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.

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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.

“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.

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