There are few modern medications that have stirred such heated debate as statins. Some health professionals believe the benefits have been overblown and the risks downplayed. Others have hailed such drugs as magic bullets against heart disease.
The controversy has raged for nearly three decades, ever since lovastatin (Mevacor) was approved in 1987. Since then, so much money has been spent on drugs like atorvastatin (Lipitor), fluvastatin (Lescol), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor) that it takes the breath away. Americans alone have spent well over $100 billion on statins. Worldwide the sales numbers are staggering.
Many doctors tell patients that these cholesterol-lowering medications will protect them from a heart attack or stroke. Some cardiologists are so enthusiastic about the benefits of such drugs that they have half-jokingly suggested that statins should be put in the water supply.
Who Should Be Taking Statins?
We hope no one is really serious about that, but guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) would put 97 percent of Americans between 66 and 75 years of age on statins (JAMA Internal Medicine, Jan. 2015).
If cardiologists followed the recommendations of their organizations, all men and most women in the 66-75 age group would be prescribed a statin-type medication, regardless of how fit or healthy they might be. In other words, a 67-year-old marathon runner who is a vegetarian and has no family history of heart disease might be prescribed a statin based on the recommendations of the ACC and the AHA.
Hopefully no doctor in her right mind would ever do that, but the guidelines ignore many important lifestyle issues, such as weight, diet and exercise patterns. There is a lack of high-quality research showing a benefit from statins for people this age who haven’t been diagnosed with heart disease.
Dr. Steve Nissen is one of the country’s leading cardiologists. He is chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic. Dr. Nissen has been a staunch statin supporter for many years. But even Dr. Nissen believes the new guidelines from the ACC and AHA are over the top. According to this renowned cardiologist, the risk calculator that is used to determine who should be on a statin overestimates risk by at least 50%. That’s means that a lot of people will end up getting a prescription who really do not need one.
Most cardiologists think that statin side effects are extremely rare, even in older adults. Reports of muscle pain, weakness, nerve damage, reduced libido, diabetes, cataracts and memory problems are often discounted as coincidental and not caused by statins.
How Good Are Statins Really?
There is another side to the statin story. Two articles in the journal, Expert Review of Clinical Pharmacology (March, 2015), challenge the prevailing wisdom. One is titled “How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease.”
Exaggeration and Deception
For example, in one highly quoted study 3 percent of those on placebo had a heart attack compared to 2 percent of those taking Lipitor. In other words, out of 100 people taking atorvastatin, one would benefit. That probably doesn’t seem very impressive to you. After all, if 99 people taking Lipitor get no noticeable benefit so that 1 person can avoid a heart attack, the results just don’t sound exciting.
But wait, there is a way to manipulate the data to make the drug seem more appealing. Because the difference between 3 percent and 2 percent is only 1 percent, the manufacturer promoted the drug as reducing the risk of heart attack by 36 percent. That sounds much more appealing to prescribers and patients, even though only 1 person out of 100 actually benefits. In statistical terms, drug companies use relative risk reduction rather than absolute risk reduction to make it seem as if their medications are far more effective than they really are.
According to the authors of the analysis, other studies of statins show similarly unremarkable results. Statin users had between 1.2 and 1.5 percent fewer cardiovascular complications than those taking placebo. The authors believe that for statins, “their modest benefits are more than offset by their adverse effects.” Here is a link to the abstract.
The other article is even more worrisome. The Japanese scientists who wrote the perspective, “Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms,” explain the biochemical basis for their contention that statins may be contributing to clogged arteries and heart muscle failure. They conclude, “Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs.” Here is a link to the abstract.
What About Side Effects?
A study recently published in the journal Diabetologia (posted March 4, 2015) reveals an unexpectedly high rate of diabetes linked to statins:
“Conclusions/interpretation: Statin treatment increased the risk of type 2 diabetes by 46%, attributable to decreases in insulin sensitivity and insulin secretion.”
The authors also found that statin therapy “was associated with a worsening of hyperglycemia.” In other words, people already diagnosed with type 2 diabetes had a harder time controlling their condition if a statin was on board. Even though the 46% is a relative risk, it is still worrisome.
What is so paradoxical about this new observation is that the American Heart Association and the American College of Cardiology recommend that all people with diabetes take a statin, which could make their condition harder to treat.
This came from Beau:
“I am a Type 2 diabetic. Several years ago I was prescribed simvastatin at the local VA and developed most of the the negative side effects of statins.
“My blood sugar also rose dramatically. When I attempted to describe the problems I was having on simvastatin to the prescriber, my complaints were discounted and actually derided.
“My solution was ‘heal thyself.’ My statin experience was one of the driving pressures that began my search for natural alternatives and also landed me on this site.”
While statins may provide protection for those with serious heart conditions, people without heart disease may not get as much benefit as they expect. Doctors and patients should review the clinical trial data before making a decision on statin use. Please do not accept what you have read here without reviewing the actual data. Here are some links to check out for yourself if you cannot access the full articles in Expert Review of Clinical Pharmacology
Popular Articles
http://www.sciencedaily.com/releases/2015/02/150220110850.htm
http://www.eurekalert.org/pub_releases/2015-02/uosf-sal022015.php
Other Options
For people without heart disease, there are many ways to control cholesterol and reduce the risk of heart disease. In our book, Best Choices from The People’s Pharmacy, we provide many non-drug steps worth your consideration. You will learn about the best oils to cook with, juices that relax blood vessels, minerals that are heart healthy and a diet that can make a huge difference in your lipid levels. Here is a link to learn more.
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