When statin is mentioned, many patients are worried about the side effects of statin harming liver and kidney, which also become the reason for refusing statin. It is true that statin has certain side effects, but the more important role of statin is to protect the heart. Do not refuse statin treatment because of the fear of side effects and choke on it. This article explains statin side effects in detail and answers the concerns and confusion of internet users.
Does an increase in liver enzymes after taking a statin necessarily mean that liver damage has occurred?
It is believed that all statins can cause an increase in liver enzymes (ghrelin and ghrelin), and the incidence of liver enzyme elevation exceeding 3 times the upper limit of normal is about 1%-2%. Elevated liver enzymes only represent the release of enzymes in hepatocytes. The causes of elevated liver enzymes after taking statin may be related to the decrease in cholesterol levels secondary to drug effects; combined fatty liver; combined use of drugs that elevate liver enzymes; and heavy alcohol consumption.
Mild to moderate elevation of liver enzymes alone (i.e., not accompanied by elevated bilirubin) does not represent hepatic “toxicity” of the drug and is not clinically significant. It should be evaluated in conjunction with other liver function parameters including albumin, prothrombin time, and direct bilirubin.
The incidence of drug-derived liver damage after statin administration is rare, with an incidence of 1.2/100,000; acute liver failure is even rarer, with an incidence of about 0.2/1 million. This indicates that statins do cause liver damage, but the incidence is extremely low and generally safe.
What should I do if I have elevated liver enzymes after taking a statin?
Liver function should be monitored regularly while taking statins. Liver enzymes should be checked before starting statin therapy, and liver function should be rechecked 4-8 weeks after starting statin therapy and again at 12 months, and gradually adjusted to 6-12 months if there is no abnormality. If liver enzymes are elevated more than 3 times the upper limit of normal, the drug should be discontinued but liver function should still be rechecked weekly until it returns to normal. If liver enzymes are elevated less than 3 times the upper limit of normal, statin therapy is generally not affected and does not need to be discontinued.
Which patients with liver disease should not take statins?
Statins should be contraindicated in patients with active liver disease, persistent elevation of unexplained transaminases and elevation of liver enzymes above 3 times the upper limit of normal for any reason, decompensated cirrhosis and acute liver failure. In contrast, patients with non-alcoholic fatty liver disease or non-alcoholic steatohepatitis, as well as chronic liver disease or compensated cirrhosis without obvious signs of liver impairment are not contraindications to statin drugs.
What is muscle pain after taking a statin?
Muscle symptoms after taking statin can be diagnosed as statin-related myopathy if other causes are excluded. There are three main manifestations: myalgia refers to muscle weakness, soreness, pressure, stiffness, cramping or pain at rest or during activity, with normal creatine kinase (CK); myositis refers to elevated CK with or without myalgia; rhabdomyolysis refers to elevated CK more than 10 times the high limit of normal value with muscle symptoms.
The incidence in clinical trials is approximately between 1% and 5%, and the clinical incidence is between 9% and 20%, and is a common cause of drug discontinuation in patients. Only a very small number of serious adverse effects of rhabdomyolysis occur, and the incidence is only 0.04% to 0.2%, which is generally safe.
Who is prone to myopathy after taking statin?
Patient’s own causes: elderly people over 65 years old (especially over 80 years old), women are more common; thin and weak; renal insufficiency; hepatic insufficiency; hypothyroidism; metabolic myopathy; history of elevated CK, previous history of myopathy with lipid-lowering drugs or family history of muscle symptoms and unexplained muscle spasms during treatment; genetic factors, etc.
External causes: alcohol consumption; strong physical activity; trauma or surgery; infection; high-dose statin therapy; drugs that affect the metabolism of P450 enzymes can increase the blood levels of statins, including, for example, sunglasses (1L/d).
People with the above risk factors taking statins should pay attention to monitoring the level of muscle enzymes to detect adverse reactions early and to avoid the development of rhabdomyolysis. People with risk factors should try to avoid applying high doses of statins and drugs that affect statin metabolism to avoid serious adverse effects.
What should I do if I have myalgia or elevated muscle enzymes after taking a statin?
Before starting statin therapy, if there is persistent and unexplained myalgia, it is recommended to check creatine kinase (CK): if CK is more than 5 times the upper limit of normal, repeat the test in 5-7 days; if it is still more than 5 times, do not start statin therapy; if it is less than 5 times elevated, start statin therapy in low doses. Seek medical attention if muscle symptoms such as myalgia, fatigue or weakness occur during treatment. If a statin has been used previously without adverse effects and muscle pain or weakness is newly developed, other possible factors should first be ruled out. Routine monitoring of CK may not be necessary if there are no uncomfortable symptoms on statins.
If a patient cannot tolerate statin therapy due to adverse reactions during statin therapy, the following strategies are recommended: consider discontinuing the drug if the adverse reaction is severe, restarting therapy after the symptoms disappear, and observing the correlation between the appearance of symptoms and the statin; if the adverse reaction is not severe, the dose can be reduced appropriately, and additionally, hydrophilic statins such as pravastatin and resulvastatin can be switched to intermittent dosing to reduce the intensity of therapy. The available evidence does not recommend coenzyme Q10 or vitamin D for the relief of muscle symptoms.
Can statins cause diabetes?
Patients are occasionally encountered in outpatient clinics who have experienced an increase in blood glucose after taking a statin for a period of time. Current research also confirms that patients on long-term statins have an increased risk of new-onset diabetes, and in 2012 the FDA issued a statement that statins may cause abnormal blood glucose and new-onset diabetes; in 2013 the CFDA in China also required all statin instructions to include information about the potential for elevated blood glucose. However, the benefits of statins in reducing cardiovascular events far outweigh the risk of new-onset diabetes. Statin treatment for 4 years reduced deaths, myocardial infarction, stroke, and revascularization by 9 per 255 cases, compared with only 1 case of new-onset diabetes. The cardiovascular benefit of statin far outweighed the increased risk of diabetes, and the score was 9:1 in favor of statin. Patients who need treatment with statin do not have to stop because of elevated blood glucose.
Monitor fasting blood glucose or glycated hemoglobin before starting statin in people at high risk for diabetes; intensify healthy diet and exercise while taking statin; monitor weight and waist circumference regularly; there is no need to stop statin therapy if blood glucose or glycated hemoglobin rises while taking statin; intensify lifestyle interventions and take glucose-lowering medications to control blood glucose and glycated hemoglobin in patients with confirmed new-onset diabetes.
Do statins harm the kidneys?
The current study results show that statins do not increase the risk of acute renal failure. FDA adverse event data show that patients taking statins have a low incidence of renal failure, with only (0.3 to 0.6)/1 million patients taking them for 1 year, similar to those not taking statins. Data from the U.S. FDA and the New Drug Application Bureau indicate that statins have no significant nephrotoxicity. On the contrary, one study found that statins were instead nephroprotective, with a value of 1.22 ml/min per year less decrease in glomerular filtration rate after statin treatment than in the control group; the nephroprotective effect was more pronounced in patients with cardiovascular disease. The current evidence has confirmed the renal safety of statin and there is no need to be overly concerned about the renal side effects of statin.
Can patients with chronic kidney disease take statins?
Newly published clinical studies have shown that the incidence of adverse events in patients with moderate chronic kidney disease is similar to that in patients without chronic kidney disease, with no adverse effects on renal function in patients with moderate chronic kidney disease. The meta-analysis also found that statins reduced mortality and cardiovascular event rates in patients with chronic kidney disease. Statins have no adverse effects on renal function in patients with chronic kidney disease, and statin use is safe in patients with chronic kidney disease; instead, statins may even delay the decline in renal function.