How serious are the side effects of statins?

Let's look at a case first. Last week, a patient who had just undergone coronary stent surgery came to the hypertension clinic and stopped taking the statin prescribed by the doctor. He said that it was because he thought the side effects of statins were too great and there were too many adverse reactions. Let's take a look at the side effect data of statins and make an assessment.

In December 2018, the American Heart Association (AHA) released a statement on statin safety and drug-related adverse events, pointing out that the risk of adverse reactions to statins is very low and their benefits far outweigh the risks. The adverse reactions of statins are a common concern in clinical applications. Currently, the main reports include abnormal liver function, statin-related muscle complications, new-onset diabetes, and other adverse reactions.

Among them, liver enzyme abnormalities are mainly manifested as elevated transaminases , with an incidence of about 0.5%~3.0% , which is dose-dependent. Statin-related muscle complications include myalgia, myositis, myopathy, and rhabdomyolysis , with an incidence of about 1%~5% . The risk of statins causing severe muscle damage (including rhabdomyolysis) is <0.1% , and the risk of severe liver toxicity is <0.001% . The risk of newly diagnosed diabetes induced by statins is approximately 0.2% of the number of people receiving drug treatment each year, and this data also depends on the potential risk of diabetes in the study population.

After looking at the risks, let's look at the benefits. The 2023 China Lipid Management Guidelines point out that statins are the cornerstone of lipid-lowering drug treatment for dyslipidemia. Moderate-intensity statins are the preferred strategy for lipid-lowering treatment in the Chinese population. The advent of statins is of milestone significance in the history of the prevention and treatment of human coronary atherosclerotic cardiovascular disease (ASCVD). A large amount of evidence-based evidence has confirmed that statins can significantly reduce cardiovascular events in ASCVD patients, and also have the effect of reducing cardiovascular events in primary prevention in high-risk populations. The latest meta-analysis found that statin treatment can reduce all-cause mortality by 9%, myocardial infarction by 29%, and stroke by 14%.

In summary, the benefits far outweigh the risks in patients for whom statin therapy is recommended by current guidelines.