Cholesterol and Statins

This article isn't necessarily about cholesterol and statins. I'm just using them as an example to make my point.  The thrust of this article is thus:  when we read about science based medicine (SBM) and follow the advice of our science based medical doctors, looking closely at the evidence for ourselves will help us make better decisions. About 10 years ago, I saw a woman who had high cholesterol levels controlled with a statin drug, and had no previous history of coronary artery disease.  She developed severe myalgia (muscle pain) due to the drug, so she took herself off of the medication and I supported her decision to do so.  Her family physician called me up and asked me if I was aware how important it was for patients with hyperlipidemia to stay on the statin medications he prescribed for them, since these drugs doubled the chance for preventing cardiac mortality and non-fatal MIs in these patients.  I told him that I was aware of the benefits that these drugs produced, but that I didn't realize their preventive capacity was that high.  I told him that I would work with his patient using botanicals and nutrition to lower her cholesterol since she could not tolerate this drug.

I bought into this bogus line of thinking regarding the efficacy of statins -  hook, line and sinker.  Wow, I thought.  Double the protection for heart attack prevention?  Could the number #1 killer disease in North America really be prevented by statins in 50% of the population?  Holy smokes.  You couldn't get better odds than that at a race track.  On the other hand, I knew that nutrition, exercise, botanical medicines and nutrient therapies could also help prevent the #1 killer.  Obtusely, I didn't bother to research the studies on statins.

After that conversation with the MD, I became a bit leery about supporting those patients who wished to discontinue their statins, but I assessed each case on a patient-by-patient basis, still leaving many people on their statins, while helping others to discontinue them.   I just took this unfounded information for granted; that is, statins were helpful drugs for people who tolerated them well.

I took a pharmacology prescribing course a few years ago, that now allows naturopathic physicians in British Columbia to prescribe most pharmaceutical drugs, after passing oral and written examinations.  I studied pharmacology in naturopathic medical school over 20 years ago, but only studied the mechanisms of the drugs, their interactions, their side effects and their general use.  Back then, naturopathic physicians were not licensed to prescribe drugs to their patients nor to discontinue drugs.

This particular pharmacology course  I took just blew my mind.  There were many drugs that I studied in that course that were not the golden goose I once thought they were.  Statins were among those drugs that took me by surprise.

Here and here are the conclusions from science based medical data.

In short, statins are completely useless for the primary prevention of cardiovascular disease and cardiac death.  They do . . . . NOTHING.  Nada.  People with no previous history of heart disease who have high serum cholesterol levels, are taking these useless drugs and believe they are actually receiving benefit from them.  Statins do zippo for these types of patients.  NOTHING.  I have visions of George Costanza and Jerry Seinfeld doing a Seinfeld skit about NOTHING and statins for primary prevention.

However, for the secondary prevention of cardiovascular disease and death, there is some efficacy from these drugs as seen in the literature.  Let's see what those figures mean exactly.  If a person has existing ischemic heart disease and chooses to go on a statin, (depending on which study you read), he or she will have a 1 in 23 chance of preventing a stroke or heart attack over 5 years, and a 1 in 56 shot of preventing death from cardiovascular disease over 5 years.  We don't know what happens after 5 years.  It became very clear to me, that statins, while helpful, are no magic bullet or panacea for our #1 killer.  Not even in those with pre-existing disease.  What we have here, are many, many people taking statins, and very, very few people benefiting from them.  However, as cardiovascular risks start to accumulate (i.e. hypertension, diabetes and smoking) in a given patient, the efficacy of secondary prevention with statins also starts to climb.

Statins are no golden goose in the prevention of heart disease.  Moreover, serious adverse effects are often under reported in these trials, let alone the complete lack of reporting of numerous mild side effects.  It is well known now that Baycol, a potent statin, was pulled off of the market because it caused kidney failure from rhabdomyolysis (muscle breakdown) resulting in the deaths of 52 people.

So what do I now do personally, in clinical practice regarding statins?

I educate.  A few years ago, I saw a 56 year old obese woman with hyperlipidemia who was on Lipitor.  She had no history of heart disease herself, but had a strong family history of heart disease and hyperlipidemia.  Her family members were also obese.  I showed her the data regarding the lack of efficacy regarding statins (especially for women) and she didn't care.  She was too afraid to discontinue the drug because she truly believed that she would be extremely susceptible to having an MI without it.  While I disagreed with her rationale, I supported her decision to remain on the med since she tolerated it well.  I then proceeded to prescribed CoEnzyme Q10, Vitamin D and Milk Thistle to support her body.  (Statins decrease levels of the first 2 nutrients, and this particular botanical medicine encourages liver health that can be adversely affected by the drug).

On the other hand, patients that I see with multiple and concurrent cardiovascular risk factors who have pre-existing disease, I encourage to remain on their statin unless they do not tolerate it.

Science based medicine is good medicine, but without looking at the particulars, it becomes medicine that is poorly utilized.