The majority of these patients experienced a slowly evolving syndrome of cough and shortness of breath with decreasing exercise tolerance coming on several years after statins were started. Several of their patients also complained of angioneurotic edema and itching of the skin. In most cases elevation of the sedimentation rate and ANA was noted.

There is no reason to suspect that the statin's effect on inhibition of cholesterol synthesis had any significant role in this reaction. Suspicion is more logically directed to the effect of statin drugs on the immunodefence system mediated by the known inhibitory effect of statins on nuclear factor kappa B. Along with inhibition of platelet activation, smooth muscle migration, monocyte adhesion and macrophage aggregation, the results of NF-kB inhibition include inhibition of such cytokine mediated events as TNF and IL factors.

Somewhere along this sequence of events in the immunologic responsiveness, statin drugs appear to promote a hypersensitive reaction to the drug while at the same time decreasing the magnitude of the inflammatory response. The lack of the usual steroid sensitivity in these cases is no doubt due to this statin suppressed inflammatory response.

This is not the first time we have heard how insidious and subtle the side effects of statins are. Muldoon reports in two major studies that 100% of statin users suffer cognitive damage if sufficiently sensitive testing is done. And Draeger reported 100% of biopsy verified, muscle fibril damage in statin users whether symptomatic or not. This is very sobering news to me.

Ref: Liebhaber and others. Chest 115: 886-889, 1999

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