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Statins: ‘Intermittent’ doses may help dodge side effects – ‘As effective as daily dosage’

Statins: How the drug prevents heart attacks and strokes

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Statins have become the most reliable weapon in the war on heart disease. But a considerable amount of users discontinue the drug when side effects become debilitating. Discontinuing carries risks of its own set of risks, and is widely advised against. One way to circumnavigate

Statins work to lower the production of low-density lipoproteins – “bad” cholesterol – by blocking the enzyme that prompts its production.

While the majority of users take the drug on a daily basis, there is evidence the drug’s lipid-lowering actions can be achieved with alternate-day use of statins.

Maintaining the same degree of decrease in LDL, or “bad” cholesterol, however, may require frequent increases in doses.

The American College of Cardiology (ACC) states: “The cholesterol-lowering action of alternate-day statins is as effective as daily dosing in many individuals.”

One benefit to reap from alternate-day dosing is a decreased risk of adverse effects, such as myopathy.

“Muscle problems can range from mild to serious, and the terms experts use to describe them can be confusing,” explains Harvard Health.

“The StatinSmart website says 29 percent of people who take a statin develop statin-induced myopathy”.

This condition is defined as muscle aches, pains, weakness and cramps which can become emphasised during exercise.

Myopathy comprises a spectrum of muscle-related complications such as myalgia, myositis, rhabdomyolysis, and an asymptomatic increase in the concentration of creatine kinase.

Studies assessing the prevalence of statin-induced myopathy have produced varying results, but all point to a low incidence rate.

Many who develop the disorder are able to live a normal lifespan with little or no disability.

For others, however, the disorder can be progressive, severely disabling, life-threatening or fatal.

What’s more, a common problem seen among statin users who develop myopathy, is discontinuation with the drug.

This, however, could be avoided if more users were to spread out their doses, argues the ACC.

“The efficacy of intermittent dosing of statins relates to the fact that the duration of the cholesterol-lowering effect of the statins is not related to the pharmacokinetics of the individuals’ drug,” explains the health body.

“Steady-state statin drug levels may be achieved in a few days, but steady-state LDL reductions take several weeks to achieve.

“And after discontinuation, it takes several weeks before the cholesterol level returns to baseline.”

It should be noted, however, that the effect of alternate-day statin therapy hasn’t been studied on any other cardiovascular disease marker than LDL cholesterol, so its efficacy for reducing the risk of cardiac events remains unknown.

The ACC states: “In small cohorts of patients, atorvastatin 20 mg daily decreases the high-sensitivity C-reactive protein by 35 percent compared to 22 mg atorvastatin every other day.

“Large-scale studies with outcome endpoints and prolonged follow-up are needed to substantiate the hypothesis that alternate-day statins are an equivalent strategy for reducing cardiovascular events.”

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