, Steven Peterson hesitated. "If it meant taking a pill every day for the rest of my life, I wanted to make sure it was safe," said the Petaluma, Calif., business consultant. He remembers exactly what his doctor told him. "If it was up to him, he said, they'd put this stuff in the water supply."

Indeed, doctors have been prescribing statins to millions of Americans because of the drugs' remarkable success at cutting a type of cholesterol that has been linked to heart disease. Now, a host of studies suggest that statins may have other significant benefits, from strengthening bones to lowering the risk of Alzheimer's disease.

Though almost everyone, from doctors to patients, agrees that statins are saving many lives, some experts caution that the drugs' benefits are being overblown and that serious side effects are being largely overlooked.

Statins, for example, don't lower cholesterol in every patient who tries them. As for side effects, about 5% of patients experience muscle aches and pains. In rare cases, a more severe condition occurs, one called rhabdomyolysis, in which muscle cells die and are sloughed off. Rhabdomyolysis can lead to kidney failure and death.

One of the newer statins, Baycol, was pulled from the market after reports of 52 deaths linked to the drug. And a consumer watchdog group has called for tough warnings on the labels of statins because of these potential risks.

But circumstances surrounding Baycol, a particularly potent version of statins, were an exception, many researchers say. "Statins have been in use for 15 years, we have millions of people taking them, and we've seen remarkably few problems associated with these drugs," said Dr. P.K. Shah, director of the cardiology department at Cedars-Sinai Medical Center in Los Angeles. "Are we likely to see risks show up when people take them for 20 or 25 years? There's no way to know.''

One thing doctors do know: Statins save lives. Studies show they reduce the risk of death from heart attacks and other causes by 30% to 40% in people with elevated cholesterol levels. "The fact is, the risks of not taking statins are far greater than the potential side effects," said Dr. Gregg C. Fonarow, professor of cardiology at UCLA. In randomized studies of more than 100,000 patients taking statins, there have been no deaths attributed to the medication. (The deaths associated with Baycol occurred outside clinical trials in patients taking drugs but not closely monitored, as they would be in a research study.)

According to Fonarow, statins have been associated with less serious adverse events than has aspirin, a medication that is sold over the counter.

Statins, formally known as HMG CoA reductase inhibitors, were first approved because of their ability to interrupt a biochemical pathway by which the liver produces cholesterol, thus lowering lipid levels in the bloodstream. Since then, they've been found to do a lot more.

Indeed the real surprise, many experts say, is the range of their benefits. "These are wonderfully interesting and powerful drugs that are turning out to have multiple effects," said David A. Drachman, professor of neurology at the University of Massachusetts Medical School. Statins have been shown to reduce the risk of heart attacks and strokes, two major killers. Cardiologists have been surprised to discover that they also improve the survival of patients suffering from heart failure and heart transplant patients. Taking statins also reduces the need for coronary bypass surgery.

"The amazing thing about statins is that they have many benefits that don't have anything to do with lowering cholesterol," Fonarow said. And not just benefits for the heart. Several observational studies suggest that people on statins may lower their risk of Alzheimer's disease by as much as 70%. By maintaining blood flow through the tiniest capillaries that supply blood to brain cells, statin drugs could even reduce the risk of garden-variety age-related memory loss, experts speculate. Some neurologists, Drachman said, have even begun to call statins "Viagra for the brain."

The same drugs may help keep bones strong as people age, reducing the incidence of fractures that plague older people. There's also preliminary evidence that they may help treat diseases associated with abnormal immune function, such as multiple sclerosis, lupus and rheumatoid arthritis, researchers say. Diabetics, too, may benefit.

Statins also boost certain levels of nitric oxide, a substance that helps keep blood vessel walls flexible enough to fully open and allow ample blood flow. This could well be one of their most important effects, Drachman believes. "The cells that line blood vessel walls, called endothelial cells, are turning out to have many other functions," he explained. "Keeping them healthy could promote the health of organs throughout the body."

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