Statins Have Rare Side Effects
Mar 3, 2015
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
It is a summer day. Sunlight streams onto a beautiful field. A young woman in a white sun dress spins and dances joyfully. Upbeat music pervades the scene. The narrator cuts in. Nozulla may cause...full body hair loss, projectile vomiting, full high ball, the condition known as hot dog fingers, children born with the head of a golden retriever, seeing the dead, possession by the prince of darkness,..... I love this E-Trade commercial from a couple of years ago. However, it does highlite my problem when I try to explain medication side effects to people. Some people only hear the worst possible scenarios when they start a new medication.
If I tell a patient starting a medication they have a 1 in 1000 chance of having side effect , they all seem answer the same way. They all say, I'll probably be the one who gets the side effect. So let me put it another way. One in 1000 means that 99.9% of the time you will not get the side effect. If I told you that you had a 99.9% chance of being given $1000 if you raised your left hand, what would you do? Would you expect the $1000 or be convinced you would be the 0.1% of people not getting money?
Let's look at some of the most effective medications we have. They are called statins. The statins stop the liver from making cholesterol. The statins are especially good at reducing LDL which we call bad cholesterol. We have lots of studies that show if we reduce someones LDL with statins we can reduce the chances of heart attacks and strokes by 25% to 35% with five years use. To put it another way, a doctor would only have to treat 23 patients at high risk for heart problems for 5 years to prevent one of them from having a heart attack or stroke. That is a very effective class of medication.
Whenever we talk about putting people on a medication, they ask about side effects. Statins are generally well tolerated. Statins can cause some stomach upset which can usually be fixed by taking them with food. It seems that everyone is concerned that their statin will cause muscle pain or liver damage. These are possible side effects but they are very rare. If you get muscle pain all over your body on your statin, call your doctor. They will probably take you off your statin, and the muscle pain will resolve on its own. As for liver damage, your doctor will do blood tests. If there are signs of liver damage, again they will take you off of the statin and the liver damage will resolve.
Let's put some numbers to the side effects. About 1 in 10 patients on a statin will have some muscle pain, but it will be short term and it will go away. Only about 1 in 100 patients on a statin will have persistent muscle pain that will cause the doctor to stop the statin. About 1 in 100 patients will have muscle pain and a small increase in a liver enzyme called creatine kinase. But only 1 in 1000 will need to stop their statin. A rare but serious side effect of statins is called rhabdomyolysis. It is when creatine kinase is 10 times it's normal level and you have muscle pain. Rhabdomyolysis can lead to heart problems, clots everywhere and kidney failure. It effects about 1 in 100,000 people on statins. In about 1 in 1,000,000 people on statins, their rhabdomyolysis can lead to death.
Now stop yourself for a second. I threw a lot of numbers at you. Did you picture yourself as the 1 in 23 people whose statin saved them from a heart attack or stroke, or the 1 in 1,000,000 people who died from taking a statin. Did you realize you were 43,478 times more likely to have your statin save you from a heart attack or stroke, than for it to cause your death?
We humans seem to be terrible at assessing risk. In their book, Freakonomics, journalist Stephen J. Dubner and economist Steven D. Levitt talked about swimming pools vs guns. If you have an 8 year old girl Molly with two best friends, whose house will you let her go to play dates at? One friend has a backyard pool and the other friends has parents who own a gun. Most people would automatically say the friend with a pool. But the numbers say Molly is 100 times more likely to drown in a backyard pool than to be killed by a gun. It is important to be informed even if it goes against our gut feelings.
Let's go back to the numbers one more time to try to put statin risk into perspective. In 2012, Manitoba had 805.5 injuries in motor vehicle accidents per billion vehicle-kilometer driven. That means you will have 0.8055 or approximately 1 injury in a motor vehicle for every 1,000,000 kilometers you drive. We are back to the 1 in 1,000,000 chance of a problem. Does a 1 injury per 1,000,000 km driven stop you from driving. No. Because if you drove 100 km per day, it would take 27 years until you had an injury. The risk-benefit ratio is really favorable for driving. It is the same with statins. A statin is 43,478 times more likely to save you from a heart attack or stroke than to cause your death. Those are great odds.
We all react first with our gut. That is why lottery tickets sell and Casinos are in business. We all think we will be the winner eventhough the math says we wont. If we didnt lose often, Manitoba Lotteries and the Casinos would all go out of business. Try to remember the benefits of medications you are taking when a pharmacist talks to you, not just the side effects. Now I have to go get some Nozulla. That hot dog finger condition sounds delicious.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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Canadian Motor Vehicle Traffic Collision Stats 2012 http://www.tc.gc.ca/media/documents/roadsafety/cmvtcs2012_eng.pdf
Freakonomics Swimming pools vs guns - http://freakonomics.com/books/freakonomics/chapter-excerpts/chapter-5/
Nozulla -eTrade commercial- https://www.youtube.com/watch?v=0o33tZfqF_M