Clinical Review State of the Art Review

Non-cardiovascular effects associated with statins

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g3743 (Published 17 July 2014) Cite this as: BMJ 2014;349:g3743
  1. Chintan S Desai, cardiovascular disease fellow,
  2. Seth S Martin, Pollin cardiovascular disease prevention fellow,
  3. Roger S Blumenthal, director
  1. 1Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
  1. Correspondence to: C S Desai cdesai6{at}jhmi.edu

Abstract

Statins form the pharmacologic cornerstone of the primary and secondary prevention of atherosclerotic cardiovascular disease. In addition to beneficial cardiovascular effects, statins seem to have multiple non-cardiovascular effects. Although early concerns about statin induced hepatotoxicity and cancer have subsided owing to reassuring evidence, two of the most common concerns that clinicians have are myopathy and diabetes. Randomized controlled trials suggest that statins are associated with a modest increase in the risk of myositis but not the risk of myalgia. Severe myopathy (rhabdomyolysis) is rare and often linked to a statin regimen that is no longer recommended (simvastatin 80 mg). Randomized controlled trials and meta-analyses suggest an increase in the risk of diabetes with statins, particularly with higher intensity regimens in people with two or more components of the metabolic syndrome. Other non-cardiovascular effects covered in this review are contrast induced nephropathy, cognition, cataracts, erectile dysfunction, and venous thromboembolism. Currently, systematic reviews and clinical practice guidelines indicate that the cardiovascular benefits of statins generally outweigh non-cardiovascular harms in patients above a certain threshold of cardiovascular risk. Literature is also accumulating on the potential non-cardiovascular benefits of statins, which could lead to novel applications of this class of drug in the future.

Footnotes

  • Acknowledgments: SSM is supported by the Pollin Cardiovascular Prevention Fellowship, Marie-Josée and Henry R Kravis endowed fellowship, and a National Institutes of Health training grant (T32HL07024). RSB is supported by the Kenneth Jay Pollin professorship in cardiology.

  • Contributors: All authors were involved in the conception of the manuscript and literature search. CSD drafted the manuscript and all authors helped revise it. All authors accept full responsibility for the published article and serve as guarantors.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: None.

  • Provenance and peer review: Commissioned in September 2013; externally peer reviewed.

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