Should I Take Statin Drugs for Cholesterol?

Dr. Sinatra: Another subscriber writes in: My doctor wants me to take a statin drug. Should I? Another great question.

I've said for years that statins are a blessing and a curse, because they do incredibly good things, but they can do bad things. The problem with a statin is this: You don't want to choose a statin to lower a cholesterol number. To me, that's bad medicine and I'll tell you why.

Statins can have horrific side effects. I've seen side effects across the board. I've seen weakness of the limbs, weakness of the hands. I've seen almost like a pre-Alzheimer's condition where people literally forget who they are. We call it, "total global amnesia." I've seen difficulty with vision, I've seen liver problems, I've seen kidney problems, polyneuropathy-I've seen it all. Why? Because I'm a cardiologist and I see the side effects of statins that other physicians give patients and they come to me to get them off statins and they use lifestyle changes instead.

Again, statins can have a light side, though. Would I use a statin in certain individuals? Of course I would. Let me tell you how statins work.

First of all, statins happen to lower cholesterol numbers, but the way they really work is they're anti-inflammatory agents-and we know that inflammation is the sine qua non of coronary artery disease. So, if you take an anti-inflammatory like a statin, could you do your vessel some good? Yes, you could. The other thing a statin does: It changes the shape of red blood cells. In other words, we use that term, "blood rheology," it has an effect on blood aggregation where it can literally make the blood cells less sticky. So, statins work in two ways. They're potent anti-inflammatory agents and they make the blood less viscous.

So, would I use them in a coronary population with advanced coronary disease? Of course I would. But I'm specific. I especially like statins in men, ages between 50 and 75. Why not above 75? Well, I'll tell you. In patients over 75, I don't get as much bang for my buck. In other words, I don't really see the usefulness of a statin for elderly people because I'm more afraid of CNS [central nervous system] effects and memory effects. And remember, whenever I choose to use a statin, I give every one of my patients, either male or female, at least 200 milligrams of CoQ10, because the side effects of statins is that they're marvelous cholesterol killers because they intercept about 20 different biochemical pathways; one of those pathways is for CoQ10. So whenever you take a statin, you must, you must give yourself CoQ10 and I like at least 200 milligrams.

Now, what other population do we use statins in? Well, I do use them in women, but only in women with advanced coronary artery disease, especially diabetic women, women with inflammatory mediators such as high C-reactive protein, women who are progressing downhill and they're getting more and more symptomatic-I use a statin. But in general I have not been as impressed with women with a statin as I am with middle age men.

Where else would I use a statin? Well, in anybody with advanced heart disease, whether a stent or angioplasty, heart attack, anybody with a high calcium score, even a calcium score over 200, I would use a statin drug, but not to lower cholesterol, folks. I use a statin to have an impact on the blood thinning, the blood rheology, the blood viscosity, and as an anti-inflammatory. So, if I had a male, for example, with a very low HDL and coronary calcium, I would use a low dose statin, because a low HDL makes the blood more viscous, it makes the blood more like red ketchup and that's the reason why a male with a low HDL is more prone to heart disease. So, I would use a statin in that situation, but, again, I don't treat numbers. One of the more common consults I saw in my office was a woman who would come in with a cholesterol of 280 and an HDL of 100 and her doctor would put her on a statin. To me, that's bad medicine. Why? Because, again, statins deplete CoQ10 and CoQ10 is one of the most important nutrients to protect your immune system.

So, when do you take a statin drug? To summarize, if you have advanced coronary disease, you're a middle age male, you have inflammatory mediators, you have coronary calcification, you're diabetic, and if you're a woman, where the coronary artery disease is getting out of control; those are the populations that would use statins. To treat your cholesterol? No, I want to lifestyle interventions first.