You have probably heard of Statins. Statin drugs work by blocking a key enzyme in the production of cholesterol. Cholesterol is a natural product of the liver and in the right amounts does not pose a problem to the body. The body, however, sometimes produces too much cholesterol and that is often caused by poor dietary choices (you know what you eat!).
Statin drugs block the enzyme linked to the liver’s cholesterol production, thus inhibiting the liver’s ability to produce LDL. Your LDL cholesterol levels will often be measured in a standard HIV blood test and you may have heard that LDL levels should be lower and HDL cholesterol levels should be higher. Statin drugs can achieve this for people with cholesterol problems. Studies have also shown that statin drugs can help the body reabsorb cholesterol that has accumulated on the artery walls.
As HIV patients we have to be more aware of our cholesterol levels than most. HIV patients are at a higher risk for cardiovascular disease in part due to lipid abnormalities that can occur with the use of certain antiretroviral therapies so Statin drugs may be prescribed to help maintain healthy cholesterol levels.
However... Statins themselves can cause Neuropathy!
Time to talk to the doctor again, if you are advised to take these drugs. If you don't already have neuropathy, there isn't too much risk until you begin to show symptoms but if you already have neuropathic problems, it's important to discuss the consequences of statin use with your doctor. It's also important to realise that statins can have other side effects too; especially muscle pain or weakness. Sometimes just one more side effect can be one too many for the long-suffering HIV patient. Always ask - there may be an alternative available.The following article is from Science Daily: http://www.sciencedaily.com/releases/2002/05/020514075710.htm
from the American Academy of Neurology.
Statin Drugs May Increase Risk Of Peripheral Neuropathy
Statin drugs can increase the risk of developing peripheral neuropathy, according to a study published in the May 14 issue of Neurology, the scientific journal of the American Academy of Neurology.
Peripheral neuropathy results from damage to the peripheral nerves and causes weakness, numbness and pain in the hands and feet. Statin drugs are prescribed for millions of Americans to lower cholesterol.
People taking statins were 14 times more likely to develop peripheral neuropathy than people who were not taking statins, according to the Danish study. However, the overall risk of developing neuropathy is rare, said study author David Gaist, MD, PhD, of the University of Southern Denmark in Odense
"The positive benefits of statins, particularly on reducing the risk of heart disease, far outweigh the potential risk of developing neuropathy," Gaist said. "These findings shouldn't affect doctor or patient decisions to start using statins. But if people who take statins develop neuropathy symptoms, they should talk with their doctor, who may reconsider the use of statins."
For the population-based study, the researchers used a patient registry to identify all of the first-time cases of peripheral neuropathy with no known cause (such as diabetes) in Funen County, Denmark, over a five-year period. Each case was matched to 25 people of the same age and sex with no neuropathy as a control group. The use of statins was then determined for each group.
They identified 166 cases of first-time neuropathy with no known cause. Of those, 35 had a definite diagnosis, 54 were probable cases and 77 were possible cases. Nine of the people with neuropathy had taken statins. They had taken statins for an average of 2.8 years.
For those with a definite diagnosis of neuropathy, the statin users' risk of developing neuropathy was 16 times higher than for the control group. When all cases of neuropathy were taken into account, the statin users' risk of developing neuropathy was four times higher than the control group's risk. Taking statins for longer periods of time and taking higher doses of them increased the risk of developing neuropathy.
Statins lower levels of low-density lipoprotein (LDL) cholesterol by blocking the production of a liver enzyme used by the body to make cholesterol.
For more information about the American Academy of Neurology, visit its web site at http://www.aan.com.
Today's post from neuropathy.org (see link below), is the first of two, looking at statins and their potential role in neuropathy development. Statins are one of the fastest growing drug groups around at the moment and have been proved to be very successful in reducing 'bad' cholesterol levels. Cholesterol problems are unfortunately a feature of the modern age as our diets become more and more fats-based but neuropathy patients have long been advised not to take them for fear of worsening their symptoms. Similarly, there are thousands of cases where statins have been given the blame for actually causing neuropathy in the first place. What's the truth? This article suggests that statins may not be as harmful to the nervous system as first thought. Tomorrow's post suggests the opposite. The best advice has to be to discuss the issue very carefully with your doctor and don't leave until your satisfied that these drugs are not going to bring your nerve problems. In the end you may need to trust your doctor's opinions but be aware of possible beginning or worsening of symptoms.
This is a column in which leading clinicians answer your questions about neuropathy – usually one question per issue, and more when we are able. Please send your questions to “Ask the Doctor” c/o Neuropathy News, The Neuropathy Association, 60 East 42nd Street, Suite 942, New York, NY 10165.
Dear Doctor: I have just read the part of Dr. Weimer's article (on www.neuropathy.org website) dealing with the influence of statins on neuropathy--most helpful. But a recent article (2007) I found on Google suggests that for people with controlled type 2 diabetes the use of statins may actually retard the progression of neuropathy. Do you have a comment on this please? Thank you. - Michael S.
Dr. Louis H. Weimer Answers: In clinical medicine, an occasional dilemma occurs when two well designed and well-conducted large trials produce seemingly contradictory results. This situation arose in June regarding the correlation between statins and neuropathy as reported in an earlier study conducted in Denmark and a recently announced Australian study.
The Danish study concluded that patients taking statin-class cholesterol-lowering drugs were more likely to have neuropathy, especially if they took the drugs for a longer time period or had definite evidence of neuropathy. One criticism of the Danish study was that no assurance was given that some of the patients taking statins did not have mild and unrecognized forms of diabetes or simple glucose intolerance, now recognized to be risk factors for neuropathy. In addition, the lipid disorders prompting the statin use in the first place are under scrutiny as a neuropathy risk factor as part of the metabolic syndrome—the study's authors acknowledged this limitation. This one study was the primary basis for the widely publicized concerns of statins and toxic neuropathy. Beyond this study, there have been a small but recognized number of individual patients who appear to develop neuropathy soon after starting a statin and then improve after stopping the drug.
The more recent Australian study found that diabetes patients were less likely to have neuropathy if they received a statin or fibrate. For statins, the reduction in neuropathy rates was found to be about 35%. Fibrates, a separate class of lipid-lowering drugs, had a similar effect, suggesting that improved lipids and cholesterol could be more important than an independent effect of the drugs. However, exactly why these drugs are beneficial or harmful to nerves is poorly understood. The Australian study tracked almost 1,300 diabetic patients over eight years. Its findings also reported significantly higher rates of neuropathy in untreated patients. The study's findings have not yet been published in a medical journal, but they were announced and discussed at this year's American Diabetes Association annual medical meeting.
It is too early to know if these protective effects are valid and can be duplicated by other studies. Also unknown is if these effects will be applicable to patients without diabetes. It is well accepted that any toxic nerve effects of statins are quite rare: some of these patients may have developed neuropathy for the reasons mentioned above despite the statin treatment while others may have a rare sensitivity to the drugs. In addition to the findings from these two studies, there is also experimental animal study evidence that appears to support both contentions of toxicity and protection—adding to the uncertaintybut there is better evidence for neuroprotection than toxicity.
The critical decision for neuropathy patients is whether statins are more beneficial to their overall health than whether they are potentially harmful. There is well-established and convincing evidence for the benefits of these agents and now possibly added nerve protection for patients with diabetes. The evidence for nerve toxicity remains less clear. Patients with existing neuropathy and a lipid or cardiac condition known to benefit from statins probably should not avoid these agents simply for the rare neuropathy risk. The situation is more complex for the rare patients who worsen soon after starting new treatment or patients who develop neuropathy while taking statins for an extended period. Further studies will be needed to address all of the outstanding questions.
Dr. Louis H. Weimer is associate clinical professor of Neurology at Columbia University. He is also co-director of the Peripheral Neuropathy Center of Excellence at Columbia.
http://www.neuropathy.org/site/News2?id=7161
There are other posts about statins and neuropathy on the blog (see list on the right) but this one from suite101.com (see link below) explains the problem clearly and poses the question as to whether statin drugs used to lower cholesterol are actually increasing problems for the nervous system. If you already have neuropathic problems, it's probably not a good idea to begin taking statin drugs but it's always advisable to discuss it with your doctor, especially if you have high levels of unhealthy cholesterol. 
Statins Linked to Peripheral Neuropathies
Cholesterol Drugs Linked to Peripheral Neuropathies: Apr 2, 2010
Kathryn Picoulin
Statin drugs were considered the magic pill to reverse cardiovascular disease, but the serious side effects are mounting up enough to question if they're worth it.
More than 16 million people in the US, and more than 18 million around the world are currently taking statin drugs to lower their cholesterol levels. The first statin drug was approved in 1987. There are seven forms of statin drugs being prescribed around the world. The eighth statin drug, Baycol, was recalled in 2001 four years after its approval by the FDA due to the serious side effects and many lawsuits.
Lipitor, the world’s top selling statin drug brings in more than $12.7 billion a year. It is 100% synthetically made compared to most of the other statin drugs that are made from fungi. Mevacor (lovastatin) is derived from the Aspergillus fungus. (Statin Answers 2006-2010) Mevastatin, the source to make pravastatin, is derived from a strain of penicillin.
Statins work by blocking the enzyme in the liver that is involved in making cholesterol. This causes less cholesterol to be made. However, cholesterol is a vital substance required for the function of every cell in the body including the neurological system. Lowering cholesterol levels lower than what the body needs may end up causing more harm than good.
Research Studies Linking Statins to Peripheral Neuropathies
Current research has linked the use of statin drugs to the development of peripheral neuropathies. Peripheral neuropathy is a condition that develops from progressive damage to the peripheral nerves and affects the hands, feet, legs and arms. Common symptoms are loss of feeling in feet and or hands with some tingling, numbness and pain often causing unstable gait. There are more than 100 different forms of peripheral neuropathies identified so far.
Numerous studies have reported that peripheral neuropathies often developed in subjects that used statin drugs for a period of one to seven years. The incidence rate is one in 2200 persons and is often permanent even after stopping the statin drug.
Researchers studied over 500,000 individuals taking statin drugs. They found that taking statin drugs for one year increased their risk of developing neuropathies by 15%, after two years the risk rose to 26%.
Researchers at the Montreal Neurological Institute at McGill University found that statin drugs prevent the repair of the myelin sheath. (The American Journal of Pathology). Myelin is like a conductive insulator of the nervous system delivering messages between the brain and the rest of the body. Myelin is composed of more than 80% cholesterol and up to 20% protein. Cholesterol works to maintain the integrity of the myelin sheath.
Not long after statin drugs became global and after noting an increased rate of peripheral neuropathies in subjects using statin drugs a group of researchers reviewed 460,000 residents in a Danish community. They excluded all subjects with systemic illnesses that were prone to developing peripheral neuropathies as well. They found that people who took statin drugs were 14 times more likely to develop peripheral neuropathies than those who were not. Current research has increased the number to 16 times the risk. (Journal of the American Academy of Neurology)
Alternative Treatments Decrease Symptoms of Neuropathy
There are several alternative treatments that may help decrease the symptoms of peripheral neuropathies. Vitamins E, B1 and B12 have been shown to diminish tingling and pain stemming from neuropathy. B12 helps to maintain the integrity of the myelin sheath that protects nerves.
Alpha lipoic acid (found in spinach, broccoli potatoes and organ meats), omega-3 fatty acids and GLA (gamma linolenic acid) have all been shown in studies to reduce the symptoms of peripheral neuropathies and increase better blood flow to the areas of damage.
Evening primrose oil (contains GLA) was tested in three double blind studies. The finding showed mild improvement in the symptoms of neuropathy.
Studies at the University of Maryland Medical Center showed that acetyl-L-carnitine (L-carnitine) helps to not only diminish the symptoms of peripheral neuropathy but also helps the return of regular sensations in the extremities. L-carnitine is naturally found in peanut butter, dairy products and red meat; however, supplements of L-carnitine are more concentrated.
Acupuncture has been effective in most cases in easing the pain associated with peripheral neuropathies.
1. Journal of the American Medical Association (JAMA); “Vitamins for Chronic Disease Prevention in Adults,” Clinical Applications, Robert H. Fletcher, MD,MSc; Kathleen M. Fairfield, MD,DrPH
2. JAMA. 2002;287:3127-3129.
http://kathryn-picoulin.suite101.com/statins--linked-to-a-new-side-effect-a221061
