To Statin or Not to Statin

I spend a lot of time answering questions about whether statin drugs should be taken. It seems the more that’s written on statins, the more confused people get. Well, my position is that statins have their place, but are often inappropriately overprescribed by physicians.

For people with established heart disease, statins can be a true blessing and add years to their lives. But the current overprescribing of statins for patients who merely have high cholesterol may actually be raising the incidence of heart failure.

This is because statins deplete the body of CoQ10, a biochemical central to cellular energy production and heart health. Without enough of this critical nutrient, heart failure will occur.

Let’s take a closer look at the pros and cons of statin drugs.

The Good Side of Statins

In selected patients, statin drugs can improve quality of life and may even save your life. A study was performed with 1,616 patients hospitalized for acute coronary events. If their statins were discontinued, they were nearly three times as likely to have a non-fatal myocardial infarction (heart attack) or die as their counterparts who continued to receive statins.

In another study involving 1,707 patients undergoing coronary angiography, 985 were found to have severe coronary disease. More than 100 of these patients died within three years, yet their cholesterol measurements failed to predict that. Nonetheless, initiation of statin therapy was associated with improved survival rate, especially for those patients with the highest C-reactive protein (CRP) levels.

In this case, it seemed that statins were working on something other than lowering cholesterol, so the search began for another mechanism that offered protection—theoretically, a reduction in inflammatory mediators such as CRP.

Based on this and other research, I believe that statin therapy can significantly reduce the incidence of coronary morbidity and mortality, especially for those who are at the greatest risk for coronary artery disease.

In a patient with a history of heart attack, stent, bypass, or angioplasty, and even in diabetic patients with high CRP levels or high coronary calcium scores, statins may be a reasonable intervention regardless of one’s cholesterol level. I’m convinced that taking statins after a heart attack reduces your risk of recurrent coronary events because of their ability to reduce inflammation rather than lower cholesterol.

Not So Fast

With that said, the reason I’m so concerned about the over-prescription of statins is because physicians tend to pull out the prescription pad and order a statin for healthy men and women with high cholesterol levels, but who are without any history of heart disease, coronary events, or high coronary calcium scores (greater than 1,000).

In my opinion, physicians who treat patients on the basis of high cholesterol levels alone in the absence of previous coronary events, diabetes, and/or high CRP numbers are not practicing smart medicine.

Although the use of statins in high-risk coronary patients—especially those with inflammatory markers—is good medicine, the prescribing of these potent pharmacological agents with known and unknown side effects for long-term use in otherwise healthy people is not justifiable.

The Dark Side of Statins

The side effects of statins are potent and sometimes can be lethal. As a practicing cardiologist, I can personally attest to the numerous side effects of statins.

Some of the more “mild” side effects include:

• Muscle pain and weakness;
• Flu-like symptoms; and
• Generalized soreness.

Some of these patients with elevated blood enzymes (creatinine phosphokinase enzymes or CPK) could have full-blown statin myopathy. In severe cases, muscle cells can break down (rhabdomyolysis) and release myoglobin into the blood. Too much myoglobin can impair kidneys, leading to kidney failure and even death.

Shockingly, I have heard a lot of my colleagues say that the muscle pain you hear about just doesn’t exist. I say to my colleagues, either you’re not seeing enough patients or you’re not asking the right questions.

And then there are the more serious side effects, incluiding:

• Liver dysfunction with elevation of the liver enzymes;
• Problems of the nervous system, including a condition called peripheral neuropathy, which doctors call polyneuropathy; and
• Total global amnesia, which means forgetting where and who you are for a few minutes to several hours. (If cholesterol LDL levels get too low, they can interfere with neurotransmitter mechanisms in the brain.)

Ironically, another severe side effect of statins is diastolic dysfunction and/or congestive heart failure, an outcome that was written up in the American Journal of Cardiology. In fact, some of my cardiological colleagues believe that statin cardiomyopathy could be one of the major reasons there has been an increase in congestive heart failure over the past decade.

What Should You Do?

After researching the data extensively and taking care of thousands of patients, I can tell you this is how I approach the subject.

DO take a statin if:

• If your inflammation cannot be lowered by lifestyle interventions, and if you have a family history of heart disease or if you have diabetes.
• If you’re at high risk for coronary artery disease, or have known heart disease, such as:
  • Peripheral vascular disease,
  • Angina,
  • Heart attack or stroke,
  • Angioplasty or a stent procedure, and/or
  • Coronary bypass surgery.
• If you have a coronary calcium score greater than 1,000 (as determined by EBCT scanning).
• Any elevated markers of inflammation such as C-reactive protein, homocysteine, or fibrinogen. (One elevated marker is cause for concern; two or more elevated markers are very serious. You must take action immediately.)
• If you’re a male up to age 75 and have coronary artery disease, and the advanced test shows you have predominantly small LDL.

Consider taking a statin drug if you have high cholesterol levels and one or more of the following:

• You lost a parent or sibling to sudden cardiac death.
• You have a parent or sibling who had a heart attack at age 49 or younger.
• You have diabetes plus one or more elevated markers of inflammation.

DO NOT take a statin if:

• You are healthy (have no known coronary artery disease).
• You are treating high cholesterol numbers alone.
• You have no history of cardiovascular disease among your parents and siblings.
• You have no elevated markers of inflammation, such as Lp(a), homocysteine, AA/EPA, fibrinogen, and CRP.
• You’re over age 75, unless you have chest discomfort or shortness of breath. The drugs have too many downsides in this age group.

If you fall into any of the categories for which statin use is acceptable, be sure to take at least 90–180 mg of hydrosoluable CoQ10 daily to counteract CoQ10 depletion.

The bottom line is that everyone is unique when it comes to weighing the risks/rewards of taking a statin. That’s why you need to make your own decision with balanced information and the assistance of a health professional who does their homework…instead of just listening to the drug company sales reps.