Women at greater risk for side effects when taking statin drugs for cholesterol

~ Carolyn Thomas

by Carolyn Thomas  ♥ @HeartSisters

Statins are the largest selling class of prescription drugs on earth, and account for over 40% of all heart  medications. Lipitor, for example, at over $26 billion in global sales, was the world’s biggest selling drug, manufactured by the world’s biggest drug company, Pfizer.

Because of their effectiveness in managing cholesterol levels, statins are often prescribed to lower total cholesterol in the belief that lower numbers will mean fewer heart attacks. Most people who are prescribed statins are healthy people who don’t have heart disease but who simply have high cholesterol. They will take these drugs for the rest of their lives, making statins a dream drug for the pharmaceutical companies that make them.

For some people, the side effects of statins can include:

  • Muscle pain – can also feel like weakness or extreme fatigue especially on exertion
  • Liver damage – get a liver function test six weeks after starting statins, and then every 3-6 months afterwards, especially if your dosage has increased
  • Digestive problems – nausea, diarrhea, or constipation may be reduced if you take the statin in the evening with a meal
  • Rash or flushing – particularly common if you’re taking the statin Simcor, or a combination of a statin plus niacin
  • Neurological side effects – some researchers suspect that memory loss may be linked to statin use
  • Mood disorders and violent or aggressive behaviour – you won’t find these mentioned on the drug company’s package inserts, but researchers have found associations between aggressive behaviour and statin use that were not reported in clinical trials. This research* found that some statin users who had mood and memory problems also had muscle problems and weakness, which would affect their ability to undertake proven heart-protective exercise programs.
  • As much as a 48% higher risk of diabetes (particularly in middle-aged or older women)

NOTE: See your physician immediately to report any of these symptoms.

If you’re experiencing severe side effects in response to taking a statin drug, here’s what you and your doctor might consider, according to Mayo Clinic cardiologists:

  • Take a brief break from statin therapy. Sometimes it’s hard to tell whether the muscle aches or other problems you’re having are statin side effects or just part of the aging process. Taking a break of 10 to 14 days can give you some time to compare how you feel when you are and aren’t taking a statin. This can help you determine whether your symptoms are due to statins instead of something else.
  • Switch to another statin drug. It’s possible, although unlikely, that one particular statin may cause side effects for you while another statin won’t. For example, it’s thought that simvastatin (Zocor) may be more likely to cause muscle pain as a side effect than other statins when it’s taken at high doses. Newer statin drugs are being studied that may have fewer side effects.
  • Change your dose. Lowering your dose may reduce some of your side effects, but it may also reduce some of the cholesterol-lowering benefits your medication has. It’s also possible your doctor will suggest switching your medication to another statin that’s equally effective but can be taken in a lower dose. For example, if you’ve successfully taken atorvastatin (Lipitor) for a long time at higher doses, your doctor may keep you at this level. However, higher doses are not recommended if you’re new to this medication.
  • Take it easy when exercising. Exercise could make your muscle aches worse. Talk to your doctor about changing your exercise routine.
  • Consider other cholesterol-lowering medications. Taking ezetimibe (Zetia), a cholesterol absorption inhibitor medication, may help you avoid taking higher doses of statins. However, some researchers question the effectiveness of ezetimibe compared with statins in terms of its ability to lower your cholesterol.
  • Do not try over-the-counter (OTC) pain relievers. Muscle aches caused by statins cannot be relieved with acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) the way other muscle aches are. Don’t try an OTC pain reliever without asking your doctor first.
  • Try co-enzyme Q10 supplements. Co-enzyme Q10 supplements may help to prevent statin side effects in some people, though more studies are needed to determine benefits. If you’d like to try adding co-enzyme Q10 to your treatment, talk to your doctor first to make sure the supplement won’t interact with any of your other medications.

The rationale for prescribing statin drugs, according to Dr. Harriet Rosenberg‘s report called Evidence For Caution: Women and Statin Use for the Canadian Women’s Health Network, is based on something called the cholesterol hypothesis.

This theory argues that drugs that lower total cholesterol or LDL cholesterol (often called “bad” cholesterol) or raise HDL (“good”) cholesterol will prevent heart disease.

Measurements of these improved levels is called a surrogate or intermediate endpoint, which is different from the measurement of the more important primary or hard endpoints of decreased heart disease or death – since that’s the whole point of taking a statin drug every day for the rest of your natural life.

Dr. Rosenberg explains:

“Having high LDL cholesterol is often thought of as a virtual disease state in itself.
“However, cholesterol performs many vital functions in the body: it maintains cell wall structure, is crucial for hormone and Vitamin D synthesis, bile salt production and digestion, brain and neuron function. It is critical in fetal development and is an essential component of breast milk.”

She also cites one of the most in-depth reviews of women and statin trials, undertaken in 2004 by researchers Walsh and Pignone. They evaluated data from every significant clinical trial about women and cholesterol-lowering drugs (both statins and non-statin drugs). After reviewing over 1,500 articles, they concluded that for women without heart disease, lowering cholesterol does not reduce the death rate from heart disease or the overall death rate. They also noted that there is not enough evidence to know if events such as non-fatal heart attacks or strokes are reduced.

Dr. Rosenberg refers to further analysis by researchers at the Therapeutics Initiative at the University of British Columbia, who studied 10,990 women; these researchers also found no evidence that statin therapy reduced coronary events in women without heart disease. Reserchers reported:

“The coronary benefit (of statins) in primary prevention trials appears to be limited to men.”

In addition, an overview in the medical journal The Lancet (2007) also emphasized that there has never been a clinical trial showing that statin therapy is beneficial for women who don’t already have heart disease or diabetes.

Researchers question the evidence base for guidelines promoting statin use for this large population of women (75% of women statin users do not have heart disease) which is based on research which even the guideline authors say is “generally lacking” for women – and extrapolated from men’s results.

Dr. Shah Ebrahim, a professor of public health at the U.K.’s London School of Hygiene and Tropical Medicine agrees. He and his team analyzed 14 drug trials dating from 1994 to 2006 that involved a total of 34,272 patients taking statin drugs, the majority of whom had no history of heart disease. This review was prepared by the Cochrane Collaboration — an international network that collects the best available evidence at the time and summarizes it for doctors. Dr. Ebrahim’s conclusions?

“Prescribing statins to people at low risk of heart attack – for example, middle-aged women with no major risk factors other than a modest elevation in cholesterol – is both wasting money and exposing people to potential adverse effects.”

But for women who already have pre-existing heart problems, statin use according to the survey by Walsh and Pignone, has been shown to reduce coronary events and coronary death.

Since 2004, Dr. Beatrice Golomb*, a professor of medicine at the University of California, San Diego and her colleagues have been compiling information on extreme statin-related problems, including memory loss, mood disorders and violent or aggressive behaviour.

Their work has found associations between aggressive behaviour and statin use not seen in clinical trials. This research found that some statin users who had mood and memory problems also had muscle problems and weakness, which would affect their ability to undertake proven heart-protective exercise programs.

Their research has also estimated that, while clinical trials may report that only 1-7% of all statin patients experience adverse drug reactions, the number of adverse reactions with statin use may actually be closer to 15%.

So you might wonder:  if statins do not help prolong women’s lives, why are so many women taking them?

And who’s most at risk for developing side effects?

Not everyone who takes a statin drug will have side effects, of course, but some may be at greater risk than others. Risk factors include:

  • taking multiple medications to lower your cholesterol
  • being a female
  • having a smaller body frame
  • being age 65 and older
  • having kidney or liver disease
  • having type 1 or 2 diabetes

For more useful information about intermediate (surrogate) endpoints in clinical research, read Your Health, Ball Possession, and the World Cup.

UPDATE: December 2014  – Emerging research published in the Canadian Medical Association Journal suggests that taking the antibiotic clarithromycin may be linked with dangerous side effects when paired with one of three specific statins: rosuvastatin (Crestor), pravastatin (Pravachol) or fluvastatin (Lescol).

See also:

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* Rosenberg H. “Women and statin use: a women’s health advocacy perspective”.  Scandinavian Cardiovascular Journal. 2008 Aug;42(4):268-73.

** Criqui MH and Golomb BA 2004. “Low and lowered cholesterol and total mortality.” Journal of the American College of Cardiology 44(5): 1009-10.

WARNING:  Do not start or stop any prescription drug without consulting your own physician.

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NOTE FROM CAROLYN:  I wrote more about taking cardiac medications in my book A Woman’s Guide to Living with Heart Disease, (Johns Hopkins University Press, 2017). You can save 20% off the book’s cover price if you order it directly from Johns Hopkins University Press (use their code HTWN). Or ask for it at your local library, your favourite independent bookshop, or order it online (paperback, hardcover or e-book) at Amazon.

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Published by Carolyn Thomas

24 thoughts on “Women at greater risk for side effects when taking statin drugs for cholesterol”

  1. Started Lipitor because my cholesterol was 278, but have been feeling just plain mad and angry all the time… Is it the meds causing this?

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    1. Hello Jacqueline – I’m not a physician so cannot comment specifically on your situation. I can tell you generally that a number of studies have looked at these issues.

      A small (12-person) case study published in 2016, for example, reported that, out of the 12, five were taking the Lipitor brand of statins: “Statin psychiatric effects included irritability/aggression, anxiety or depressed mood, violent ideation, sleep problems including nightmares, and possible suicide. Problems resolved when the drug was discontinued, and recurred with re-challenge where attempted.”

      It’s important to remember that this does not necessarily mean that the drug CAUSED your symptoms; in such a small study (and by the way, only ONE woman included among the 12 people reporting side effects), there could have also been a wide variety of other influences at work on the subjects’ mental health.

      Talk to your doctor about taking a ‘statin holiday’ just to see if symptoms do decrease or go away entirely, or if a different brand of statin might be tried to help manage your cholesterol.

      Take care, stay safe…

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  2. Do you base your opinion of your cardiologist on their experience or their gender?

    My male cardiologist has done hundreds of stents but is better at talking to my husband who is also a patient. I don’t take a statin because of side effects even though my cholesterol is only 165 and my LDL is only 67 but I did have a STEMI (heart attack)

    I would hate to pick a female just because of her sex and then find out she has little experience in doing stents. Any thoughts?

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    1. Hi Chris – Personally, I think it’s a bit of both. My own cardiologist happens to be a male, has years of training and experience, was recently named the Chief of Cardiology at our local heart hospital, and is both compassionate and skilled. Couldn’t possibly ask for a better human being to entrust with every aspect of my ongoing cardiac care. I wrote about the first time I met him (in the ER!) here.

      My opinion about those who implant stents (the interventional cardiologists) is exactly what you describe: it’s very important to have the most experienced person you can find to implant your stent(s).

      Yet very few women are interventional cardiologists (this article in Cath Lab Digest estimates, for example, that only 4.5% of interventional cardiologists in the U.S. are women, and only 2.8% of all angioplasty procedures are performed by women.

      So if a patient insisted on a female doctor doing this particular kind of invasive cardiac procedure, chances are she might have to travel far away to a major teaching hospital to find one – often not even possible or desirable if the patient is in mid-heart attack. In an emergency (i.e. NOT an elective procedure), better to take who you can get! The suggested reasons listed in this article for this huge gender gap are very interesting.

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  3. I am 86 years old, never high BP, no diabetes, have arrhythmia, (questionable) proxsymal afib, never high cholesterol. Always sensitive to medication. Upper/ lower GI trouble. Still undecided about taking statins to keep carotid arteries clear enough. So scared about side effects/cost.

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  4. My MD wants me to take cholesterol med to help prevent stroke. My cholesterol numbers have always been good. The side effect stories I am seeing are making me rethink. what do you think of the reasoning?

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    1. Hello Carol – I’m not a physician so cannot comment specifically on your case. I can tell you generally that there is limited research on low-risk people who have not had a cardiac event and have normal or near-normal cholesterol numbers (e.g. one was the HOPE-3 study published in the New England Journal of Medicine in 2016). This study looked at older people with high blood pressure but nearly normal cholesterol and who had another risk factor such as smoking or obesity.

      You might be interested in trying this risk assessment tool developed by Dr. James MacCormack at the University of British Columbia, so you’ll have a better understanding of your decision (there are two “Relative Benefit” statin options – moderate or high dose) for you to click, one at a time after completing the basic fields.

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  5. I am extremely grateful for the sound data you have provided as my doctor has prescribed lipitor for me which I have yet to take do to concerns addressed in the above information. It will factor into my decision of whether or not I need to start taking this medication.

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  6. I was prescribed Lipitor; I had dizziness, nausea and vomiting. I immediately called my Dr and they made it sound like I picked side effects off the sheet that came with the drug . She knows I do not like taking drugs. She told me to continue it. I had the same side effects, now I know it’s the drug . Going to try over the counter natural herbs and supplements. Cholesterol was only 230. I exercise and watch my diet. Any other suggestions? I thought about cutting it in half its 10mg what about 5mg. I’m a very small person only 108 pounds. Any ideas?

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    1. Hi Debra – I’m not a physician so cannot advise you one way or the other. I can tell you that generally speaking, if you have already had a cardiac event (heart attack, etc), the evidence does support taking a statin to prevent future cardiac events. If you have never had any heart issues, the evidence is far less robust (as this article reports). Talk to your doctor about your idea to cut your tablets in half and other possible alternatives to your Lipitor.

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  7. High cholesterol runs in my family. At age 54 I am struggling to staying on them. Had adverse reactions when I went from 10mg to 20mg. Insomnia and cold pulling sensations in my left arm at night. Also short electrical shock pains randomly located in upper body. Complained to my Doctor only to hear she wants to send me to a neurologist. I want to get off these things and find alternative treatment. I exercise daily and will change my diet, anything to get off these pills . Any sound advice out there?

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    1. Hi Maria – I’m not a physician so cannot comment specifically on your experience with statins, but I can tell you generally that whenever patients – any patients – experience symptoms like you describe that may be linked to the drugs they’re taking, they deserve to be taken seriously.

      It’s very interesting to me that for years, so many physicians have generally ignored or dismissed patients’ reports of debilitating statin side effects – until just recently when a new class of cholesterol drugs called PCSK9 Inhibitors was approved by the FDA. Last month, the New England Journal of Medicine sang the praises of these new drugs for “patients unable to take statins” due to debilitating side effects.

      Unable to take statins? Suddenly, such patients are being taken seriously – because there are now new drugs on the market (although not without their own controversy) – like the high cost of PCSK9 Inhibitors, the fact that their clinical benefit “has not yet been demonstrated”, and the possible forfeiture of personal privacy for patients who take these new drugs.

      You didn’t mention if you’ve been diagnosed with familial hypercholesterolemia or not. Please discuss your concerns about side effects with your physician.

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  8. I started taking generic Lipitor approximately one month ago. A couple weeks ago my hip began hurting/aching. The pain has become so severe the hydrocodone (prescribed for serious spinal problems) will not help it. I have not had pain this severe in 10 years. I decided to look up the possible side effects of Lipitor and see if this drug could be the culprit. BINGO !! I am stopping the Lipitor immediately. I bet when it’s out of my system the hip will stop “killing” me. I bet this drug is why my muscles have become rigid, too.

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    1. Hello Vickie – Please report your side effects to your physician and request an alternative treatment option. If you both come to the same conclusion (that your new pain is linked to your current meds), you can also report your side effects on MedWatch, the FDA database of adverse drug events if you live in the U.S. or here if you live in Canada. Best of luck to you…

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  9. I am 59, female, and had first heart attack on February 19th, 2015. My Cath according to the Cardiologist was clear, no blockages. I was sent home the next day & later that night had to go to ER for dizziness & heart rate dropping to 40. Was in complete heart block for which I received a pacemaker. Doctor Prescribed a statin. I discussed my options & that I wanted to try diet modification & exercise first. My total cholesterol was 230. I was hypertensive, but blood pressure is coming down with the DASH program. I feel I can avoid statin use for now with vigilance to diet & exercise.

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    1. Hi Susann – you are in very early weeks still, and good for you for getting onboard the DASH program right off the bat to help address your blood pressure issues! Best of luck to you…

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  10. After just a few doses I noted extreme fatigue and worsening insomnia, also I have had shortness of breath which is the main culprit…I called my doctor and I see her on Wednesday.

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  12. I want to stop taking pravastatin; the side effects are awful! I want my health back… I have high cholesterol (over 230) but the other numbers are good (HDL/LDL/trig).. I am looking for alternatives so I can get back into feeling healthy again!! Any ideas?

    Thanks!! Love this website too!

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    1. Hello Cheryl,
      Nobody should continue to live with “awful” side effects. Please report your side effects to your physician and request an alternative treatment option.

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  13. I stopped taking Pravastatin cold-turkey after a series of unpleasant side effects manifested: muscle pain, severe exhaustion, weakness and general malaise, skin rash, insomnia. My cholesterol wasn’t high to begin with, I had to assume that the only reason it had been prescribed was because it’s part of the “protocol.” It’s unfortunate that the only “solutions” they can devise for individual problems and/or drug reactions is to replace one drug with another. I’m now on the fourth new drug regimen in less than six months,

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  15. Thanks for this clear overview on this controversial topic. My PCP is really pushing me to go onto statins but I’ve read a number of sources like this one from Mayo Clinic that have made me doubt the wisdom of these blanket recommendations for statins, given that my cholesterol numbers are good! Just read of a new Johns Hopkins study this morning that questioned the JUPITER results raving about statin benefits in lowering CRP levels. Who knows who to believe? When studies are funded by drug companies?

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  16. Thanks for this. I’ve been reading more and more about the other side of statin drugs especially for women. I will pass this on to my friends. I love your website!

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