This is the first in a four-part video series on cholesterol-lowering
statin drugs. In these videos,
I look at the effectiveness of statins, who should take them,
and what the true risks and benefits are, so people can make
a fully informed choice. Check it out.
"Who Should Take Statins?"
The muscle-related side effects from cholesterol-lowering statin drugs
are often severe enough to make patients stop taking them.
Of course, the side effects could be coincidental or psychosomatic
and have nothing to do with the drug,
given that many clinical trials show such side effects are rare.
Of course, it's also possible that those clinical trials, funded by
the drug companies themselves, under-reported the side effects.
The bottom line is that there's an urgent need to establish
the true incidence of statin side effects.
What proportion of symptomatic side effects in patients taking statins
are genuinely caused by the drug?
Even in Big Pharma-funded trials that found only a small minority
of symptoms to be attributable to statins, researchers found that
those taking statins were significantly more likely to develop
type 2 diabetes than those randomized to placebo sugar pills.
Why? We're still not exactly sure, but statins may have the double-whammy
effect of impairing insulin secretion from the pancreas as well as
diminishing insulin's effectiveness by increasing insulin resistance.
Even short-term statin use may approximately double the odds
of developing diabetes and diabetic complications.
Here are the graphs. Those developing diabetes and diabetic complications
off of statins over a period of about five years,
and the development of diabetes on statins.
And if that's not bad enough, this increased risk persists for years
even after the statins were stopped.
Now, in view of the overwhelming benefit of statins in the reduction
of cardiovascular events, the #1 killer of men and women,
any increase in risk of diabetes, only our 7th leading cause of death,
would be outweighed by the cardiovascular benefits, right?
That's a false dichotomy.
We don' t have to choose between heart disease and diabetes.
We can treat the cause of both with the same diet and lifestyle changes.
The diet that can not only stop but reverse heart disease is
the same one that can also reverse type 2 diabetes.
But what if, for whatever reason, you refuse to change
your diet and lifestyle?
In that case, what are the risks and benefits of starting statins?
Don't expect to get the full scoop from your doctor, as most seemed clueless
about the causal link with diabetes,
so only a small fraction even bring it up with their patients.
Overall, in patients for whom statin treatment is recommended
by current guidelines, the benefits are said to greatly outweigh the risks.
But that's for you to decide.
Before we quantify exactly what the risks and benefits are,
what exactly are the current guideline recommendations?
How should you decide if a statin is right for you?
If you have a history of heart disease or stroke, taking a statin medication
is recommended. Period, full stop, no discussion needed.
If you do not yet have any known cardiovascular disease,
then the decision should be based on calculating your own personal risk,
which you can easily do online if you know your cholesterol and
blood pressure numbers with the American College of Cardiology Risk Estimator,
the Framingham Risk Profiler,
or the Reynolds Risk Score. Those are the direct links, but you can
also use these shortened links.
My favorite is the ACC one, since it not only gives
your current 10-year risk, but also your lifetime risk.
So for this person, for example, even though their risk of having
a heart attack or stroke within the next decade is less than 10%,
but if they don't clean up their act with those numbers
it's going to be nearly a flip of the coin;
whereas if you improved your cholesterol and blood pressure,
you could drop that risk by more than tenfold.
But the statin decision is based on your 10-year risk,
so what do you do with that number?
Well, under the current guidelines, if your 10-year risk is under 5%,
then unless there are extenuating circumstances you should just stick
to diet, exercise, and smoking cessation to bring down your numbers.
In contrast, if your 10-year risk hits 20%, then the recommendation is
for you to add a statin drug on top of making lifestyle modifications.
Under 7.5%, unless there are risk-enhancing factors,
the tendency is to just stick with lifestyle changes,
and over 7.5% to move towards adding drugs.
Here's a list of risk-enhancing factors that your doctor
should take into account when helping you make the decision:
a bad family history, really high LDL, metabolic syndrome,
chronic kidney or inflammatory conditions,
persistently high triglycerides, or C-reactive protein, or LP(a).
If you're still not sure, these guidelines suggest you consider getting
a coronary artery calcium score, but even though the radiation exposure
from that test is relatively low these days, the U.S. Preventive
Services Task Force has explicitly concluded that
the current evidence is insufficient
to conclude that the benefits outweigh the harms.