Primary Evaluation and Management of Statin Therapy Complications

Dean A. Seehusen, MD, MPH, FAAFP; Chad A. Asplund, MD; Dawn R. Johnson, DO; Kevin Horde, A. DO

Disclosures

South Med J. 2006;99(3):250-254. 

In This Article

Other Possible Adverse Effects

Early observational studies and meta-analyses seemed to show an association of statin therapy and depression, aggression and suicidal behavior[40] More recent studies have failed to confirm the association.[41] In a nested case-control study, Yang et al2[4] found a decreased risk of depression among those taking statins. The authors were quick to point out that they did not believe there was a causal relationship, however.

Concerns have been raised about the potential carcinogenicity of long term statin use. However, both randomized trials and meta-analyses of statin exposure have shown no association with increased risk of fatal or nonfatal cancer over a 4- to 6-year period of use.[7,19,43] Prospective studies that look at longer exposure remain to be done. One Danish population study[44] found a slight decreased risk of all cancers in statin users over a 13-year period. Atorvastatin and fluvastatin have been shown to inhibit the growth of breast cancer cells in vitro[45] although no clinical trials have examined the potential antitumor effects of statins.

There is conflicting data on the impact of statins on cognition. Numerous case reports have raised the possibility of cognitive decline after initiation of statin therapy.[46] A meta-analysis done by Etminan et al[47] showed a lower risk of cognitive decline in patients taking statins. A randomized study designed to evaluate cognitive effects of statins is currently underway.[48]

There may be an adverse association between statin therapy and diastolic heart failure. Statin therapy in patients with congestive heart failure has not been well studied because these patients have been excluded from many major trials.[49] Some studies have shown lower serum cholesterol to be independently associated with a worse prognosis in patients with congestive heart failure.[50] In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), more heart failure admissions were seen in patients randomized to 10 mg of atorvastatin than those taking placebo.[51] Whether or not statins actually worsen heart failure remains controversial and currently, several large prospective, randomized trials are being conducted to evaluate the effects of statins in patients with congestive heart failure.[52]

Silver et al[51] recently published a small study confirming with Doppler echocardiography that many patients' left ventricular diastolic function declined with atorvastatin treatment, and improved with supplemental CoQ10 administration. Although not all studies have found coenzyme Q10 to be beneficial, many have reported significant subjective and objective outcome improvements and none have shown CoQ10 to be harmful.[53,54,55,56,57,58,59] Until further studies are available, providers may want to discuss the risks and benefits of such therapy with their congestive heart failure patients on statins.[60]

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