GAINING POUNDS AND APPETITE: STATIN'S DOUBLE-EDGED EFFECT ON PRIMARY PREVENTION

Therapeutic Area

ASCVD/CVD Risk Assessment

Case Presentation

A 66-year-old female with hyperlipidemia was referred to cardiology due to a family history of coronary artery disease (CAD). Prior to her initial visit, she had a total cholesterol (TC) 264 mg/dL, triglycerides (TG) 89 mg/dL, high-density lipoprotein (HDL) 76mg/dL, and low-density lipoprotein (LDL) 173 mg/dL; her lipoprotein (a) was 314.4 nmol/L. She had undergone Commuted Tomography (CT) Coronary Artery Calcium Score (CACS) testing and had an Agatston calcium score of 5.6 (57th percentile). Her weight was 66 kg with a BMI of 25.7 kg/m2. She was initiated on pravastatin 20 mg and her LDL improved to 70 mg/dL, however she began to note weight gain. She was switched to rosuvastatin 20 mg and noted a profound lack of satiety, with a further 4kg total weight gain since statin initiation seven months prior, while her LDL improved to 44 mg/dL. She was switched to evolocumab, and her lack of satiety improved immediately. She lost 3 kg within three months of stopping her statin.

Background

Dyslipidemia is a primary risk factor for atherosclerotic cardiovascular disease, and a target of preventative cardiology. Prior studies have shown that statin users may adopt a less heart-healthy diet while on a statin, due to a belief of being protected from bad outcomes, ultimately resulting in more weight gain. However, even in those making favorable lifestyle choices, statins may be a hindrance to their goals of weight loss though a leptin-mediated impairment of satiety.

Conclusions

Anecdotal evidence has demonstrated weight gain as a frequent side effect of statin use. This case illustrates a clear temporal relationship between statin use and weight gain, primarily mediated by a lack of satiety. While statins may address one element of primary prevention, in some patients, they may contribute to another, and alternative agents should be used. Further studies are needed to better understand the mechanism behind this effect.