By Duane Graveline, M.D., M.P.H.
Adverse reports about statins were relatively rare years ago when I first experienced my Lipitor amnesias (TGAs). Naively suspecting those in the medical arena might want to hear about this, I encountered nothing but editorial skepticism and peer review resistance on submitting my story to them and my offers to talk on this subject at medical meetings got the "busy agenda" treatment.
Shortly thereafter, an article I co-authored with Dr. Beatrice Golomb of the UCSD statin study on the first 30 cases of statin associated TGAs also never made it to print. So it was not my retired status, it was the subject.No one wanted to hear bad things of their beloved statins. It should be put in the drinking water, many proclaimed. We should all be thankful that cooler minds prevailed. Now, the climate is changing and medical journals are beginnings to carry the truth about the statin class of drugs.
I already have written on some of the mechanics of myopathies, neuropathies, cognitive dysfunction and emotional changes associated with statin use in the past few years, but there is more, much more. Medical researchers now accept that side effect problems exist and they have been industrious.
Meske's work on tau protein and Wang's work on the role of cholesterol in cell signaling was just the beginning. Now we have an article by William Campbell in the October 2006 issue of Muscle and Nerve with the presentation of a host of statin associated neuromuscular problems recently encountered by clinicians and an excellent review of the vital role of cholesterol with its extraordinary sensitivity to statin manipulation in some people.
Don't be dismayed if you see some of those long medical words in the following paragraphs. Sometimes you have to call it what it is and it is not worth defining. I just want to illustrate the full range of statins' reach. One of you folks called it Satan in a letter and I suppose there is some justification for that when you have permanent damage but we must remember these drugs have helped many people and some of this may be due to the tendency to use high doses.
Campbell describes such adverse statin effects as pediatric nephrotic syndrome, macular degeneration, acute pancreatitis, thrombotic thrombocytopenic purpura, a dermatomyositis-like syndrome, aggravation of diabetes mellitus, drug induced pneumonia and a lupus syndrome. He suggests these effects may reflect loss of immune tolerance and the production of autoantibodies.
In the area of neuropathy, he describes an acute polyneuropathy resembling Guillain-Barre syndrome and a mononeuropathy, both from Zocor and describes the problems in sorting out diabetic induced neuropathy from statin neuropathy when so many diabetics are on statin drugs.
Many of you have heard me talk about the inhibitory effect of statins on CoQ10 and dolichols to explain some of the side effects. Campbell discusses the terpenoids, another vital product synthesized through the mevalonate pathway and hence inhibited by statins. Researchers now know that cholesterol and other lipids are not evenly distributed throughout a cell but exist with proteins as cholesterol "rafts" having key roles in cell signaling and all this under the direction of terpenoids, giving us still another way in which statin drugs can complicate the lives of some people.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor