Heart Rhythm Disturbances and Statins


The usual side effect of Statins on the heart is congestive heart failure based upon CoQ10 depletion, an inevitable consequence of all HMG-CoA reductase inhibitors.

More recently, however, reports are surfacing of cardiac arrhythmias associated with the use of statin drugs. These take the form of extra systoles of both atrial and ventricular origin, occasional bradycardia and runs of tachycardia's of various types.

Although the energy depletion mechanism of heart failure is thoroughly documented by the work of cardiologist, Peter Langsjoen, that of the cardiac rhythm disturbances is much less well understood.

The heart is usually the first to feel statin associated CoQ10 depletion because of its extremely high-energy demands. Physicians are seeing this as cardiomyopathy and congestive heart failure but what of these new reports? What possible mechanism can explain them?

Most of us now know that Statins lower cholesterol through inhibition of the mevalonate pathway of cholesterol biosynthesis. An unfortunate and inevitable side effect of mevalonate blocking is interference of ubiquinone metabolism. The implications of this were well known to the pharmaceutical industry from the very beginning of statin development.

Ubiquinone is more commonly known by the names Co-enzyme Q10, CoQ10 and Q10. Its role in energy production is to make possible the transfer of electrons from one protein complex to another (within the inner membrane of the mitochondria) to its ultimate recipient, ATP. The statin drug impact on CoQ10 availability and mitochondrial energy production in the form of diminished cardiac contractility is easily understood. This same explanation must also be considered for altered nodal sensitivity and cardiac conductivity as well.

CoQ10 has a possibly even greater role within the mitochondria as an anti-oxidant, with a powerful thirst for free radicals. Without adequate stores of CoQ10 and lacking the repair mechanisms common to nuclear DNA, irreversible oxidative damage to mitochondrial DNA results from buildup of super oxide and hydroxyl radicals. The inevitable result of excessive free radical accumulation is an increase in the rate of mitochondrial mutations. This too is a possible explanation for heart rhythm disturbances associated with statin drug use in some people.

The following are a few of the adverse reports I have received on the subject of heart rhythm disturbances and statins.

1) I am a 59 year old nurse for 34 years and been taking Lipitor for about 4 months. It truly lowered my cholesterol, even though it hovered only around 240 to begin with (now 176). My concerns are with my heart. I never had any problems other than a childhood-detected murmur. Recently my family doc noticed an irregular heart beat. I've been noticing some palpitations but no chest pain. A Holter monitor revealed 5600 ventricular ectopies. Sadly, my family doc failed to inform me about it. Since it was done in the same hospital I am working at, I was able to peek at the info. In the meantime, I weaned myself off the Lipitor. I have a cardiology appointment pending.

2)
I am sure that I am too late with my experience with Statins, but I was glad to find your website. My cholesterol is very high. Every doctor keeps trying to get me to use Statins. With Lipitor I had terrible aches and pains. Shortly after that I was diagnosed with fibromyalgia. I tried Zocor and felt like I wasn't myself. I tried Zetia. After one week I developed severe nausea. Now I am on my second trial of Pravachol. My chest has had all kinds of strange things happening in it. While I normally experience palpitations, last night I could not go to sleep because the palpitations were so strong. I have other health problems including carcinoid cancer. I have not wanted to use Statins because in my humble mind I thought I was protecting the liver. At any rate, I think I have big problems with Statins and I am not being heard by my doctors.

3) Having a long history with mild high blood pressure (145/85) for several years and elevated cholesterol (235-285) my Dr. advised me to go onto Lipitor. My LDL was somewhat high while my HDL has also been quite high. My ratios have always been quite good. But with the LDL over 150 Lipitor was advised. Within one month my total came down to 165. Then I noticed that I was getting high neck aches with associated head aches.

I told my doctor and went in for liver tests. All liver functions came back normal. My doctor told me to stay on the Lipitor, but I quit anyway. Within three days my symptoms were gone. I told him of this and he sent me to a lipid doctor for further treatment. This guy put me on Pravachol® and within a few weeks I started to feel muscle weakness and aches. Back for another blood test... this time my liver functions were way out of bounds. I then went onto Welchol. Also, tried niacin but did not like the side effects. Next thing happens, I start getting some minor arrhythmia (PVCs & PACs).

The doc said, "Don't worry, not a big deal." I tend to be a critical observer of my body functions. I grew up in a drug store and have always taken an interest in medicine.
It seems to me that the lipid modifying drugs may have a permanent effect upon ones body functions.

4) I am a physician, M.D. who has personal experience of several untoward effects of the statin drugs. First is that of my wife who experienced a severe case of polymyalgia rheumatica as a consequence of taking Pravachol.

Second is my own case of an episode of cardiac arrhythmia lasting a month and unquestionably related to Lipitor. I also have a feeling that many other episodes of an untoward nature similar to mine are occurring and not being reported.

I particularly suspect in light of my own experience with Lipitor that there are many other arrythmias occurring such as sudden episodes of atrial fibrillation occurring while taking or sometimes just starting on statin drugs. I proposed a study that would check all arrythmias against the co-taking of some statin drug, and I believe the investigators would be surprised at the correlation. It's never been done--isn't it time to do so?

Addendum: Well, just the other day I met a husband and wife who both had had arrythmias on Lipitor, just like I did. I'll just bet there are many other statin users out there who have experienced similar episodes and the connection with the statin drugs was never suspected. Hopefully your work will awaken those that need to be awakened before the drug industry kills us all.

5) Recently I awoke during the middle of the night and was experiencing some dizziness. I thought it odd, but thought no more about it. The next few days I felt very fatigued, out of sorts, and somewhat light-headed. I have three children who were trading bouts of strep throat, so I attributed my symptoms to an infection working its way through the house. That Friday I went to my family physician who checked my heart rate (48 bpm - low even for a runner) and performed an EKG. The EKG indicated unusual bradycardia and possible myocardial ischemia, so my GP made an appointment with a cardiologist for Monday.

However, the day before the appointment I was experiencing tingling in the lower portions of my arms and legs (both sides) and increased lightheadedness. I was admitted to the ER on Sunday and, over the next two and a half days they conducted multiple tests, including chest MRI, head MRI, EKG, stress test, echocardiogram. On Tuesday I was discharged with an appointment for a follow-up MRA of the carotid arteries.

That same day I developed a ringing in my ears that still continues. The neurologist was concerned about the possible occurrence of a transient ischemic attack (TIA). The MRA results indicated 40% stenosis on my right side and 20% on my left. On a subsequent visit to my GP he had me stop taking Lipitor. I am still feeling somewhat fatigued. I will be very interested to see if I improve with more time.

6) I began taking 20mg of Pravachol in 2000 at age 50 because my physician and I decided I was not able to control my cholesterol by diet alone. It did help and the numbers came down. In 2003, I requested the dosage be increased to 40mg because I had read a book that placed me in a risk category that required even better cholesterol numbers. My doctor agreed.

A few months later, I experienced gastric reflux/nausea for the first time in my life. I developed some anxiety then, too, but brushed it off to age. For the first time, it was noted on my EKG that I was having some delayed repolarization heading towards first degree AV block. When I increased the dosage in 2003, the anxiety increased as did the gastric problems.

My first-degree block was getting more pronounced. I consulted a cardiologist in November of 2004. I went on 80mg of Pravachol then along with Niaspan 500mg. Then I developed almost constant PVCs and my first degree AV block became more pronounced. I cut the dosage of Pravachol back to 40mg on my own and felt somewhat better. Now I have been off the medication for 10 days and am a new person!

7) I am just beginning my own research on the possible side-effects of taking Lipitor. I've been taking it for approximately three months (59 yr. old female - high BP and cholesterol) and have started having heart palpitations (my term). The problem started about a month ago and was so sudden and worrisome that I saw my family doctor prior to leaving town for a long weekend. He indicated that it sounded like heart arrhythmias and referred me to a heart specialist.

I wore a Holter monitor for 24 hours and was told that one of my lower heart chambers was not functioning properly. Since then I've had a nuclear stress test and an echo cardiogram, the results of which I'll get next Monday. I'm not a pill-popper and naturally suspicious of taking drugs so I decided to do my own research. I've found one internet report from an individual that indicated he suffered from heart palpitations (heart stopping for one to two seconds which sounds like what is happening to me).

I've read all of the info I can find on the typical side effects of Lipitor but heart problems aren't mentioned in what I've found so far. I'm not expecting an internet diagnosis from you but wondering if you have heard of heart related "issues" from people taking Lipitor. Even though I go back to the doctor on Monday, I'm considering discontinuing the Lipitor to see if I note improvement.

8) Ever since starting Vytorin about three months ago I am experiencing a fluttering in my heart, especially in the evening when I am quieter. My cholesterol is very high and I am a little hesitant to stop taking it, I started at 326 and after taking Zetia it went to 277 and now I am about 244 after 6 weeks of Vytorin. I had to stop Lipitor because of muscle pain.

9) I discovered your site while doing some research on Lipitor. My experience with Lipitor began 12 months ago. I woke up in the middle of the night with my heart racing and fluttering. After an hour of this, I headed to the emergency room. When they checked me in my pulse was 160 and my heart beat irregular. They very quickly gave me some medication, which almost immediately got my heart back in rhythm and my pulse back to 60 (about my normal range). Over the next two days, they did numerous tests and concluded that everything was fine. They sent me home with instructions to take a St. Joseph's aspirin at bedtime along with my 10mg of Lipitor.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

 


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