The Truth About Statins
"I don't want to take a statin."
I hear this all the time. I understand why. We are bombarded by numerous opinions, some informed, some less informed. Many have conflicted agendas in promoting a book, a program or a supplement as an alternative to these widely prescribed and effective medications. It is unfortunate that there is so much misinformation about statins guiding ill informed choices. I hope this brief overview adds more light than heat to the discussion.
Statins are the most proven treatment (other than healthy diet and exercise) for the reduction of heart attack and stroke events. The evidence of statins causing reduction in death and disability from heart attack and stroke in high risk populations is overwhelming. That evidence guides our prescribing statins for those with atherosclerosis, which we identify using carotid ultrasound and coronary calcium scoring.
They are highly effective, but not for the reason most think. While they lower bad cholesterol levels, their most potent benefit is reduction of inflammation in the artery wall.
At the Center for Prevention, we use statins to improve diseased arteries. We measure benefit by demonstrating a reduction in artery wall thickness, reduction and healing of plaque using carotid ultrasound (See Know Your Arterial Age- The CIMT). In some cases, knowing that arteries are healthy has made it safe to ignore elevated cholesterol levels. In other cases, arteries are sick in spite of normal cholesterol levels. They improve with statins in spite of "normal" cholesterol because statins reduce inflammation. We generally use lower doses (fewer side effects) because we are treating for artery improvement, not the lowest possible LDL cholesterol.
Though statins can provoke side effects in a small percentage of users (most commonly muscle aching) the vast majority of us can take them safely with benefit and little or no adverse results. Untreated sleep apnea and low vitamin D increase the likelihood of muscle aches. Correction of these issues reduces these side effects and has other benefits. Evidence that Coenzyme Q10/Ubiquinol is helpful is mixed, but it is worth trying.
Reduction in arterial disease related dementia is far greater than the incidence of cognitive harm from statins. If you experience cognitive changes after starting a statin, they will reverse when the drug is stopped. Don’t get stuck on this worry. Preventable dementia due to arterial disease and Alzheimer’s is not reversible.
Concerns about increasing diabetes risk and insulin resistance are offset by reduction in heart attack and stroke events, which are more frequent in those with insulin resistance, even with a normal blood glucose. Lovastatin and rosuvastatin are better choices than atorvastatin and simvastatin for those with prediabetes and Type 2 Diabetes.
Without personally trying a drug, predicting whether you will tolerate that drug is impossible. The experience of a friend or family member will not predict your experience with statins or any other drug. Predictions of statin intolerance tend to be self fulfilling. Google “nocebo" effect. Intolerance of one statin doesn’t necessarily predict intolerance of all statins. Some side effects disappear with lower doses with continued benefit.
Personally, I take lovastatin daily with a ubiquinol supplement. When I stopped it for a time (to see if my muscles ached from hard workouts or the drug) my arterial age increased by 10 years with same sore muscles while I was off the statin! And I continued to work out!
When I resumed lovastatin, my arterial age returned to its baseline. My "n of 1" experiment won't convince skeptics, but it convinced me I should stay on it. My life. my health and my wealth all likely depend on it.
Our bottom line: If you have atherosclerosis, and you can tolerate them, you should be taking a statin to reverse arterial disease and prevent life altering events.
But, if you are still not convinced, we can discuss alternatives like Niacin, Bergamot BPF and red yeast rice. None of these have the track record of statins, and side effects are not zero, but they offer some benefit that varies by individual.
Open minded willingness to consider risks AND benefits of any choice leads to the best outcomes.