Thursday, March 20, 2014

Are Statins Really Your Best Solution? Please Consider the Alternative

About two years ago, I wrote a blog titled, Selenium, Statins and Super Fish Oils, Oh My (here is the link: http://mdprevent.blogspot.com/2012/03/selenium-statins-and-super-fish-oils-oh.html). In that blog, I described what I consider the growing enchantment between the medical community and the use of statins. It's kept growing since then.

Back in November 2013, the the American Heart Association and the American College of Cardiology issued new guidelines regarding who should take a statin. This week a new study calculated that based on these guidelines, an additional 13 million Americans should be taking a statin, bringing the total to over 56 million users, representing over one out of six Americans. It is estimated that about one-quarter of U.S. adults age 45 and older already take such drugs

Even though the FDA issued a warning two years ago that statins may raise the risk for diabetes by 9%, a subsequent study that compared the increased risk for diabetes versus the benefits of statins, concluded that the benefits won. The study found that only among those who already had the highest risk for diabetes was the risk greatest for developing diabetes from statin use.  (That's kind of funny in a very sad way as those at greatest risk of developing type two diabetes are the same as those with increased risk factors for having a heart attack such as elevated blood sugar, and obesity.) In addition, although other side effects, like liver dysfunction and leg cramping, and in more severe cases, muscle necrosis has been reported with statin use, these side effects are generally dismissed as irrelevant when compared to the 'great' benefits associated with taking statins.

So what are those great benefits? The primary endpoint is preventing a heart attack.  According to the recent study, it was calculated that if an additional 13 million people took stains, there could be 475,000 fewer heart events.  Wow, that's almost a half million fewer people suffering a life threatening event.  So that's a good thing, right?  It's really not that clear to me.

If you calculate what percent of people taking the statin would presumably (I say presumably, because it is not proven) benefit, it comes out to about 3%.  That means that 97% or over an additional twelve and a half million people would have taken the stain for no benefit, but still possibly suffered some side effect(s) along the way, such side effects estimated at higher than 3% than those deriving benefit to as high as 20% side effects among users by some reports.

To be fair, I had this discussion multiple times with my recently deceased brother, the cardiologist, who felt that if 100 people took a stain with 99 of those people deriving no benefit, but one life being spared a heart attack, than the use for all 100 was justified. How can one argue against saving a life if no real harm (let's just say that muscle necrosis and liver damage, because they are relatively infrequent don't count) is done to the others?

I'll tell you how.  People taking statins to reduce cholesterol and now based on the new guidelines, to reduce inflammation, are subject to a "licensing effect" bestowed upon them by their statin use. Before I address this "licensing effect," first let's consider some other relevant points.  Heart attacks still occur even among statin users so it's no absolute panacea.  Second, a number of heart attacks are delayed or prevented among statin users by other physician actions such as the placing of stents and bypass surgery. In almost all cases of high cholesterol and inflammation, other than familial hypercholesteremia, a genetic disorder that runs in families that results in high cholesterol levels, the overwhelming majority of people's cholesterol and vascular inflammation is under the influence of diet and lifestyle and statins buy some relatively short period of time, at best a few years,  of reprieve.

In other words, if a person taking a statin continues to consume foods and live a lifestyle that is conducive to having a heart attack, the effects of the statin are by and large mostly neutralized and nearly twice as many statin users will have a heart attack than will not. 

Unfortunately, it appears that many statin users feel like they have a "license" to keep eating all the artery clogging and inflammatory foods they want, live as sedentary life as they can comfortably endure, and not take any responsibility for what happens inside their body because they are comforted by the knowledge that they are under the care of a physician who prescribed a statin for them.

(Let's ignore for a moment that there are other major reasons we die such as cancer and strokes that are also affected by our lifestyle choices.  True, you may say, death is inevitable today so does it really matter how you go?  That's a personal preference, but I vote for avoiding such a fate and letting heaven wait for as long as possible.)

The question then remains, do we really want to have a vast majority of Americans taking pills, absolved of any personal responsibility, instead of confronting the difficult lifestyle choices that will have a far more profound affect on their overall health?

Now some reading this post may argue that most Americans are either unwilling or incapable to make the changes necessary to preserve good health and therefore pills like statins are a viable alternative.  It is difficult, albeit painful, to argue with this logic.  Nevertheless, I write to inform people taking statins that they would ultimately be better off making tough lifestyle changes than placing their bets solely on pills as such pills are not the best answer for most of you. 

No one should discontinue their use of a stain based on this post. If my words, however, resonate with you, please consider speaking with your physician and discussing how you may discontinue your statin by making some changes to your lifestyle and diet that may make such pills irrelevant and superfluous. 

Choices really do have consequences when it comes to good health.  It's your health. It's your life. Take control.

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