Blog | Tuesday, July 10, 2012

Statins and fatigue

Over 6 years ago I wrote this post, "Why patients stop taking statins!"

Whether the statins were causing problems in these two otherwise healthy men is unclear. What is clear is that they believed that statins caused a decreased quality of life. They clearly put blame on the statin for feeling less well. Despite being very intelligent, and understanding that their cholesterol levels were greatly improved, they decided to stop the statins.

Now in both these cases, one could argue that they need not have received the prescription originally. Neither has CAD nor diabetes mellitus. Neither smokes cigarettes and both have father alive at ages greater than 80. I generally reserve primary prevention for those with multiple risk factors, especially strong family history of premature CAD.

I do not know their baseline LDL levels.

Although the side effects of statins are probably less than most drugs we use, they still do have a risk benefit profile. When side effects are felt and the benefits are abstract, many patients will eschew the drug.

Yesterday in the Archives of Internal Medicine this research note appeared: "Effects of Statins on Energy and Fatigue With Exertion: Results From a Randomized Controlled Trial.

To our knowledge, this is the first randomized evidence affirming unfavorable statin effects on energy and exertional fatigue. Effects were seen in a generally healthy sample given modest statin doses, and both simvastatin and pravastatin contributed to the significant adverse effect of statins on energy and fatigue with exertion. Particularly for women, these unfavorable effects were not uncommon. Findings support case reports citing adverse effects to these outcomes and are buttressed by literature rationale. These findings are important, given the central relevance of energy and functional status to well-being.

We have no debate about the value of statins for secondary prevention (prevention in patients who already have the disease), but we continue to argue about primary prevention. Should I try to convince patients who feel well to fell less well in order to get some protection? These data should change how we all think about primary prevention.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.