There were new guidelines announced earlier this week for statin therapy and heart disease /stroke prevention that would by some estimates double the number of Americans on cholesterol-lowering medications. Statin drugs are already amongst the most widely prescribed medications in the world.
Dr. Sanjay Gupta of CNN tweeted whether we are “waving the white flag” when it comes to helping Americans avoid heart disease.
Dr. Eric Topol, a cardiologist and chief academic officer of Scripps Health, also tweeted that the doubling of patients on statins, which can lower cholesterol by up to 50%, was “not good.”
I suggested in a recent tweet that taking the time to learn how to eat to lower inflammation may make better sense as a first line defense before you pop yet another pill as a patch to cover your poor diet.
What the new Statin guidelines mean:
Under these new guidelines, people without a history of heart disease can start taking statins if they have a 7.5% higher risk of developing heart problems or stroke in the next 10 years, based on their cholesterol levels, blood pressure, weight, gender, race and smoking status. (You can calculate your 10-year risk here but take note it is not an easy thing to understand.) Perhaps an infographic or better yet I ‘d suggest a convenient app for this might make better sense. Regardless, the new guidelines for statin use represent a dramatic change from the 20% higher risk that previous guidelines advised.
The new advice also recommends statins for anyone with type 1 or type 2 diabetes, regardless of whether they have additional heart disease risk factors, between the ages of 40 and 75 years old. Diabetes carries a higher risk of heart disease, in part because of the changes in cholesterol levels. Please check with your doctor because what the news this week didn’t remind us all is these statin drugs have real risks.
How statins work and a reminder of the previous FDA warning on their use
Last year, as reported in an article in the New York Times the FDA added new safety alerts to the prescribing information for statins, citing rare risks of memory loss, diabetes and muscle pain.It was the first time that the Food and Drug Administration has officially linked statin use with cognitive problems like forgetfulness and confusion, although some patients have reported such problems for years.
Statin Drug Names and Prescription Numbers
Among the statin drug names are huge sellers like Lipitor, Zocor, Crestor and Vytorin. Nearly 21 million patients in the United States were prescribed statins last year. Whether that number of users is too high or too low has been hotly debated as well as the possible financial ties to the panel making statin recommendations. While advice on whether to take statins involves a complex mix of factors like age, family history and blood pressure, some experts have suggested that those with total cholesterol levels around 200 would benefit from treatment. Others have argued that treatment should not start until a cholesterol level of 240 or higher, all other factors being equal.
So, why take a Statin? What do they do??
Statin drugs inhibit the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. The theory is that lower cholesterol equates to better cardiovascular health, though there has been no actual proven cause and effect and the body needs a healthy amount of cholesterol. Many recent studies suggest arterial plaque and inflammation are much more likely culprits for heart disease and perhaps simply changing your diet and exercising more could offer the best defense.
What you should ask your Doctor about Statin side effects
Statins have some side effects including a mildly increased risk of diabetes and abnormalities in liver enzyme tests. Additionally they have rare but severe adverse effects as mentioned in the New York Times article and reported here, which includes increased risk of muscle damage.
From a nutrition standpoint, statins also inhibit natural production of Co-enzyme Q10 (CoQ10)*, which is vital to good health, particularly muscle health. One of the most important roles CoQ10 plays is helping the body’s cells produce energy, particularly muscle cells. As it so happens, the largest and most important muscle in the body is none other than the heart.
*(This is in the fine,fine print of your drug warning and it amazes me still that doctors prescribing this drug don’t mention this to their patients.)
So, should you “wave the white flag” and simply give in and pop a pill? It is up to you and your doctor to weigh the risks and in the end decide together. Either way, please don’t give up on your diet and exercise, that’s my bottom line and what I fear will get lost in these new pill guidelines for statins.