title: Non-cardiovascular effects associated with statins.
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.
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA cdesai6@jhmi.edu.
authors.forename: Chintan S
authors.initials: CS
authors.lastname: Desai
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA.
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D002386:Cataract / Q000139:chemically induced; D056486:Chemical and Drug Induced Liver Injury; D002986:Clinical Trials as Topic; D003071:Cognition / Q000187:drug effects; D003287:Contrast Media / Q000009:adverse effects; D003704:Dementia / Q000139:chemically induced; D003920:Diabetes Mellitus / Q000139:chemically induced; D007172:Erectile Dysfunction / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced; D020022:Genetic Predisposition to Disease; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D006937:Hypercholesterolemia / Q000188:drug therapy; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control; D008099:Liver / Q000737:chemistry; D027381:Liver-Specific Organic Anion Transporter 1; D008297:Male; D015201:Meta-Analysis as Topic; D009135:Muscular Diseases / Q000139:chemically induced / Q000235:genetics; D009369:Neoplasms / Q000139:chemically induced; D027361:Organic Anion Transporters / Q000235:genetics; D010195:Pancreatitis / Q000517:prevention & control; D020641:Polymorphism, Single Nucleotide; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012107:Research Design; D012307:Risk Factors; D000637:Transaminases / Q000032:analysis; D054556:Venous Thromboembolism / Q000139:chemically induced
chemical_list: D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D027381:Liver-Specific Organic Anion Transporter 1; D027361:Organic Anion Transporters; C503999:SLCO1B1 protein, human; D000637:Transaminases