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Lipitor and Memory Loss

Posted Oct 01 2008 4:31pm
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).
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