“Myths” About Statin Drugs

Patients frequently ask me about statin drugs.  These are a powerful group of drugs used to prevent heart attacks and strokes.  The heart attack rate in my patients dropped when I started using these drugs.  The number of studies that supports their use is astounding.  So it is curious that many of the questions I get tend to be the same.  Last month a patient brought me a brochure with a list of “Cholesterol Myths”, really a list of reasons not to take statins.   Here are the answers I would give to my patients about these common “myths.”

“Myth: People with high cholesterol aren’t more prone to heart attacks.  Cholesterol is an important part of normal body functioning.”

Reality:

There are many kinds of cholesterol.  Some kinds of cholesterol are “good” like HDL and some are “bad” like triglycerides and LDL.   The total cholesterol number is not a very important number.  It is more important to keep the “good” cholesterol high and the “bad” cholesterol low.  When the HDL or “good” cholesterol is elevated, the risk of heart attack drops. This is because HDL cholesterol protects against heart attacks when it is high.   A high LDL level is clearly related to a higher risk of heart attacks and strokes.  Lowering the LDL cholesterol lowers the risk of heart attacks and strokes.  It is not possible to decide a person’s risk based on their total cholesterol, the parts must be known.    Even though high LDL and triglyceride “bad” cholesterols are linked to heart attacks and strokes, other problems can cause heart attacks and strokes.  About 50% of all heart attacks occur in people with “normal” cholesterol numbers.  So it is true that cholesterol alone cannot predict exactly everyone who will have heart attacks and strokes.   Many kinds of cholesterol are important to normal body functioning, but some kinds of cholesterol increase the risk of getting sick.

“Myth: Cholesterol doesn’t clog arteries and cause heart attacks.  There is very little cholesterol or saturated fat in the arterial plaque or clogs.  Most of the material is a calcium deposit akin to lime and most of the fatty acids are unsaturated.”

Reality:

The sentence above is kind of like saying “after the car wreck all we found were tires, so there wasn’t a car involved.” Getting the complete picture requires current information and the history of events. Cholesterol and saturated fats are clearly associated with arterial plaques and clogged arteries.  Plaques and clogged arteries are complicated and there are other parts.  Calcium deposits can be found near plaques and may be part of the common inflammation or irritation within the blocked arteries.  The exact way all these parts fit together isn’t clear.  What is clear is that blocked inflamed arteries lead to heart attacks and strokes.  Cholesterol and saturated fats are one part of this whole reaction. Statins can decrease inflammation as well as cholesterol, heart attacks and strokes.    The Jupiter trial looked at inflammation.  Inflammation is measured by the test HS-CRP.  HS-CRP decreases with the use of Crestor (a statin).  When the HS-CRP level drops the number of heart attacks drops as well.  This  happens in people with already low cholesterol numbers.  So statins can prevent heart attacks in people at high risk for heart attacks no matter what their cholesterol levels.  No one really knows how it works exactly. Calcium deposits occur in other parts of the body and are normal, like in your bones.

“Myth: There is no evidence that saturated fat and cholesterol-rich foods contribute to heart disease.  As Americans have cut back on saturated fat and cholesterol rich foods, rates of heart disease have gone up.”

Reality:

The heart attack rate in the United States has dropped. “From 1995 to 2005 the death rate from coronary heart disease declined 34 percent, but the actual number of deaths declined only 19 percent.” http://www.americanheart.org/presenter.jhtml?identifier=4591

No diet has been well tested that makes people only eat saturated fat and cholesterol-rich foods.   Fully testing any strict diet has its difficulties.  Some foods like olive oil and canola oil raise HDL and total cholesterol and reduce heart disease.  The best evidence shows that avoiding large amounts of saturated fat and trans fat will reduce the risk of heart disease and stroke.  This is easiest to do by eating lots of vegetables and fruit, low fat dairy products and liquid oils instead of solid fats.  Meat should not be most of what you eat.  Diet shouldn’t be the only strategy to be healthy. People shouldn’t smoke. They should exercise every day. People may recommend other kinds of diets, but they don’t have scientific studies to prove that they work.  What works for a few people may not work for everyone.  People that don’t want to take chances don’t experiment with homemade seat belts; they put on the seat belt that someone else tested.

A recent study published in the American Journal of Medicine showed that when people actually take their statin, their risk of stroke  drops 25%.  A stroke will change your life, so a 25% reduction is significant.

http://www.amjmed.com/article/S0002-9343(09)00286-1/abstract

Any medicine can have side effects. The most common side effects of a statin are NONE.  About 10 percent of people that take these medicines may have muscle aches (Annals of Internal Medicine 2009; 150:858-868.)  

Don’t be scared by half truths.  Not all medicine is right for all people.  Some people have side effects, but others have none.  But just because one person has problems doesn’t mean everyone else should miss out on a chance to be well. 

Here is a source for cholesterol guidelines and research studies:

http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04.htm