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Statins Controversy: Extraordinary or Unwise?

Finally, I decided to write about cholesterol and statins. I am going to issue a warning at the beginning that this will be a very long blog post.

I have been dealing with a very close family member with high cholesterol and triglyceride for years. Problem is that this dear family member is against taking statins and he thinks at age 67 he can control his blood lipid panel with exercise. Well, as a doctor you can imagine my answer used to be “NO”. However, recently, I do not push him to take statins anymore. You know why? Because statin use is very controversial and now I truly believe he is not a good candidate for statins anymore.


Cholesterol guideline updated:
In November 2013, American Heart Association and American College of Cardiology released new guidelines for statin use. Few days later two physicians from Harvard University challenged the guidelines. As you can imagine, it was a debate that caused a huge coverage in media.


What is the new guideline?
To make it simple, previous guideline was only number focused. The new guideline is population focused and it recommends statin for:
• Diabetic patients ages 40 to 70
• Anyone with cardiovascular disease
• Anyone with high level of bad cholesterol (LDL) (>4.91 mmol/L)
• Framingham score of over 7.5 % (Framingham score calculates chances of having heart attack or stroke in the next 10 years)

I am not going to bore you with all the details. You can go to the following link if you need more information:
http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp


So what is the controversy in the new guideline?
The problem is the 7.5% Framingham score. Many physicians believe that at 7.5 % there are no visible cardiovascular disease symptoms. Hence, they argue that the approach must be patient- based, as statins might not be necessary at this point and lifestyle and diet changes might suffice. Think about it, age and gender are the risk factors that we have no control over, and they increase the Framingham score as they go up. Basically, this new guideline means most, if not all, elderly benefit from statins.


My approach when I look at statins:
I am not a fool and there is no doubt in my mind that statin is beneficial for people who already have cardiovascular disease. However, I have difficulty, accepting that elderly, and menopausal women, and younger people who don’t have any cardiovascular disease (the 7.5% number) all need statin. There is no strong published data that in these groups of people, statin will prevent heart attack. I remember reading somewhere that it will prevent developing heart problem in 1 person out of 140. This means that 139 people would not develop fatal heart disease. (Sorry I cant reference this as I do not remember the source)

I also agree with many of the cardiologists, that the new guideline ignores target values. They say if your LDL (bad cholesterol) is high just take statin. However, what is the ideal number for your age? The guideline never mentions it anywhere. Put yourself in the patient’s shoes. If you don’t have a goal, you are either going to be confused, or you will not care about your lifestyle, thinking statin is going to do all the work. That is why I don’t like the new group focused approach.


Statin problem in my opinion:
I usually see the following problems in my practice
• Muscle complaints and pain
• Liver fatigue (toxicity=rarely)
• Patients on statins lead a sedentary life and they are usually overweight. They think statin is their life saver
• Co Q10 deficiency
• I have to also mention that since 2012 statin labels note that there is a possibility of memory loss and diabetes with statin use (Umm, makes you think twice, right?)

I am also going to cite FDA warning about statins published in January 2014. (http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm)
Possible side effects of statins are:
1. Cognitive impairments (such as memory loss)
2. Developing diabetes type II
3. Muscle damage due to drug interactions
4. Rare but possible liver damage (I am not concerned because it can happen with literally any medication)


Bottom line:
I am pretty sure, by now you are probably scratching your head and thinking, now what? If statin is that bad, why is it still being prescribed? Should I take my statins or not? And many more questions that you may not have an answer for.

This is all I want you take from this long blog post. Remember that guidelines are just that. I do not want you to fear statins or think taking statins is an absolute no. A qualified health practitioner can help you navigate through the pros and cons for your individual case.

However, before discussing statin talk with your doctor, there are few numbers and facts that you need to know and take into your appointment:
1. Your total cholesterol and LDL number
2. Your weight
3. Do you smoke
4. Are you diabetic
5. What is your blood pressure (specifically the high/first number,
meaning in 120/80 you need to know the 120 or systolic blood pressure)
6. Your gender
7. Your diet
8. Your family history
9. Your medication list (how much you take and how often)

Whether you are healthy, borderline in developing heart problem, or already have a heart disease, your first starting point must be diet and lifestyle. After weighing benefits and risk, even if you decide to go on statins, you still need to maintain a heart healthy diet and lifestyle.

Remember that with the new guideline, millions of people are now eligible to go on statin. However, there might be no need; so do your research and consult your doctor before making any decision.

I want you to know that cholesterol is only a number. If your total cholesterol and bad cholesterol (LDL) are high, it does not mean that you will have stroke or heart attack tomorrow. There are many more risk factors involved.


ALWAYS KNOW YOUR NUMBERS AND RISK FACTORS!


I hope this blog post clarifies most of the questions I get in my practice about statin use, after The Cholesterol Question that was aired on CBC’s The Nature of Things in October.

Warning: Do not discontinue your statin, thinking that you do not have the risk factors. This is the decision you have to make with your healthcare professional.

I hope you always have a heart healthy life!


Dr. Z

Picture taken from: http://nutri.com/blog/2013/07/high-triglycerides-what-it-means-and-vitamins-that-can-help/

Author resumes no liability for incorrect information or any action reader decides to take based on the information on this blog post. This blog post is only author’s personal input on the topic and by no means entails any medical advice.