Do stronger statins raise the risk of kidney damage?
Taking a stronger statin to lower cholesterol may increase the chance of kidney damage compared with taking a less potent dose, a study shows.
BMJ Group News
What do we know already?
Statins are widely prescribed to reduce the risk of heart and circulation problems by lowering people’s cholesterol. Common statins include atorvastatin (brand name Lipitor), fluvastatin (Lescol), pravastatin (Lipostat), and simvastatin (Zocor, Simzal).
Doctors sometimes prescribe a higher dose of a statin or a stronger, more potent, type of statin - such as rosuvastatin (Crestor) - to lower people’s cholesterol even more. This can further reduce the chance of heart and circulation problems. However, some research suggests that the extra reduction in risk may be fairly small, raising questions about whether the benefits of taking stronger statins outweigh the risks of side effects. However, research on the possible risks with stronger statins has been fairly limited.
In the new study, Canadian researchers focused on one potential harm: kidney damage. Earlier studies had suggested a possible link with statins, particularly at higher doses. Using large databases of health records in Canada, the US, and the UK, the researchers gathered information on more than 2 million people who started taking statins between 1997 and 2008.
They looked at whether people taking stronger statins (defined as rosuvastatin at doses of 10 milligrams or higher, atorvastatin at doses of 20 milligrams or higher, and simvastatin at doses of 40 milligrams or higher) were more likely to get kidney damage that required hospital treatment than those taking less potent statins (all other types of statins). The researchers did separate analyses for people with and without chronic kidney disease (long-term kidney damage).
What does the new study say?
For people without kidney disease, those taking stronger statins were 34 percent more likely to have hospital treatment for kidney damage within 120 days of starting treatment, compared with those taking less potent statins.
This may sound like a large increase in risk, but the actual increase was fairly small. The researchers estimated that for every 1,700 people taking a stronger statin rather than a less potent statin for 120 days, one extra person would be treated in hospital for kidney damage.
The risk of kidney damage dropped over time, although people taking stronger statins still had a higher risk after two years, compared with those taking less potent statins.
For people with kidney disease, the researchers found a small increase in the risk of hospital treatment for further kidney damage. However, the increase was small enough that it could have been down to chance.
How reliable is the research?
This was a very large study that gathered information from well-established health databases. The researchers also accounted for many things that might have affected people’s risk of getting kidney damage, such as their age, health, and which medications they used. These things strengthen its findings.
However, we can’t yet be certain of these results, as this study can’t prove cause and effect. It’s possible that the researchers might have missed something that increased people’s risk of kidney damage besides using stronger statins. We need more research to confirm these findings and to fully explore the benefits and risks of taking stronger statins.
What does this mean for me?
If you have been prescribed a stronger statin, this study suggests that your risk of kidney damage may be higher than if you were to take a less potent statin. This is something you may want to discuss with your doctor when weighing up the benefits and risks of treatment. However, bear in mind that the overall increase in risk seems to be fairly small.