Statins

According to new guidelines, everyone with diabetes should take a statin drug to lower cholesterol. It doesn’t matter how low his cholesterol already is. This makes little sense to me. See what you think.

The American College of Cardiology and the American Heart Association just released these new guidelines. In one way they look like an improvement. According to Harlan Krumholz MD, the guidelines say doctors should be treating people, not just cholesterol numbers. Only those at “high risk” of heart disease and stroke should be treated.

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“The question is not whether a drug makes your lab tests better,” says Krumholz, “but whether it lowers your risk of heart disease and stroke.” Improving your lab numbers with drugs is not the same as lowering risks, he says. “Drugs have thousands of effects on the body, and a drug’s effect on an individual lab test cannot necessarily predict its overall effect on you.”

Hooray for that! Finally, medicine is realizing that treating lab numbers can cause harm; it’s good they are looking past the lab numbers.

Unfortunately, the definition of “high risk” includes an awful lot of people. According to science writer Gina Kolata, almost anyone with diabetes, anyone who is African-American, anyone who has had a heart attack or high blood pressure, or has an LDL (“bad”) cholesterol reading over 190 qualifies as high risk.

More people on statins?
An article on CNN.com cites cardiologist Gina Lundberg MD, of Emory University. Dr. Lundberg says that even people with an LDL below 70 (extremely low) should get statins if they have diabetes or other risk factors. “There will be very few people coming off statins under the new guidelines,” she says, “and many more going on them.”

Maybe I should think about being one of them. I checked my own risk profile using a “Cardiovascular Risk Calculator” put out by the American Heart Association (AHA). You can download the calculator from this Web site.

It’s an Excel spreadsheet. You put in your age, gender, smoking, cholesterol, and blood pressure numbers and get your “risk of heart attack or stroke” in the next ten years. If the risk is above 7.5%, they want you on a statin.

I’m not sure exactly what my cholesterol numbers are, but I remembered as best I could. My risk came out to 12.3%, about one chance in eight of a heart attack or stroke. So I should be on a drug, according to the AHA.

I’m not going to start taking one, though. Statins can have side effects, including severe muscle damage, which I can’t afford, and diabetes, which I don’t want.

Besides, other top doctors think the calculator is flawed and “significantly overestimates the risks for patients.” Using this calculator, not only every person with diabetes, but everyone above a certain age should be on statins, even if their other “risk factors” are perfect.

Are they worth it? According to studies, the best a statin could do for me would lower my risk from 12.3% to 8.7%, and in most studies they don’t help even that much.

A Business Week article by John Carey points to studies showing that statins had no benefit in terms of risk for heart attack or death for men over 65 or women of any age who did not have heart disease.

Even statin advocates believe you have to take the drugs for a long time to see any clear benefit.

“When you take a cholesterol-lowering drug, it is a huge commitment,” says Scott M. Grundy, MD, PhD, of University of Texas Southwestern Medical Center. “It doesn’t make sense to take it for five years. You take it for life.”

What does this mean for you?
According to analysts, the main message of the new guidelines is to use more statins. Don’t use other cholesterol reducing drugs that aren’t yet “proven” to reduce heart attacks.

Most people reading this column are probably on a statin already. Some large studies in 2006 found that statin use for people with diabetes reduced the risk of heart attack by 29% and stroke by 14%.

None of those studies looked at complications and side effects of the drugs. These side effects can include cataracts, cognitive problems, and sexual dysfunction, in addition to diabetes and muscle pain.

Many people lower their cholesterol without drugs. More exercise and more fiber in the diet are two proven ways. According to our nutritionist Amy Campbell, niacin (Vitamin B-3), garlic, red yeast rice, and several other plant foods have good evidence for lowering cholesterol.

Although studies differ, it seems that death rate from all causes is about the same whether you take statins or not. Your doctors will likely be recommending statins and maybe even raising your dose with the new guidelines. If they’re working for you, fine. Most people don’t get major side effects. But remember it’s your choice whether to take them or not.

  • airblade

    I have had a few friends who died crossing the street. I realize that not everyone dies this way but i never cross the street anymore. John Doe, a local engineer has proposed building overpasses on every street corner, to solve this problem, but the streetlight industry is very powerfull. I have noticed that the majority of people who take statins do not post on forums, but the “Health Police” who have never taken statins, all know someone who had a near death experience and of course you must listen to them. PS.. i am T2 since april of this year, and i have been on lipitor for six years. PPS… Everyone diagnosed with diabetes in nov 1910 is dead…A

    • david

      I took a statin. See https://plus.google.com/102631385922452069974/posts/EAu1sWEBjyX
      Obviously the effects can be devastating for some people.
      But still, I’m not saying that in your case you shouldn’t take a statin. But I am saying two things:
      1. Look for conflict of interest in any studies you read. Also check your doctors on Dollars for Doctors and see if they’re gotten money from Big Pharma.
      2. Be aware of the early signs of adverse effects from statins. You can stop a disaster that would otherwise unnecessarily occur.
      In my case, the benefit was less than 2% over 10 years of preventing cardiovascular disease–taking me to age 80; the adverse effect rate is about 10%. This I now know–too late.

      If the reward or benefit for you is large, then you face a dilemma/decision that I didn’t even face.
      But no matter what, it’s worth knowing the facts!

  • Bob Fenton

    It would be very interesting to see the conflicts of interest for those that developed the guidelines.
    You can almost bet that there are some significant conflicts.

  • Bruce

    Thanks for this article David. I just read another article that mentioned the “Risk Factors” study and I was concerned about reports that the committee that generated the study was comprised of people connected with pharmaceutical companies; some of whom left the committee because of where the study was going. Another point was made about the negative affects of statins, including calcification, muscle damage and the reversal of the affects of exercise. I have been taking a statin drug for a number of years because I have type 1 Diabetes and my cholesterol was high (lower now from exercise and diet change).

    What’s most frustrating is that so many studies are contradictory, making it difficult to know who to believe and what path to take for proper treatment.

    Thanks again! Bruce

  • JohnC

    One does have to wonder how statins are being recommended even more than they were before, considering the newer research showing some really negative, long term effects of these drugs.

    Certainly the overall stats would disagree with these findings.. especially for people of advanced age. Just goes to prove once again you better do a lot of research yourself and then make up your mind whether you want or need this stuff in your body. Even with a good lipid profile my doctor says I should take them — told him I would pay for them and he can take them for me.

  • Pat B.

    Well, I’m not surprised by these new “findings”. There’s too much money involved here. If big pharma
    had their way every man,woman,and child would be on statins, IMHO. It’s interesting how that over the years the guildlines for cholesterol, set at one time by the experts much lower keeps getting raised
    by the new “experts”. So the first experts where wrong? What makes the new experts think that they know better? It doesn’t inspire confidence in me!
    If big money wasn’t involved, it could certainly clear the muddied waters a lot…

  • Mary G

    Bravo, JohnC! I wanted to tell my last three doctors that they can take the statins for me since they loved them soooo much!!!

    As for ‘airblades’ comment…I was unwittingly put on a statin when in the hospital for a minor stroke unrelated to my lipid profile. They had discovered new onset diabetes and a statin was standard of care. I was never informed of any side effects, which I personally think is criminal. I found out later that I had been set up to have a worse and possible fatal bleeding stroke because my normal levels dropped to 151 total cholesterol after only 3 doses!!! Everyone is entitled to their opinon, but I can’t help but wonder what ‘airblades’ might think or do if he ever suffered a serious side effect…as he’s only been on statins 6 years and sometimes people can go longer without having one…would he then join the “Health Police” ????

  • Cynthia

    I have been on statins before and have had problems with each one. I developed peripheral neuropathy after taking Zorco for several years, deep muscle pain after Lipitor and another statin. I lowered my cholesterol by diet and taking a flush free niacin and fish oil capsules.

    Recently, a cardiologist insisted that I needed to be on a statin even after I told him my history with them. He felt that a small dose would be ok. I couldn’t get an answer to what my level was which it turns out is ok. I refuse to take a med that I’ve had nothing but problems when taking it.

    We as patients have to decide what is in our best interest and taking meds for health issues we don’t have or taking meds that we have issues with or questions about is a decision we have to make for ourselves.