Wednesday, February 13, 2008

Lipitor and Memory Loss

When my patient came back today to discuss management of cholesterol he mentioned a report on ABC News that only confirmed his suspicion that the Lipitor I had prescribed him was causing problems with his memory. Interestingly, the ABC News piece was discounting a story reported in the Wall Street Journal the other day that generated some buzz when one doctor claimed that Lipitor "makes women stupid."

Bottom line: There are no perfectly safe drugs. Lipitor is one of the most prescribed drugs in the country, with approximately 18 million people currently taking it. Though there is little evidence for memory problems with Lipitor, a rare side effect (1/10,000) will occur in 1800 patients if 18 million are taking it. On the other hand, for certain people at high risk for heart attack and stroke, Lipitor can decrease these chances by 25% or more. If you are on Lipitor (or other cholesterol medications) don't stop taking them because of newspaper reports of rare and unconfirmed side effects. On the other hand if you notice anything strange after starting any new medication, talk to your physician.

More info: Statins clearly work. Though some may joke about putting them in the water, several have suggested that if every adult over 55 took a pill containing some statin, aspirin, and blood pressure medications (a polypill), this would prevent substantial numbers of heart attacks and strokes. On the other hand, some of the millions of Americans that might take such a pill would get side effects. The key is to balance the risks and benefits of the medication. Cost is a separate issue because you can consider either cost to you ($20 co-pay) or cost to society (thousands of dollars to prevent just one heart attack).

Regarding memory issues, these have been reported, but the link between memory disorders and Lipitor is unclear. Memory loss was not seen in the thousands of patients Lipitor was tested in prior to its approval. However, for a rare side effect, it may take tens of thousands of patients to take the medication before a side effect becomes apparent. There was some preliminary evidence that statins might prevent Alzheimer's disease. Unfortunately, this does not seem to be the case. However, in a recent study of almost 1000 elderly patients, statins were not associated with increases in Alzheimer's, dementia or decreased mental function. Yet, there continue to be reports of memory problems thought to be related to Lipitor, including a NASA astronaut who experienced transient global amnesia after starting the drug.

So how to you weight the risks and benefits?
You have to look at not just the side effects of the drug, but the chances you will get that side effect, and balance that with the chances the drug will actually improve your health, which is usually related to your base line risk.
The most common side effect of statins (including Lipitor) is muscle pain, which occurs in 2-3% of patients. It is usually mild and usually goes away.
Looking at one study (ASCOT-LLA), for patients without prior heart disease, but who had risk for heart attack and stroke (high blood pressure, plus 3 other risk factors such as family history, being overweight, high cholesterol), for every 100 patients who took Lipitor for 3 years, one heart attack or fatal heart attack or stroke was prevented.
Let's say that memory loss is caused by Lipitor (unclear) and happens for every 1/1000 patients (probably much less, like 1/100,000):

For every 1000 patients with high risk for heart attacks taking lipitor, 30 will get mild muscle pain, 10 will have a heart attack prevented, and 1 might have some memory loss. These numbers are still look pretty good (as long as you don't cost-about $1 million a year).

22 comments:

Anonymous said...

All easy for you to say since, unlike me, you don't have permanent muscle damage to one leg from taking a statin. You reference the astronaut -- maybe you ought to read the side effect blogs on his website.

Dr. Matthew Mintz said...

I am truly sorry if you suffered a leg injury from a statin medication your doctor prescribed. When you introduce any man-made substance into the body, especially medications, there is always the possibility of bad things happening. My job as a doctor is to counsel patients on the benefits of taking a drug compared to the risks of potential side effects. Of all currently available medications (not including immunizations, statins probably have the best risk/benefit ratio. Aspirin for heart attack prevention is probably a close second, but the risk of serious bleeding from a baby aspirin a day is much greater than the risk of serious side effects from statins.

Anonymous said...

Dr. Mintz. Are you saying if 1000 pts at high risk for having heart attacks take statins, only 10 heart attacks will be prevented? If so, how many heart attacks occur in that 1000? I'm just trying to figure out the risk-benefit profile.
Karen RN

Dr. Matthew Mintz said...

Great question.
I am basing my example using the number needed to treat or NNT. The NNT means how many patients you would have to treat with a drug compared to not treating them with a drug to get an outcome.
I based the example on the ACSCOT-LLA study. ASCOT was a large study looking at both cholesterol and high blood pressure. For the cholesterol part, about 10,000 patients with high blood pressure plus 3 or more risk factors for a heart attack were treated with either Lipitor or nothing. There were 154 heart attacks or deaths from artery disease (stroke, heart attack) in patients without a statin and 100 heart attacks in patients with Lipitor. The study was planned for 5 years, but was stopped early at 3.3 years due to the benefit. The NNT from the ASCOT-LLA study was 100, which means you would have to treat 100 high risk patient patients for 3.3 years with Liptor instead of nothing to prevent 1 heart attack or death from atherosclerosis. Risk for heart disease is entirely different. The risk for the heart attack in the placebo group of ASCOT LLA was about 3% in 3.3 years. However, in another study (4S) which looked at treating patients who had already had a heart attack with either simvistatin or placebo, the risk of second heart attack for the placebo group was 28% compared to 19% of the patients who took simvistatin. This is a NNT of about 11, which demonstrates that the higher your risk is for having a heart attack, the more likely you will benefit from taking a statin.
As far as calculating individual risk, I recommend using a risk assessment tool based on the Framingham data. There are several versions, but my favorite is the one on the NHLBI's web site. It allows you to easily plug in numbers and estiamte and individual patients risk,

Anonymous said...

It is good to know of the benefits that most enjoy from taking statins like Lipitor. It is not comforting, however, if you are one of the very small minority who suffer memory losses.

Having suffered such problems for more than a year since my mitral valve was replaced, I have been struggling to find an explanation.

Please try to understand how frustrating this can be, there are so many variables to be investigated. And the physicians do not have answers or time to seek them out.

It is especially difficult when I keep forgetting that I have a problem. I frequently need others to remind me of how often I forget really basic things. It is extremely troubling. I think it has cost me my very good job.

I do not believe that stopping my Lipitor for a few days will pose a serious risk, and based on these admittedly anecdotal reports I think it is worth trying. I only hope I can remember this discussion long enough to call the doctor for an appointment do discuss my plan. (a small joke)

Bill Cobabe
Yakima, WA

Anonymous said...

A few days may not be enough, Bill. Your body may need more time to repair the damage.
http://www.spacedoc.net/lipitor_thief_of_memory.html

Dr. Matthew Mintz said...

Bill,
I am sure it is frustrating. There is so much about medicine that we don't know. Though I feel that the benefits of Lipitor(statins) outweight the risks for the vast majority of patients, if Lipitor is causing your memory loss (which is definitely possible), then the risks of taking it may not outweigh the benefits for you.
Your are correct that a brief period off the medication is unlikely to do substantial harm, and the previous anonymous poster is also correct that a few days may not be enough to see any difference.
I would definitely speak with your physician and discuss a trial of going off your Lipitor for a brief period of time.

Fran said...

Re: "Though I feel that the benefits of Lipitor (statins) outweigh the risks for the vast majority of patients..."

And that unfortunately is part of the problem. My husband experienced
numerous ADR's from statins for 8 years and that was the mantra, "the benefits far outweight the" complaints you are experiencing.

Sleep disturbances were the first indication that side effects were occurring. Then forgetting where everyday items were located (although I hadn't moved anything to a different location). Stiffness in the neck and shoulder area were always an issue. Short term memory progressed to TGA
when Lipitor was increased from 10 mg to 20 mg, even though total cholesterol levels were far below 200. There were also visual disturbances - amaurosis fugax - like a cloud moving across one's vision (just one eye is affected). There was also unexplained anger and frustration. And muscle atrophy. Still the denial that statins were causing his problems.

When my husband failed the in-office memory test, 'dementia' was scribbled
on a script pad and we were referred to a Neurologist. MRI and PET brain scans were normal, so we were referred to a Neuro-Psychologist. NP testing placed my husband in the 9 percentile; diagnosis - Alzheimer's type dementia. He was 60 at the time. There's no history of dementia in his
family.

I maintained my position that all of these cumlative ADR's were from Lipitor. Only the NP said. "Well, if it is Lipitor and his memory improves now that he's stopped taking the drug, then it was the Lipitor." Alzheimer's patients don't improve. Once the NP report came back (in the mail - no app't to discuss results) the Neurologist just shrugged and said we should start Aricept AND resume Lipitor. We declined both and were dismissed.

So there was light at the end of the tunnel that my husband could improve. And the good news is he did improved for almost 2 years. NOW, 3 years after stopping statins, he's experiencing both short term and long term memory decline. All other ADR's have resolved. In fact to look at him he is
healthier than he's been in years.

When I look back on his cholesterol levels (before this whole fiasco), the only problem was high triglycerides, primarily due to a high carbohydrate diet. Of course no one told us that. In addition to statins the advice was to, "Make sure you eat a low fat, low cholesterol diet" (which teaches people to eat a high carbohydrate diet). It took years and lots of research to learn about conditions like 'insulin resistance', one of the primary causes of most of today's aliments.

So it's now 13 years after statins were first prescribed and at a time when we should be enjoying our retirement, we're in a state of limbo.

I encourage you as a very caring doctor to scratch beneath the surface to research statins and all the neurological disorders that can occur.

Fran

Anonymous said...

Interesting new research shows some of the toxic effects of three statins:
http://www.rsc.org/chemistryworld/News/2008/February/25020801.asp

Excerpt:
"When the researchers tested various statins, which are widely prescribed for lowering cholesterol levels in the blood by inhibiting a key enzyme involved in cholesterol synthesis, they found that three of them - fluvastatin, lovastatin and simvastatin - were toxic towards mitochondria. 'Patients have reported muscle aches and cramps as a side effect of some statins and this could be one reason,' Mootha told Chemistry World. 'This clinical hypothesis could have huge implications worldwide.'"

Dr. Matthew Mintz said...

Thanks for the post. The study you cite may shed some light on why statins cause certain side effects. However, this is a test tube study which may not relate to the real world. More importantly, even if mitochondrial damage is the mechanism that leads to of muscle problems when taking statins; muscle pain with statins only occurs in about 3% of patients, it is usually mild and usually goes away. More serious muscle side effects are much less commo (1/10,000-1/1,000,000).
There is no perfect drug that helps everyone and harms no one (and cost next to nothing). Physicians and patients must weigh the benefits and risks of every drug before using them. For many patients, the risk/benefit profile for statins is excellent.

JaaJoe said...

There's a recent series of articles I came across about the slimey way of Pfizor and there Lipitor ads. Really intresting articles check them out.
Part One: ROBERT JARVIK, PFIZER'S PIMP WITH A PUMP
Part Two: LIPITOR- THE POISON THAT CAUSES CONGESTIVE HEART FAILURE

a registered nurse said said...

My father was diagnosed with alzheimer's shortly after his doctor doubled his dose of Lipitor. When he was evaluated by a Neurologist, the Neurologist actually stated that the Lipitor at too high of a dose caused his alzheimer's disease. It is interesting to note that his dose was within the usual dosage as decided by the pharmaceutical company. The brain needs cholesterol. The pharmaceutical companies wine and dine physicians who then prescribe medications. Do not let the pharmaceutical companies control us.

Anonymous said...

Is there any data correlating Lipitor and supplementing Co Q10 as beneficial?

Anonymous said...

I was on lipitor for several years. I lost my house, my business, my wife, time with my children, and most everything I had. To think that the benefit outweighed the unexplainable loss of memory, and inability to function without explanation, is pathetic. Think about getting Alzheimer's in your thirties without any explanation. Then ask yourself would you want to be on the recieving end of those odds. STATINS ARE DANGEROUS AND WE WILL ALL FIND OUT MORE OVER TIME AND REALIZE THAT THEIR BENEFIT IS GREAT TO SOME, AND THE DAMAGES WORSE TO OTHERS.

Side Effects from Lipitor said...

Visit:

http://sideeffectsfromlipitor.com

for news about Lipitor and other statins, including information about side effects.

Anonymous said...

I'VE BEEN ON LIPITOR FOR A FEW MONTHS. MY CHOLESTOROL IS DOWN BUT I NOTICE I FORGET LOTS. YESTERDAY, I FORGOT TO GO THE SENIORS HOME TO DO MY VOLUNTEER WORK THAT I HAVE BEEN DOING FOR THE LAST YEAR. UNTIL I MET SOMEONE WHO ASKED ME WHERE I WAS THAT MORNING - I HAD COMPLETELY FORGOTTEN ABOUT IT!! THIS MORNING I WALKED HOME FROM THE EXERCISE PROGRAM AT THE SENIORS HOME TO GET MY MAIL KEYS. ONCE THERE I PUT ON MY TUQUE BECAUSE IT WAS COLD AND I WALKED BACK TO TOWN AND ONCE THERE IT DAWNED ON ME THAT I HAD FORGOTTN MY KEYS YET AGAIN. THIS IS REALLY STRANGE. I'M GOING TO CALL MY PHYSICIAN... I FEEL AS IF I'M GETTING ALZEMEIR!!

Anonymous said...

Dr. Matthew Minz, I am absolutely horrified that you would give such low numbers for muscle pain in lipitor users, I do not know anybody who uses it, sooner or later not to have severe myalgia/neuralgia. My husband a succesful telecommunication executive and a public speaker has been injured by Lipitor. He was on 40 mg. for 7 years, yeat his cholesterol level was lowered to 110 within 3 months of starting the lipitor treatment. Suddenly last year when he came to in his car on a business trip not knowing where he was or why he was there. Trancient Global Amnesia attack! After a coupel of months
he was "lost" for three months.
When he finally came home, he he at 5'11" was 140 lbs white as a ghost trembling and shaking and totally confused. He has not been able to return to work or take care his business for ever since.
I took him of Lipitor in the middle of January this year. He memory is gradually returning in bits and pieces but has now, according to the neurologist,developed early stage of a form of Parkinsons. He is suffering from extreme anxiety. How dare you defend Lipitor use in any form. Other studies show that muscle damage can be as high as 53 %.

Anonymous said...

I've recently stopped taking Lipitor and am trying CoQ10, Grapeseed Extract, Red Rice Extract, Vitamin and Omega 3 to see if that will improve memory loss and painful knees, elbows, neck and back. My GP ruled out Lupus, Gout, RA and structural problems with an X-Ray. I'm also on a low fat and low sugar diet.

Anonymous said...

Dr. Mintz, in your medical career, have you ever received payment for services rendered in lowering a patient's cholesterol?

And in doing so, did you ever utilize statins to provide that service for which you got paid?

If so Dr. Mintz, you DO have a financial interest in statins.

A physician need not own stock in a statin producing company, or receive honoraria from a drug company to have a financial conflict of interest.

All it takes is to receive $1 U.S. dollar, utilizing statins, to provide a service, and that physician is financially linked.

Francesca said...

I cannot afford to take any medicine that will cause me memory loss or disorientation--too many people, especially my senior citizen husband, depend on me--to cook, especially to drive. Lipitor has already given me nausea and vomiting once--when that never happens to me, and I hadn't eaten anything that would have caused food poisoning. I will simply never take this medicine again, which is a destroyer of sharp minds!

Anonymous said...

Just picked up my first Rx for Lipitor...scared to take it.ju

marci said...

Gee, I just was prescribed this medication last week and now I'm afraid to take it also. Holy cats!!!