Physicians don’t agree on statin use
This subject came up in my family recently after my husband’s last annual exam. He has always had borderline high cholesterol, and as the “target” or ideal cholesterol level keeps falling, his cholesterol seems to be rising.
His primary care provider immediately told him he should take a statin.
“Hold the door!” I said, when he told me his doctor’s recommendation. “Let’s think about this a little more.”
I know there are two schools of thought about statins: those researchers and physicians who think statins are so wonderful they would like to put them in our drinking water, and those who believe statins are being overprescribed to low-risk patients.
The statin wars
Unfortunately, a lot of the research showing the benefits of statins and other cholesterol-lowering drugs is funded by the pharmaceutical companies manufacturing the drugs. How’s that for conflict of interest?
A couple months ago, two medical journals published opposing views on statins.
One journal, the Lancet, reported almost everyone could benefit from statins, even if they’d never had a heart attack. This research was funded by the makers of Crestor, Zocor and Lipitor.
The other journal, the BMJ, reported that as many as 20% of patients taking statins suffered negative side effects, including muscle pain, memory loss, and type 2 diabetes. However, they weren’t suggesting patients lose weight, eat better or exercise more; they were promoting new (and really expensive!) cholesterol-lowering drugs.
Related post: Praluent – Treating cholesterol just got more expensive
Here is the problem that both sides are missing: They assume that more and more people will need to take medication for high cholesterol in the future. The controversy sends the not-so-subtle signal that cholesterol-lowering drugs may prevent heart problems, and other interventions are not as important. No need to exercise, lose weight or watch what you eat if you can take a pill or receive an injection.
In order for there to be a real winner in the statin war, our focus has to move from picking the right drug, and toward personalized medicine where each individual’s risk is determined, lifestyle improvement promoted, and medications used only as a last resort. [my emphasis]
Lifestyle changes can make a HUGE difference
A third medical journal, the New England Journal of Medicine, recently reported that a healthy lifestyle can go a long way in reducing cardiovascular risk.
It turns out that four lifestyle factors (not smoking, regular physical activity, avoiding obesity, and a healthy diet) are associated with a 46 percent lower risk of having a heart problem.
This finding was a big deal recently at the annual meeting of the American Heart Association because it showed that prevention is far more powerful than anyone expected.
The conclusion: Eating right, not smoking, and staying active really make a difference.
So back to my husband’s dilemma. He and I both fall firmly into the less medicine camp, as well. We are resistant to the idea of taking prescription medications unless there is an overwhelmingly positive reason to do so.
Other than a moderately elevated low-density cholesterol level (LDL), my husband does not have any other risk factors for cardiovascular disease. He is not overweight, he doesn’t smoke, he doesn’t have diabetes or high blood pressure, his high-density cholesterol level (HDL—the good kind) is great, he exercises regularly, and he doesn’t have a significant family history of heart disease.
He does like cheeseburgers and fries, however, and an egg or two for breakfast.
Three years ago, the American College of Cardiologists (ACC) and the American Heart Association (AHA) presented a new heart disease risk calculator. They said anyone with a 7.5% or greater risk of developing heart disease in the next 10 years should take a statin.
My husband’s score? Only 4.9%. But because his LDL was over 180, his doctor recommended the statin, anyway.
So just for fun we re-ran his numbers with a lower cholesterol (assuming a statin did what it was supposed to do). His new 10-year risk of developing heart disease? 4.2%.
Less than 1% improvement.
That’s not much of a benefit, is it, when taking into account the cost of the statin, the possible side effects, and just the annoyance of taking a pill once a day?
And we have to keep in mind that no one’s risk will ever be 0%!
Even though his overall risk of developing heart disease is low, and lowering his LDLs won’t change that risk very much, he is willing to cut back on the daily eggs and weekly cheeseburger & fries lunches.
He told his doctor that he would have his cholesterol levels checked again in 6 months to see if the dietary changes make a difference.
If they do, great. If not…well, we’ll have another discussion at that time.