Statin intolerance rarer than people think

Fear of side effects can put patients off cholesterol-lowering drugs, but the true rate is under 10%.

---

The real incidence of statin intolerance is under 10%, despite around one in three users believing they have side effects, a large global study suggests.   

Muscle pain is the most commonly reported side effect, but patients have also reported liver and kidney damage, neurocognitive disorders and haemorrhagic stroke. Statin discontinuation remains an ongoing problem, in part due to these perceived adverse effects.  

But when European researchers analysed data from more than four million patients in more than 150 studies, they found that statin intolerance in clinical trials was only around 9% overall and less than 7% according to certain recognised definitions of statin intolerance.  

“Clinicians should use these results to encourage adherence to statin therapy in the patients they treat,” the authors wrote.  

Those most at risk were women, patients aged 65 or older and those with Asian and African-American ethnicity. Other risk factors included having hypothyroidism, obesity, type 2 diabetes, and chronic liver and kidney diseases. The use of antiarrhythmics, calcium channel blockers, alcohol, or a high dose of statins were also associated with adverse events, although the researchers were unable to be specific about dosages – for example, how much alcohol posed a risk.  

The authors noted that the prevalence of statin intolerance was hard to pin down, as various factors could interact to produce an adverse experience. But many of these effects could be attributed to the nocebo or “drucebo” effect, they added.  

Associate Professor David Sullivan, from the NHMRC Clinical Trials Centre in Sydney, agreed.  

Some of the press that statins received in mainstream media was “alarmist fear-mongering” that had a “very detrimental effect on our overall level of healthcare,” he said. 

“For instance, a lot of attention is paid to making sure statins don’t cause any problems with cognitive function and memory and so forth,” Professor Sullivan said. “And yet rumours persist in those areas.”

“They’re the sorts of things which I think really influence people’s acceptance or non-acceptance of the treatment.” 

When people overestimated the risk of statin-related adverse events, they stopped taking them, and that had harmful consequences, he said.  

“If you told them the risk of a problem is as little as one in 10, I think they’d be surprised to find that it was so low.” 

European Heart Journal 2022, online 15 February