Statins as Preventive Medicine?
Some of you may have seen the article in the New York Times reporting that AstraZeneca, the manufacturer of Crestor, the statin lowering drug, has just received approval from the FDA to market the medication to those who don’t have high cholesterol – in other words to market it as preventive medicine. This occurred despite the fact that the journal Lancet just published a study that raises some concerns that statins can increase one’s risk of Type 2 diabetes by 9%.
While a market booster for AstraZeneca, some doctors believe that there could be risks associated with prescribing the medication to those whose cholesterol levels are normal. I’m reminded of a case where a patient was hospitalized with rhabdomyolysis, a condition in which muscle tissue breaks down releasing myoglobin which is toxic to the kidneys and can cause acute kidney failure. Although this rarely occurs, high statin doses can cause rhabdomyolysis, and this is what happened to this unfortunate patient.
When I saw him, he had just been released from a rehab facility where he was recuperating from acute kidney failure. Because of the extensive muscle tissue loss, he was still quite weak and requiring the use of a walker. His kidney function weeks after his hospitalization had not returned to normal. It was felt that an increase in his statin medication had triggered this rare event. In other words, he had been tolerating his previous dose of statin medication but his LDL cholesterol level was not at goal for his preexisting condition. When his medication was increased, he quickly developed muscle pain and subsequent rhabdomyolysis. There was no warning since his previous liver enzyme levels were totally normal. Now, he has a long road to recovery ahead of him.
I would be very cautious about prescribing statin medications as preventive medicine. Instead, I would like to see patients taking a more active role in their own health by monitoring their diets and exercising regularly rather than rely on a pill.
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