Lipitor, the cholesterol-lowering statin drug, has become the best-selling drug of all time, generating… More than 140 billion dollars in global salesThis class of drugs generated so much enthusiasm in the medical community that some US health authorities jokingly proposed that they be considered… It is added to the public water supply like fluoride.One cardiology journal even jokingly suggested that fast food restaurants… “MacStatin” offer [sic] condiments along with ketchup packets to help neutralize the effects of unhealthy dietary choices.
What are statins and how do they work?
Statins are drugs that can lower cholesterol. They work by blocking a substance that our bodies need to… produce cholesterol.
Are Statins Bad for You?
While statins can be effective at lowering cholesterol and potentially help reduce the risk of heart disease and even stroke, they have a number of potential side effects that can do far more harm than good.
What are the possible side effects?
As I mentioned in the video Who should take statins?Muscle-related side effects of cholesterol-lowering statin drugs “are often severe enough [to make] Patients stop taking [them]. Of course, these side effects could be coincidental or psychosomatic and have nothing to do with the drug,” given that many clinical trials show These side effects are rare.Of course, it is also possible that studies funded by the pharmaceutical companies themselves underreport side effects. The bottom line is that there is an urgent need to establish the true incidence of statin side effects.
Researchers have found that those taking statins are significantly more likely to develop type 2 diabetes than those randomly assigned to placebo sugar pills. Why? We’re not exactly sure yet, but statins may have double the effect of Alteration of insulin secretion from the pancreas.in addition to decreasing the effectiveness of insulin by increasing insulin resistance.
Even short-term statin use can roughly “double the odds of developing diabetes and diabetes complications,” and the risks may increase. persist for years after stopping statins.
Who should take statins?
How should you decide if a statin is right for you?If you have a history of heart disease or strokeIt is recommended to take a statin medication.” Period. Full stop. No need to argue. However, if you do not 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 or the Framingham Risk Profiler(My favorite is the ACC estimator because it gives your current ten-year risk as well as your lifetime risk.)
According to current guidelines, if your 10-year risk is less than 5 percent, unless there are extenuating circumstances, you should follow a diet, exercise, and quit smoking to lower your numbers. Conversely, if your 10-year risk reaches or exceeds 20 percent, then the recommendation is to add a statin drug in addition to lifestyle modifications. Below 7.5 percent, the trend is to continue with lifestyle changes unless there are factors that increase risk; above 7.5 percent, move toward adding medications. What are the guidelines? factors that increase the risk What should be taken into account when making the decision? Bad family history, very high LDL cholesterol, metabolic syndrome, kidney or chronic inflammatory diseases and persistently high triglycerides, C-reactive protein or LP(a).
Relative risk vs. absolute risk
One of the problems with communicating evidence on statins to support shared decision making is that most physicians have a Poor understanding of risk conceptsprobability and statistics, but that understanding is fundamental to preventive medicine. As explained in my video Are doctors misleading patients about the risks of statins? Benefits?When doctors offer a cholesterol-lowering drug, they are doing something very different than treating a sick patient.
When pharmaceutical companies say that a statin reduces the risk of a heart attack 36 percentThat’s the relative risk. In a large clinical study, 3 percent of patients not taking statins had a heart attack in a given time period, compared with 2 percent taking the drug. So the drug reduced the risk of heart attack by about 3 percent to 2 percentwhich represents a reduction of about one-third, hence the statistic of relative risk reduced by 36 percent. Another way of looking at the change from 3 percent to 2 percent is that the absolute risk was only reduced by 1 percent. So, in effect, the probability of avoiding a heart attack in the next few years may be about 97 percent without treatment, but it may be increased to approximately 98 percent taking statins daily. Another way to look at it: 100 people would have to take the drug to prevent just one heart attack.
Myth versus reality
If you ask patients what they were led to believe, they believe that the chance of avoiding a heart attack within a few years by taking statins is… 1 in 2when it’s actually 1 in 100. And if you ask, they want an absolute risk reduction of at least 30 percent or more for taking a cholesterol-lowering drug every day, while the actual absolute risk reduction is only about 1 percentThe secret is that if patients knew the truth about how ineffective these drugs are, almost no one would be willing to take them. So doctors are either failing to educate their patients or actively misinforming them.
Evaluate the risks and benefits of statins
If all those numbers are confusing, the Mayo Clinic developed a great visualization tool. For people at average risk who don’t take statins daily, 10 out of 100 may have a heart attack in the next ten years. However, if all 100 people took a statin every day for those ten years, 8 would have a heart attack and 2 would be saved. That’s a 1 in 50 chance that taking the drug will help you avoid a heart attack in the next decade. What if you have no known heart disease and you take statins for a few years? The chance that statins will actually save your life is about 1 in 50. 1 in 250.
What are the disadvantages? The cost and inconvenience of taking a pill every day, which can cause some gastrointestinal side effects, muscle pain and stiffness in perhaps 5 percent, reversible liver inflammation in 2 percent and more serious damage in perhaps 1 in 20,000 patients.
If you want a more personalized treatment, Calculate your risk in ten yearsI explain it in more detail in my video. The real benefits and side effects of statins.
Alternatives to statins?
As I mentioned in my video How much longer do you live on statins?Taking statins can Allowing you to live longer Because for every millimole per liter you reduce your bad LDL cholesterol, you could live three or even six years longer, depending on which study you’re reading. One millimole in U.S. units (mg/dL) is equal to 39 points. If you reduce your LDL cholesterol by about 39 mg/dL or 1 mmol/L, you could live three or even six years longer. live longerIf you exercise throughout your life, you may only increase your life expectancy by six months, while if you quit smoking, you may live nine months. So how can you lower your LDL cholesterol by about 39 points? You can do it by taking medication every day, or you can do it in as little as Two weeks of eating a diet rich in fruits, vegetables and nuts..
A plant-based diet has been shown to substantially reduce cholesterol levels and cardiovascular risk, as well as obesity, hypertension and systemic inflammation, without negative side effects.
