Do you need a statin drug?
The case for taking cholesterol-lowering statin drugs, already among the world’s most widely prescribed medications, keeps getting stronger. Mounting evidence suggests using the drugs, such as atorvastatin (Lipitor), simvastatin (generic, Zocor, others), rosuvastatin (Crestor), fluvastatin (Lescol), and pravastatin (Lipostat, others), to push cholesterol well below the levels once thought unnecessary. Other research suggests that statins may protect the heart even in people who have ideal blood cholesterol levels by reducing the inflammation of the coronary arteries.
Statins may also help prevent or treat other common disorders, including Alzheimer’s disease, osteoporosis, prostate cancer, and rheumatoid arthritis. And statins are getting less expensive, now that other generic versions of these drugs are coming on the market.
But that doesn’t mean everyone should rush to take these medications. Statins pose potentially serious risks, and the evidence is still too weak to justify taking them for anything but their heart benefits. So if your doctor prescribes a statin for you, observe the following safety tips: Have your liver function tested before starting the drug and periodically afterward. Call your doctor promptly if:
• Your muscles become achy, tender, or weak while you’re taking any statin; or,
• You develop stinging or burning pain in your hands or feet.
Lifestyle changes. such as regular exercise, a heart-healthy diet, and weight loss, are essential to all cholesterol-lowering efforts, but they’re often overlooked by doctors and patients alike. And while most “natural” cholesterol-lowering products provide minimal or unproven benefits — and some may pose risks — several of them may help certain people reduce or even eliminate their need for statins. Today’s column will discuss who needs a statin drug, which ones are best for most people, and which alternative options may be worth considering.
Statins and Inflammation
Scientists have long known that statins cut cardiovascular risk by lowering the blood level of “bad” LDL cholesterol. Numerous studies now show that the risk continues to drop when statins push LDL well below the levels once considered ideal. That led experts to conclude in 2004 that many people should aim for LDL levels 30 points below their previous goals.
Statins also seem to inhibit inflammation, which damages the artery walls and speeds the growth of plaque deposits. The inflammation also destabilizes those deposits, which can rupture and produce dangerous blood clots. Two large studies published in 2005 found that reducing the blood level of C-reactive protein (CRP), a marker of arterial inflammation, slashed heart-attack risk independent of statin’s effect on LDL.
Which statin?
According to the National Cholesterol Education Program, standard coronary risk factors include cigarette smoking; coronary disease in a father or brother before age 55 or a mother or sister before 65; systolic blood pressure of 140 mmHg or more, diastolic pressure of 90 or more, or use of antihypertensive medication; and HDL level less than 40 mg/dL.
Nearly all people who need to lower their LDL with drugs should start with a statin rather than other less-effective medications. But choosing among the five statins available in the
The introduction of generic simvastatin in June 2006 has simplified that decision. For most people, simvastatin lowers LDL as much as the strongest statins atorvastatin and rosuvastatin, and has a safety record nearly as long as lovastatin. That’s important because in rare cases, statins can damage the liver or harm the muscles, releasing protein that can fatally damage the kidneys. And today, the price of generic simvastatin has dropped substantially.
Many physicians now recommend generic simvastatin for most people who are starting cholesterol-cutting treatment. Individuals who don’t reach their LDL goal using a 40-milligram dose of simvastatin could try atorvastatin or, if that fails, rosuvastatin. In some cases, they could also consider adding or switching to other types of cholesterol-lowering medications. People who have already reduced their LDL level adequately without experiencing significantly adverse effects could stick with their current medication or, if finances are a major concern, switch to a generic version.
What else might statins do?
Preliminary research suggests that statins may help prevent or treat the disease listed below. None of the evidence is strong enough to recommend taking statins for those reasons alone. But in people with one or more of the diseases, the possible benefits may strengthen the case for taking statins to reduce LDL cholesterol levels.
• Alzheimer’s disease. Laboratory evidence suggests that cholesterol produces a substance that contributes to Alzheimer’s disease. One small trial, published in May 2005, found that a high-dose statin modestly improved cognitive performance in people with mild to moderate Alzheimer’s disease, but most studies have found no benefit.
• Osteoporosis. Statins may spur production of a bone-building protein while blocking production of one that harms the skeleton. But observational studies of statins’ ability to prevent fractures have yielded mixed results.
• Prostate cancer. A 10-year study of more than 30,000 male health professionals found that the longer they took a statin, the lower their prostate-cancer risk. Statins may protect against the malignancy by reducing cholesterol, which may possibly fuel tumor growth, and by blocking the proliferation of the blood vessels that feed them.
• Rheumatoid arthritis and lupus. A small clinical trial found that statins modestly eased joint pain from rheumatoid arthritis presumably by reducing inflammation. Animal studies suggest a similar benefit against lupus, a related inflammatory disease.
Statin Alternatives
Many “natural” cholesterol-reducers are ineffective or possibly harmful. For example, virtually all evidence for the sugar-cane derivative policosanol comes from a single Cuban laboratory. But a rigorously designed independent clinical trial, published in May 2006, failed to find any cholesterol-lowering benefit.
Supplements containing red yeast rice can reduce LDL as effectively as some statins, since they contain naturally-occurring lovastatin. But don’t use red yeast over the drug. It poses the same risks as the drugs do, and has no proven advantages. And supplements are virtually non-regulated. Indeed, some studies have found that red-yeast labels often misstate how much of the active ingredient the supplement actually contains.
