Ulcerative colitis and statins

This paper was published in the Postgraduate Medical Journal 2002 May;78(919):286-7

Study title and authors:
Ulcerative colitis after statin treatment.

Rea WE, Durrant DC, Boldy DA.
Department of Respiratory Medicine, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, Lincs, UK.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/12151572

This paper describes the case of a man who developed ulcerative colitis as an adverse reaction to simvastatin. (Ulcerative colitis is a form of inflammatory bowel disease).

(i) A 65 year old man was admitted to hospital with a one month history of diarrhoea, passing between five and 10 loose, watery motions per day, occasionally with blood.
(ii) The patient had had one similar episode, approximately one year before admission. On that occasion, it was felt by his general practitioner that the episode coincided with the patient starting pravastatin. 
(iii) The pravastatin was discontinued and the patient’s symptoms resolved.
(iv) At the time of admission, the patient was taking simvastatin 20 mg once a day. He had been started on simvastatin 10 mg once a day, six months before admission, and this had been increased to simvastatin 20 mg once a day one month before admission.
(v) Shortly afterwards, the symptoms had started.
(vi) Examination revealed he was dehydrated and had generalised rectal tenderness with a small amount of fresh blood.
(vii) Investigations showed:
A raised serum urea concentration.
Reduced haemoglobin.
Low albumin.
Partial blockage of the small intestine.
(viii) Tests found inflammation of the colon and the lining of the rectum.
(ix) A biopsy confirmed a diagnosis of simvastatin induced ulcerative colitis.
(x) The simvastatin was discontinued.
(xi) The patient received treatment but by day five had significantly more abdominal pain.
(xii) Investigations revealed severe ulcerative colitis with ulceration and polyp formation throughout.
(xiii) The patient had an operation to remove all of the colon, rectum and anus.
(xiv) Despite treatment in an intensive care unit the patient developed multiple organ failure and died.

Rea concludes: "This side effect of statin treatment is almost certainly subject to under-reporting".

 

Review of Statins Toxic Side Effects

 

Links to other studies:

Statin users of ten years have a 30% increased risk of colorectal cancer

Statin users have a 45% increased risk of acute large bowel ischemia

After only six months of therapy with a statin (Zocor), nearly a quarter of the patients suffered from side effects





With only 12 weeks of statin therapy, 36% of the patients have side effects

This study was published in QJM 1999 Jul;92(7):387-94

Study title and authors:

Atorvastatin compared with simvastatin-based therapies in the management of severe familial hyperlipidaemias.

Wierzbicki AS, Lumb PJ, Semra Y, Chik G, Christ ER, Crook MA.

Department of Chemical Pathology, St Thomas' Hospital, London, UK. Anthony.Wierzbicki@ukcl.ac.uk

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/10627888

The study investigated the side effects caused by statin therapy (Lipitor). Patients unable to tolerate previous statin therapy were excluded from the study. The trial lasted for 12 weeks and included 201 "patients" with alleged high cholesterol.

The study found:
(a) 36% of patients had to withdraw from the trial because of side effects.
(b) 7% of patients suffered from diarrhoea.
(c) 5% of patients developed an erythematous rash (An erythematous rash is characterized by redness resulting from skin inflammation surrounding a patch of skin where a rash is located).
(d) 4% of patients suffered from joint pains.

After only 12 weeks of statin (Lipitor) therapy, over a third of the patients had to withdraw from the trial because of side effects.

Useful book: How Statin Drugs Really Lower Cholesterol: And Kill You One Cell at a Time

Rising diarrhea rates linked to statins

This paper was published in Medical Hypotheses 2009 Dec;73(6):1045-7. Epub 2009 Aug 4

Study title and authors:

Clinically important interaction between statin drugs and Clostridium difficile toxin?

McGuire T, Dobesh P, Klepser D, Rupp M, Olsen K.

College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198-6045, United States. trmcguir@unmc.edu

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/19656639

Clostridium difficile associated disease (CDAD), a common type of antibiotic associated diarrhea, is increasing in frequency and is now occurring more commonly in younger patients who are relatively healthy and may not be receiving antibiotics.

This paper investigated the factors which may have caused the rise in Clostridium difficile associated disease and found:

• Gastric acid suppression, particularly via proton pump inhibitors (Losec, Prevacid, Nexium, Kapidex) is a risk factor for the development of Clostridium difficile associated disease.
• A statin trial demonstrated an increased rate of Clostridium difficile associated disease in patients receiving statins compared to non-statin controls.

Mcguire concludes that the weight of the evidence leads to the hypothesis that statins interact with Clostridium difficile toxin causing an increase in the rate and severity of Clostridium difficile associated disease (diarrhea).