January 29, 2009
Statin Side Effects Surveyed

The cholesterol lowering drugs known as statins (e.g. Crestor, Lipitor) deliver real benefits but create side effects in some.

A paper co-authored by Beatrice Golomb, MD, PhD, associate professor of medicine at the University of California, San Diego School of Medicine and director of UC San Diego's Statin Study group cites nearly 900 studies on the adverse effects of HMG-CoA reductase inhibitors (statins), a class of drugs widely used to treat high cholesterol.

The result is a review paper, currently published in the on-line edition of American Journal of Cardiovascular Drugs, that provides the most complete picture to date of reported side effects of statins, showing the state of evidence for each. The paper also helps explain why certain individuals have an increased risk for such adverse effects.

"Muscle problems are the best known of statin drugs' adverse side effects," said Golomb. "But cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported." A spectrum of other problems, ranging from blood glucose elevations to tendon problems, can also occur as side effects from statins.

Statins lower Coenzyme Q10 (aka CoQ10) which is needed for mitochondrial energy metabolism. This is probably the cause of many statin side effects.

Mitochondria produce most of the oxygen free radicals in the body, harmful compounds that "antioxidants" seek to protect against. When mitochondrial function is impaired, the body produces less energy and more "free radicals" are produced. Coenzyme Q10 ("Q10") is a compound central to the process of making energy within mitochondria and quenching free radicals. However, statins lower Q10 levels because they work by blocking the pathway involved in cholesterol production – the same pathway by which Q10 is produced. Statins also reduce the blood cholesterol that transports Q10 and other fat-soluble antioxidants.

"The loss of Q10 leads to loss of cell energy and increased free radicals which, in turn, can further damage mitochondrial DNA," said Golomb, who explained that loss of Q10 may lead to a greater likelihood of symptoms arising from statins in patients with existing mitochondrial damage – since these people especially rely on ample Q10 to help bypass this damage. Because statins may cause more mitochondrial problems over time – and as these energy powerhouses tend to weaken with age—new adverse effects can also develop the longer a patient takes statin drugs.

"The risk of adverse effects goes up as age goes up, and this helps explain why," said Golomb. "This also helps explain why statins' benefits have not been found to exceed their risks in those over 70 or 75 years old, even those with heart disease." High blood pressure and diabetes are linked to higher rates of mitochondrial problems, so these conditions are also clearly linked to a higher risk of statin complications, according to Golomb and co-author Marcella A. Evans, of UC San Diego and UC Irvine Schools of Medicine.

Obviously statins have their limits and drawbacks. We need better alternatives. A synthetic substitute for HDL cholesterol might present a better alternative.

"We have designed and built a cholesterol sponge. The synthetic HDL features the basics of what a great cholesterol drug should be," said Chad A. Mirkin, George B. Rathmann Professor of Chemistry in the Weinberg College of Arts and Sciences, professor of medicine and professor of materials science and engineering. Mirkin and Shad Thaxton, M.D., assistant professor of urology in Northwestern's Feinberg School of Medicine, led the study.

"Drugs that lower the bad cholesterol, LDL, are available, and you can lower LDL through your diet, but it is difficult to raise the good cholesterol, HDL," said Mirkin. "I've taken niacin to try and raise my HDL, but the side effects are bad so I stopped. We are hopeful that our synthetic HDL will one day help fill this gap in useful therapeutics."

In creating synthetic HDL the researchers started with a gold nanoparticle as the core. They then layered on a lipid that attaches to the gold surface, then another lipid and last a protein, called APOA1, the main protein component of naturally occurring HDL. The final high-density lipoprotein nanoparticles are each about 18 nanometers in diameter, a size similar to natural HDL.

My advice: switch to the Mediterranean diet. If that doesn't get your cholesterol down far enough then make like an ape man.

Share |      Randall Parker, 2009 January 29 11:18 PM  Aging Cardiovascular Studies

Jake said at January 30, 2009 4:46 AM:

Statins raise Vitamin D levels. That may be its only benefit. It may be that any observed benefits from statins could be duplicated with increased dosage of Vitamin D.

David A. Young said at January 30, 2009 9:03 AM:

OK, I'll ask the obvious question. Would Q10 supplementation ameliorate these effects?

MylesJ said at January 30, 2009 6:27 PM:


My understanding is that statins are generally prescribed only with CoQ-10 in most of the world. Here they are waiting until the patent expires so they can add CoQ-10 and get a new exclusive period.

The companies that sell Red Yeast Rice supplements are no longer allowed to disclose the monacolin level of that product since the chemistry was patented by big pharma. The statin in red yeast rice is the same, at a low dosage.

I was on statins for a while and developed several muscle problems and decreased mental acuity so I've done some research on the subject.

Now I eat a very low fat diet and take no flush niacin (stay away from the low flush and regular niacin) and run about 180 on my cholesterol

Tom Bri said at January 30, 2009 7:00 PM:

Or, you can just ignore your cholesterol levels, since the actual measured advantage of low cholesterol is rather small, and there are also several negative effects of low cholesterol.

People with specific genetic conditions that result in extremely high cholesterol are a different case.

willem said at January 30, 2009 7:06 PM:

Somebody needs to tell Mirkin about the new microencapsulated (ME) controlled-release Niacin that is now being formulated and sold. I can now take 1500 mg/day no problem.

Do I ever wish someone would formulate a ME product with individually ME niacin, zinc, ubiquinone and ribose modulated VitC.

We desperately need more and better product development research into formulations optimized for human gut absorption; optimized particulate sizes with timed release points along the gut and other pH encapsulation tricks that give optimized release along the alimentary path where most beneficial. (Should I note there is NO OBAMA STIMULUS PACKAGE for something this real or basic?)

The corporatista's financial obsession with "silver bullet" proprietary molecules is dwarfed by the economic opportunities presented by formulating/delivery technologies increasing bioavailability of nutrients and "nutrifying" processed foods. They can't see it. We stand at the brink of a golden age of Engineered Foods and these corporate dweebs can't see the forest for the trees. Whole foods cannot be the answer. There are too many to feed.

The cholesterol catastrophe and its discordant mythology have likely killed as many as have been allegedly saved by the Allopathic approach to human disease and healing. Dealing with pernicious malnutrition is far more involved than merely keeping people from starving. Pernicious malnutrition co-presenting with systemic cryptopathic inflammation is at the root of most modern chronic disease. Food technology is at the root. The preservation and packaging technologies have been critical advances, but we need to revitalize our technology paradigm of the food itself. There is much work to do.

We need more Orthomolecular sophistication in medicine, medical education and medical research. It's the perfect economic compliment to the profoundly advancing surgical technologies, advanced diagnostics, cost-containment modalities and morbidity management strategies which can be dramatically improved through technologically enhanced therapeutic nutrition and engineered foods.

Medical syndicalism and universal health coverage will not save you, me or our loved ones from the ravages of the ignorant single-mindedness that pervades the medical academy and its attendant bureaucracies, non-profits and publicly-traded stakeholders.

Thanks again for the post on these pioneers. I hope someone is there to protect them from their peers.

We need to remember that the medical orthodoxy is not our friend.

Randall Parker said at January 30, 2009 7:30 PM:

Before considering statins I repeat my advice: make like an ape man.

Kyle said at January 30, 2009 8:21 PM:

Don't forget exercise. It's very effective in raising HDL levels.

Greg said at January 31, 2009 5:06 AM:

Another wayt that is working for me is to increase my daily intake of soluble fiber. I do this through psyllium husk supplement. I use the Yerba Prima powder, which has 3.5 grams per teaspoon. Start with one tsp and work up to a tablespoon per day. I mix mine into a smoothie (1/3 cup no fat plain yogurt, 2/3 cup skim milk, a couple of forzen strawberries, 1/2 banana and a tablespoon or two of whey protein). My LDL went from 240 to 166 within a year. I also used niacin supplements (no fluch) and my LDL went from 43 to 68. It went back down to 49 after I changted the way I took it. I don't think you are supposed to take it with fiber supplement. Anyway, they don't cll psyllium the drink of life for nothing.

Good luck with your health!

leon dixon said at January 31, 2009 5:16 AM:

CoQ10 used to be packaged with the statins here but it was too expensive and so they dropped it according to my wife's doctor. Supplements of CoQ10 seem to help. But, everyone is different as the previous writer noted in what I think is well taken points. Wished he had a blog.

Steve said at January 31, 2009 6:12 AM:

"Statins deliver real benefits" - What? And don't tell me "they raise vitamin D levels". Show me where all the money spent on statins have increased the quality or length of life by even one minute? Why haven't the morbidity and mortality rates been budged one iota with all the "life saving" statins being prescribed?

The Healthy Librarian said at January 31, 2009 6:27 AM:

A friend of mine sent me the Glenn Reynolds link to your post about Dr. Beatrice Golomb's research on statins.

All drugs have side-effects. The Mediterranean diet isn't the complete "Big Fix"--and inflammation is the main culprit. You might want to read my "Cliff Notes" summaries on the effects of diet on heart disease. There's no "magic pill" that will do it all. It's Diet-Exercise-Stress Control.

Yes, You Can Prevent & Reverse Heart Disease - But Are You Up For The Challenge? Let Dr. Esselstyn Convince You - Part I


Lots more interesting "Food for Thought" in the side bars. And some more research by Dr. Golomb can be found in:

Do Statins Make You Stupid? Asks Wall Street Journal & New York Times


BTW health research is my hobby--I'm a medical librarian.

th said at January 31, 2009 6:35 AM:

"my understanding is that statins are generally prescribed only with CoQ-10 in most of the world. Here they are waiting until the patent expires so they can add CoQ-10 and get a new exclusive period."

Are you are referring to Pfizer and Lipitor, they're still going to lose Lipitor to generics, right? Merging with Wyeth isn't exactly what alot of people thought they were going to do. Big pharmaceuticals are losing their cash generators faster than they can replace them, this merger would seem to indicate pfizer isn't too thrilled with taking a big risk on biotech.

David Govett said at February 1, 2009 8:19 PM:

I'm first in line to buy synthetic HDL when it's marketed.

Katie the Sec. said at May 29, 2013 9:52 AM:

I am going to a new dr. Mine had prescribed a glass of wine before bed to help with my cholesterol level since the statin did not work, and the wine worked great since. I asked my dr if I can now go off the statin since the wine did the trick and he said no, it probably helps. (and he gets me in there twice a year for a doc. office call to have my liver checked). I am an executive secretary, very sharp, need to be on the ball, but over the last several months, I can feel myself slipping, not as sharp, can't think of words. All my muscles hurt and my joints. I was in the Crim race two summers ago, now it hurts to kneel down, and takes 30 seconds to get to my feet with much pain. A friend said it sounded like the statins were playing havoc with my system. I have leg problems at night, restless, burning, tingling and thought maybe it was blood flow. I was athletic until about 6 months ago, when the pain slowed me down. Now I'm a 55 year old wreck. Is it the Cholesterol drug? I am still going on the 3rd to the new doc, so don't worry that I won't go if I get advice here. Thanks, K

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