Heart drug may affect Brain
February 16th 2008 21:47
Heart drug can affect the brain, experts say
By MELINDA BECK
The Wall Street Journal
Cognitive side effects such as memory loss and fuzzy thinking aren't listed on the patient information sheet for Lipitor, the popular cholesterol-lowering drug. But some doctors are voicing concerns that in a small portion of patients, statins such as Lipitor may be helping hearts but hurting minds.
"This drug makes women stupid," Orli Etingin, vice chairman of medicine at New York Presbyterian Hospital, declared at a recent luncheon discussion on women and the brain.
Etingin told of a typical patient in her 40s, unable to concentrate or recall words. Tests found nothing amiss, but when the woman stopped taking Lipitor, the symptoms vanished. When she resumed taking Lipitor, they returned.
"I've seen this in maybe two dozen patients," Etingin said later, adding that they did better on other statins. "This is just observational, of course. We really need more studies, particularly about cognitive effects and women."
Weighing benefits
Pfizer's Lipitor is the world's best-selling medicine, with revenue of $12.6 billion in 2007. The company says the drug's safety and efficacy have been demonstrated in more than 400 clinical trials and 145 million patient years of experience, and that the extensive data "do not establish a casual link between Lipitor and memory loss."
On balance, many cardiologists see little cause for concern. Statins are widely credited with reducing heart attacks and strokes in people at high risk. And just 15 percent of patients complain of side effects; muscle aches and liver toxicity are the most common.
"The benefits far outweigh the risks," says Antonio Gotto, dean of the Weill-Cornell Medical School and past president of the American Heart Association.
Gotto, who has consulted for most of the statin makers and been involved in many of the trials, says, "I would hate to see people frightened off taking statins because they think it's going to cause memory loss."
Anecdotes linking statins to memory problems have been rampant for years. The chronology can be very telling, says Gayatri Devi, an associate professor of neurology and psychiatry at New York University School of Medicine, who says she's seen at least six patients whose memory problems were traceable to statins in 12 years of practice.
"The changes started to occur within six weeks of starting the statin, and the cognitive abilities returned very quickly when they went off," Devi says. "It's just a handful of patients, but for them, it made a huge difference."
Cognitive effects are the second most common problem, after muscle aches, reported by patients to the Statin Effect Study at the University of California, San Diego.
"We have some compelling cases," says Beatrice Golomb, the study's lead researcher.
In one, a San Diego woman was so forgetful that her daughter explored getting her Alzheimer's care and refused to let her babysit her 9-year-old child. Then the mother stopped taking a statin.
"Literally, within eight days, I was back to normal -- it was that dramatic," says Jane Brunzie, 69.
The brain is largely cholesterol. Some doctors theorize that lowering cholesterol could slow the connections that facilitate thought and memory. Statins may also lead to the formation of abnormal proteins seen in the brains of Alzheimer's patients.
It pays to think about whether you could accomplish your goals with diet and exercise. Pay close attention to any side effects and talk with your doctor. A different dose or statin might be better.
As Brunzie says, "You have to use your own brain, as well as your doctor's brain, when it comes to your health."
I have included only the most relevant, but still a very substantial part of this article.
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