Statins Hurrah – But Not For Everyone!

TBE occasionally conveys a dark view of certain popular drugs. But we’re happy to lead the cheers for a drug when it’s appropriate. A recent study in the Lancet shows that statins, America’s most widely taken class of prescription drug, are even better than was previously believed. They may be so beneficial, that even some people with normal cholesterol should be taking them.

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Statins are drugs that lower LDL cholesterol in the blood. They are commonly prescribed to people who have cardiovascular disease, or high cholesterol levels. While statins are considered very safe drugs with only very rare risk for serious side effects, they are, particularly in higher doses, associated with slight risk of reversible symptoms of muscle ache, stiffness, and mild elevations in liver function tests. The use of statins is currently recommended for subjects above normal risk for heart disease, such as elevated cholesterol, a history of atherosclerosis, or even more recently in some subjects with normal cholesterol but elevated risk factor like a marker of inflammation.

But now the Lancet study comes along and suggests that statins can also lower cardiovascular risk in healthy patients – by a lot. Results indicate that taking statins could lower the risk of heart disease by as much as a fifth in people who have no record of heart problems. This benefit is so great that it overwhelms the statistical risks for rare adverse side effects, and suggests that statins perhaps ought to be prescribed much more widely than they are already.

The truth is, almost 40 percent of people who die of cardiovascular disease have few or none of the known risk factors. Taking statins, according to this study, could save the lives of millions of people who fall into this group; especially those over age 50. But, should statins be given in healthy people to prevent future heart disease.

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“Heart disease will affect half of us in our lifetime, and 1/3 of us will die from cardiovascular disease,” says Stanley Hazen, MD, head of Preventive Cardiology at Cleveland Clinic. “We take a very aggressive approach toward statin use, and often recommend initiation of these proven life-saving medications in subjects that might otherwise not be recommended for therapy based solely on conservative national guideline recommendations.  It is important to look at the total risk profile of the patient to determine if a patient should be on a statin.”

Cleveland Clinic has been full of statin enthusiasts since well before the Lancet study was published. Cardiologists jokingly recommend that statins ought to be put in the drinking water. “Of course, we can’t endorse this idea,” writes Steven Nissen, MD, and A. Marc Gillinov, MD, of Cleveland Clinic, in their book Heart 411. But they note that, “We embrace statins because they prevent heart attacks and strokes and save lives.”

Dr Nissen also noted “All medications have risks and we don’t recommend statins for everyone. We don’t have evidence that there is a benefit for low risk individuals. It’s best to have a conversation with your doctor about the risks and benefits of taking a statin.”

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