Q: Love your column. Thanks. We have a 70ish-year-old neighbor who has seen a DO who has recommended she stop taking Simvastatin. No blood test to justify this action. She doesn’t remember if the doctor even gave her any reason. Admittedly, this may not either be enough information for your to advise (it may also be too easy, too) or you just plain may need more information about the story but this is what I’ve got. Hope you can advise with an opinion I can show her.

A: Your neighbor was either prescribed Simvastatin because of high cholesterol levels or because of her history of a cardiovascular disorder. Generally speaking, this and other drugs in the same class of meds work well by blocking a substance the body needs to produce cholesterol. Statins may further help the body reabsorb cholesterol’s build up of plaque in arterial walls. There are a number of statins. Some are generic equivalents and more reasonable to purchase but essentially perform the same function. When prescribed because of high cholesterol levels only, it’s because your neighbor has a reading of greater than 200 mg/dL if the LDL is too high.

One difficulty with statin drugs is that an individual cannot discontinue them once their cholesterol levels are lowered to an acceptable range unless major modifications are made for lifestyle changes. For example, if a person were to discontinue eating fried foods, snacks with tropical oils, and other food products high in cholesterol, reduce salt intake, exercise about 30 minutes almost every day of the week, quite smoking, reduce stress and more, he or she might be successful enough to discontinue the drug. Otherwise, the statin or other cholesterol-lowering drug is relatively permanent and must be taken indefinitely on a daily basis.

Then there are the side effects, which is why your neighbor was probably told to go off the drug. While often well-tolerated, statins have been found to cause muscle pain, confusion, memory loss, diarrhea, constipation, weight gain, upper abdominal pain, loss of appetite, insomnia, headache, dark urine, pain on urination, and nausea. While rare, the use of statins can cause liver damage. A person on a drug in this category must have periodic blood testing to determine if the liver is affected and if the drug should be discontinued. I must add here that while research is ongoing, the FDA issued a statement carried by the Wall Street Journal on February 29, 2012, warning that patients taking cholesterol-fighting statins face a small increase in the risk of higher blood sugar levels and being diagnosed with diabetes. At the time, the warning wasn’t expected to suggest to doctors they discontinue prescribing statins for patients with multiple risk factors for heart attack, and indicated cardiologists feel the benefits of statins still outweigh the risks. The FDA announced drug makers could remove label warnings that lab testing should be monitored during statin therapy, stating serious liver injury with statins is rare and unpredictable, that periodic monitoring didn’t appear effective in detecting or preventing the rare side effect. Numerous studies ensued (including one with over 90,000 patients) published in the Lancet in 2010. The conclusion was that statin therapy is associated with a minimally increased risk of development of type II diabetes. In terms of the breakdown of muscle cells, – a condition known as rhabdomyolysis that can release the protein myoglobin into the bloodstream, the study also found the risk to be low. Specific drugs include Lopid, Restasis, Sandimmune, Niacor, Niaspan, and anti-fungal meds taken in conjunction are a risk for elevated glucose levels, type II diabetes, memory loss and confusion; fortunately, it appears the memory loss and confusion will disappear if the statin is discontinued.

One option is to consider an over-the-counter cholesterol lowering drug such as niacin or Cholest-Off and similar products that contain plant sterols and stanols; however, your friend should run these options past her physician first.