"People are always looking for the single magic bullet that will totally change everything. There is no single magic bullet." Temple Grandin
Statins have been long praised for saving thousands of lives with relatively low risk of side effects. Until recently they were recommended mostly to people with high blood cholesterol level. Now, however, scientists are suggesting that instead of looking for bad cholesterol in candidates for statin therapy, we should focus on measuring the degree of inflammation in the body.
So, what causes inflammation in the first instance, and what can be done to address these causes?
Research says, that poor lifestyle choices like bad nutrition, sedentary lifestyle, obesity, chronic emotional stress, sleep deprivation or social isolation hugely contribute to chronic inflammation. Many studies have proven that lifestyle changes alone achieve comparable results as statins in both lowering cholesterol and inflammation levels. Researchers also say that a high-sensitivity C-reactive protein, or CRP and other markers of inflammation significantly decrease when people make more conscious lifestyle choices.
For many people, however, a “healthy lifestyle” is not an option.
What’s the alternative to a healthier living? Statins! Many want to believe that statins are the magic drug, the ultimate answer to all our health problems, but are they? Statins do have their place in treating high cholesterol, indeed, but they raise new concerns. Many patients have long complained about muscle aches or liver problems. A recently published study in the Lancet suggests that statins raise a risk of developing type 2 diabetes by 9 %.
Although large randomised clinical trials show measurable reduction of strokes, heart attacks and other cardiovascular events among people taking the statin, compared with people taking a placebo, the greatest beneficiaries are those with high LDL cholesterol level and a high risk of cardiovascular disease.
A recent global study of nearly 18,000 people was looking at how statins may be associated with cardiovascular events in patients with low cholesterol and an elevated level of inflammation as measured by C-reactive protein. Researchers found a 55% reduction in heart attacks, 48% reduction in stroke and 45% reduction in coronary angioplasty. Very impressive.
The study, however, was poorly designed, and the groups were not representative, for example, 500 people would need statins for a year to avoid one heart attack or stroke. The results were statistically significant, but not clinically significant, and that’s what we are looking for in clinical trials. The study, in fact, was so badly designed, that it was halted after less than two years instead of the planned five years as the board concluded that it would have been unethical to continue the research.
Let's look at what the guideline say and who can actually benefit from taking statins? The new guideline no longer supports “the lower the LDL, the better” approach. Instead, scientists suggest that anyone with elevated blood cholesterol levels should start with simple changes in lifestyle, focusing on the benefits of a healthy eating, regular modest exercise, maintaining healthy weight and avoiding tobacco products before starting statins.
Healthy people with high cholesterol who haven’t managed to implement healthier lifestyle principles need to estimate a 10-year cardiovascular risk to assess the risk of first heart attack, coronary heart disease or stroke before considering taking statins. Depending on the results statin therapy should start with a moderate-intensity or high-intensity statins. Moderate-intensity statins include Atorvastatin 10-20 mg, Rosuvastatin 5-10 mg, Simvastatin 20-40 mg, Pravastatin 40-80 mg, Lovastatin 40 mg, Fluvastatin XL 80 mg, Pitavastatin 2-4 mg. High-intensity statins are Atorvastatin 40-80 mg and Rosuvastatin 20-40 mg More specific recommendations for statin therapy include people over the age of 21 with LDL cholesterol greater than 190 mg/dL (≥4.9 mmol/L) and those between the age of 40 and 75 with LDL cholesterol between 70 and 189 mg/dL (1.8-4.8 mmol/L) and with type 2 diabetes.
People between the age of 40 and 75 with LDL cholesterol between 70 and 189 mg/dL (1.8-4.8 mmol/L) who have not been diagnosed with type 2 diabetes, but with 10-year risk of cardiovascular disease greater than 7.5% are the ones at high risk and therefore they are most likely to benefit from statin therapy.
All people taking statins need to frequently monitor and evaluate the effectiveness and long-term compliance to modify their doses. That's very important particularly for those at high risk of side effects taking high-intensity type of statins.
It's also important to mention that statins may interfere with some of the foods we eat. The most commonly asked question is about how grapefruit juice may affect statin treatment. Researchers say, that grapefruit juice interacts with statins, but also with other classes of drugs like calcium channel blockers, antihistamines, immunosuppressant and cytotoxic drugs (prescribed for cancer treatment). All these drugs are being chunked down in the intestine system by an enzyme called CYP3A to reduce the amount of drug in the bloodstream. Grapefruit juice contains compounds called furanocoumarins that block the CYP3A enzyme so that more of the drug can be absorbed by the intestine system. This mechanism increases the risk of overdose and dose-dependent adverse effects. Not all statins are affected by grapefruit in the same way, for example grapefruit juice has a big effect on simvastatin (Zocor), lovastatin (Mevacor) and atorvastatin (Lipitor) and little or no effect on fluvastatin (Lescol), pravastatin (Pravachol) and rosuvastatin (Crestor).
To summarise, statins have many biological effects that are meaningful. There is no ethical reason, however, to turn a lot of otherwise healthy people into patients and commit them to medications that can raise their risk of diabetes or damage their liver. All on the basis of a biomarker test that many researchers consider too non-specific to make any difference.