Researchers have been clashing over the benefits and risks of statin-type cholesterol-lowering drugs in the pages of two major British medical journals.
What Do the Medical Journals Say About Statins?
While most physicians agree that statins can be helpful for people who have heart disease, they argue about the value of drugs like atorvastatin (Lipitor), lovastatin (Mevacor) or simvastatin (Zocor) for healthy people. The BMJ, formerly the British Medical Journal, has published articles suggesting that statins are being overprescribed for this group. Authors in The Lancet have written that this position endangers lives and should be retracted. Those writing in The Lancet are scientists who have presided over clinical trials of statin drugs.
What Is Your Risk of Heart Disease?
Cardiologist Rita Redberg, editor of JAMA Internal Medicine, suggests that more focus should be placed on overall risk and a healthy lifestyle. Just paying attention to the cholesterol numbers alone doesn’t seem to tell the whole story.
Lori Mosca, MD, MPH, PhD, is Professor of Medicine, Director of Preventive Cardiology at NewYork-Presbyterian Hospital, and Medical Director, Columbia Center for Heart Disease Prevention. She is past president of the American Society of Preventive Cardiology. Dr. Mosca is a heavy hitter in the world of cardiology. She wrote an editorial in the New England Journal of Medicine (Nov. 14, 2002) a long time ago. She pointed out:
“More than 20 years ago, 246 risk factors for coronary heart disease (CHD) had already been identified, and the number continues to grow.”
Here we are 34 years later and researchers have discovered other risk factors beyond the 246 Dr. Mosca mentioned in her editorial. Consider that for a moment. There are probably over 250 factors that put people at increased risk for a heart attack and yet most health professionals still focus on cholesterol. Things like depression, loneliness, stress, anxiety, anger, marital strife and hostility are pretty much ignored by cardiologists, even though they may be as important as LDL cholesterol. Instead of creating special programs for at-risk patients to encourage exercise and heart healthy food, out comes an electronic prescription for a statin.
The Medical Heretics:
Physicians who question the cholesterol hypothesis of heart disease or the widespread use of statins are labeled heretics. Rory Collins, MD, a leading statin enthusiast, went so far as to say that the critique of statins in the BMJ “would lead to unnecessary heart attacks and strokes.” He is convinced that statin side effects are exceedingly rare and often go away with time. There has been an effort to shut down any further statin criticism. Medical journals and media have been put on notice that anything that might discourage patients from taking their statin is highly dangerous and must be curtailed.
One of our heroes is cardiologist Rita Redberg, F.A.C.C., M.Sc., M.D. She is a professor of medicine at the University of California, San Francisco and the Chief Editor of JAMA Internal Medicine. She and some colleagues are preparing a response to Dr. Collins and the Lancet article. In the meantime, she was interviewed in the Washington Post (October 4, 2016). Here is the gist of her thinking:
“Redberg has been a prominent critic of the existing guidelines, which she believes lead to overuse among people with low risk of heart disease who won’t see any measurable benefits from taking a statin…
“She said many of those at low risk who take statins may suffer the drugs’ side effects unnecessarily. These problems potentially include muscle pain, increased risk of diabetes (especially for women), slowed cognitive function, cataracts and sexual dysfunction.
“‘You see patients every week who complain about how miserable they feel because they were on statins, but have been put on them by doctors.'”
We are firm believers in lifestyle as the very first approach to protecting the heart. This week’s radio show is all about those factors.
You’ll learn more about cholesterol-lowering drugs and nondrug approaches as well in our Guide to Cholesterol Control and Heart Health.
