During the initial development of Mevacor well over a decade ago, it is to Merck's credit that they were sufficiently concerned about the potential side effect reactions to consider offering a combined Mevacor / Ubiquinone pill to help offset the side effects to come from the inhibition of ubiquinone that inevitably must result from Mevacor and, indeed, any other statin drug.
All pharmaceutical researchers were well aware that to inhibit the mevalonate pathway, and thereby substantially diminishing cholesterol, one inevitably must inhibit ubiquinone, known to most patients as Coenzyme Q10.
You simply cannot have one without the other. Although Merck obtained a patent for its combined Mevacor / CoQ10 pill, no further action was taken on this matter.
Today, most of the side effects we are seeing from Mevacor and the other stronger statins are due to ubiquinone deprivation; collateral damage in the war on cholesterol, made worse each year due to the relentless trend toward higher and higher doses as the target levels for acceptable cholesterol have been progressively lowered.
I am a retired family doctor and former NASA scientist astronaut. I was Board certified both in Family Practice and Preventive Medicine. My personal concerns began in May 1999 when I experienced my first episode of total global amnesia and again in May 2000, when my second attack of this harrowing condition occurred, seemingly out of the blue.
In both cases Lipitor had been started six weeks earlier at the time of my annual astronaut physical. Of course I was suspicious of a possible relationship to Lipitor but I could find only a statement of "possible memory problems" in the drug literature and no confirmation among the several doctors and pharmacists I consulted.
After working closely with Dr. Beatrice Golomb of the UCSD statin study I soon discovered that Zocor and Mevacor also were major players in the growing field of cognitive dysfunction in its users. These similarities should surprise no one for each of these drugs represents only a minor alteration of the configuration of the parent molecule. They are all HMG-CoA reductase inhibitors. Their function is to inhibit the simple reductase step of the so-called mevalonate pathway of cholesterol synthesis.
We now have hundreds of cases of transient global amnesia and tens of thousands of cases of extreme forgetfulness, confusion and disorientation associated with the use of Mevacor and the other stronger Statins. Wagstaff et al's team of doctors from Duke University reported from their 2003 review of some 25,000 adverse drug reports filed away in the FDA's Medwatch repository that many of the 60 TGA cases buried therein were associated with Mevacor use. They reported this in Pharmacotherapy in Aug, 2003. Our "few aches and pains" have evolved to many deaths from rhabdomyolysis and rising numbers of patients with debilitating muscle pain persisting for years despite cessation of the statin drug involved, a position shared by Mevacor and its counterparts.
There are also severe emotional problems with hostility, aggressiveness and suicides being reported associated with use of Mevacor and its sister drugs. Neuropathies, thought at first to be relatively rare, are of particular concern because of their failure to regress. Mevacor contributes to many of the neuropathy cases that have been reported.
It is now known that a major side effect of all statin drugs is the impairment of cellular energy, contributing to many cases of congestive heart failure and chronic fatigue. Even more importantly, we have learned that Mevacor and all other Statins lower cardiovascular risk not by cholesterol manipulation but by reducing arterial wall inflammation through inhibition of the immune system. This immuno-suppressant effect has opened Pandora's Box, so to speak, inviting the threat of increased susceptibility to certain cancers and infectious diseases.
Until recently most of these observations were anecdotal, based on reports that were forwarded to the FDA's Medwatch, to Dr. Golomb of the UCSD statin study or to my own research of statins. Now medical journals are beginning to bring them to the attention of prescribing physicians. The landmark paper by Wagstaff, "The first 60 cases of statin associated transient global amnesia", is available to all physicians in the August 2003 issue of Pharmacotherapy.
The works of Gaist on statin neuropathies and the Langsjoen's on congestive cardiac failure associated with statin drug use are available to all physicians in many of the medical journals. The NIH funded UCSD statin study report is soon to be published. No longer can physicians claim ignorance of the many adverse side effects of the statin drugs.
Prescribing physicians must now wake up to the reality that what they have been told by overzealous pharmaceutical "reps" over the past decade may not have been the whole truth. My purpose is not to malign a drug or class of drugs, which are of such established benefit to public health. I wish only to present the true legacy of Mevacor and other statin drugs to physicians and their patients.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor