Is there any evidence that statins help regarding carotid occlusive disease?

I am a 81 year old male, very mild infarction 26 years ago, high blood pressure but well controlled by meds (140/70), total cholesterol 108 (never over 130), LDL 58, 50% blockage in right carotid, left [carotid] unreadable by ultrasound. My cardiologist wants me to go on a statin. Is there any evidence at all that a statin would help someone like me? (I have arthritis and am worried about the fairly common muscle pain side effect with statins. I have plenty of muscle pain already!)

Submitted by Allen from United States on 04/04/2016

by Stephen Michaud, PharmD, BCPS

In patients with asymptomatic carotid occlusive disease, the estimated risk of ipsilateral (one side) stroke is approximately 0.5-1% a year. There is evidence to suggest that the best method to manage carotid artery stenosis is a combination of therapy that includes lipid lowering therapy (statin), antiplatelet medication (aspirin usually), and treatment of high blood pressure and diabetes along with smoking cessation, weight control, limited alcohol intake, and regular aerobic physical activity. Statins have been shown in several clinical studies to lower the rate of carotid plaque progression and significantly reduce the rate of ischemic stroke. This data may or may not pertain exactly to your case, and consultation with your physician is recommended.

Statin related muscle pain remains the most common side effect of this drug class. Some statins have higher overall risk of muscle pain than others. The statin related muscle pain may also be dose dependent. Additionally, there are also many contributing factors to muscle pain such as age, vitamin D deficiency and hypothyroidism. If muscle pain develops while on a statin therapy, the medication can be stopped until the symptoms resolve. The original statin can be restarted at the same or lower dose, or a different statin therapy can be used with a lower dose to re-challenge and find out if muscle pain recurs. Unfortunately it is not possible to know prior to taking the statin whether or not you will have statin related muscle pain. In addition, patients may react differently to two different statins. You are encouraged to discuss this with your physician.