Statins. Weighing the Risks and Benefits.

By Dr. Kathryn Retzler

The drugs of first choice for elevated LDL particles are the HMG CoA reductase inhibitors or "statins." There are three main types of statins: lipophilic [lovastatin (Mevacor) and simvastatin (Zocor)], mildly lipophilic [fluvaststin (Lescol) and atorvastatin (Lipitor)], and hydrophilic (pravastatin (Pravachol) and rosuvastatin (Crestor)].

Statin drugs are very effective for lowering LDL cholesterol levels. They are less effective than niacin and fish oil for reducing triglycerides and changing small dense LDL to large buoyant particles, or niacin for raising HDL cholesterol.

Data is clear that statins can decrease the risk for cardiovascular events in people who are at high risk or who already have had a heart attack. Statin medications can improve nitric oxide synthesis in the endothelium, inhibit LDL oxidation, decrease macrophage uptake of LDL, and reduce monocyte adhesion to endothelial cells. In addition, statins can reduce inflammation, lowering hsCRP and pro-inflammatory cytokines. These mechanisms may provide stabilization of plaque. It’s likely that the cardioprotection offered by statins is due to its pleitrophic effects, rather than just LDL lowering.

The JUPITER trial, including nearly 18,000 patients, showed that rosuvastatin (Crestor) is the most effective statin, reducing heart attack and stroke risk by approximately 50%, decreasing blood clots by 43%, and decreasing all cause mortality by 20%. Crestor given at 80 mg once per week may be as effective as 10 mg of Lipitor given daily. In addition, alternate day dosing of statins results in the same LDL reduction as daily dosing (less expensive with fewer side effects).

The most recent evidence regarding the use of statins and prevention of cardiovascular disease from the Cochrane Database reviewed 18 randomized controlled trials where patients without cardiovascular disease were given statins or placebos for a minimum of one year. The conclusion was that statins reduced the risk of stroke, heart attack, and death. There is debate about whether or not statins actually decrease mortality (risk of dying).

It's important to consider how many people need to take statin medications as primary prevention, meaning prevention of heart attack in people without cardiovascular disease or high risk. This is termed the "number needed to treat" or "NNT". The NNT with statins and heart attack prevention is 60. That means, 60 people need to take a statin medication for 5 years to decrease 1 heart attack. The NNT for preventing stroke is 268. To put this in percentage terms, it takes 5 years of daily statin therapy to achieve a 1.6% chance of avoiding a heart attack, and a 0.37% chance of avoiding a stroke in patients who are not high risk.

The harms of statins are less publicized than benefits, but are well documented. A recent review of statin-induced myopathy (muscle inflammation) suggests that 10% is a relatively conservative estimate for this side effect. Statins may also slightly increase this risk for diabetes, especially in women. The most common side effects of statins are gastrointestinal, including constipation and abdominal cramps. These symptoms may be mild to severe and generally subside as therapy continues.

If you are pregnant, have active or chronic liver disease, or are allergic to statins, you should not use any statins. Consuming grapefruit or grapefruit juice inhibits the metabolism of statins, which may increase the risk for myopathy or rhabdomyolisis.

If you've been prescribed a statin, please let me know immediately if you develop any significant malaise, fever, muscle tenderness, or weakness. Replacing CoQ10 (depleted by statin medications) has been shown to improve statin-induced muscle pain and weakness by approximately 50%.

About Dr. Retzler:

Dr. Retzler received her doctorate from the National College of Naturopathic Medicine in Portland, Oregon in 2001. After completing an internship in integrative medicine with Andrew Weil MD, and a residency in McMinnville, OR with Dr. Bruce Dickson, she decided to focus her enthusiasm, talents, and knowledge in building bridges between conventional and alternative medicine.

Dr. Retzler founded HormoneSynergy to help people achieve vibrant health, ideal brain function, and longevity. As a specialist in holistic medicine, she understands the role balanced hormones and neurotransmitters play in all areas of health. She has completed a fellowship in preventive cardiology through the American Academy of Anti-Aging Medicine with Mark Houston, MD and attends several age management and brain health seminars and conferences yearly, with gratitude to the mentors who've influenced her work--Rebecca Glaser, MD, Thierry Hertoghe, MD, and Daniel Amen, MD.

Dr. Retzler recommends effective, evidence based natural therapies, lifestyle changes, and bioidentical hormones to address the underlying causes of hormone imbalance and restore health and vitality.

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