Are statins safe?

Review of trials and studies on safety of statins

Adverse Effects of Statin Therapy: Perception vs the Evidence
Eur Heart J 2018 Apr 27; F Mach, KK Ray, O Wiklund, et al 

This paper in European Heart Journal summarizes evidence regarding safety of statins from randomized clinical trials and genetic studies published from 2000 to 2017. The authors specifically assessed the evidence for the risk of diabetes, cognitive decline, renal impairment, deterioration of hepatic function, cataracts, and the risk for hemorrhagic stroke associated with long-term statin therapy.

Diabetes 

Statins increase the onset of diabetes at a rate of approximately 1 case per 1000 patients per year of treatment, but statins prevent about 5 cardiovascular events per 1000 patients. New diabetes onset is greatest in those with pre-statin risk factors for diabetes.

Cognitive function

Statin treatment and extremely low LDL-cholesterol levels from other cholesterol treatment do not affect cognitive function.

Renal function

Statins do not reduce renal function and may actually protect the kidney, but this possibility requires further study.

Hepatic function

Mild increases in ALT occur in patients on statins, but do not alone signify clinically significant disease. Clinically important liver injury can occur with statins, but this is extremely rare and is likely a statin class effect. Routinely monitoring of liver enzymes is not necessary or clinically justified.

Hemorrhagic stroke

Statins reduce the risk of first and subsequent ischaemic strokes, but may produce a small increase in haemorrhagic stroke in individuals with prior stroke.

Cataracts

Statins do not increase cataracts.

The researchers conclude that statins are very safe drugs, and the small risks described do not outweigh the significant cardiovascular benefits that patients receive from these drugs. I am sure that this is not the end of discussion about statins and it's probably preaching to the converted. However, the evidence is clear; statins in appropriate indications save lives and concerns about potential side effects are in most cases misplaced.

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