Preventative use of statins

June 28, 2010

Upon starting this blog, there were a number of concerns that came to mind. Would I run out of things to talk about? Would anybody listen/care? Would my opinions just come off as silly? (‘not yet,’ ‘enough, it seems,’ and ‘too early to tell’ are the answers as far as I can tell to date). But it really didn’t occur to me that I’d come off as the crotchety, perpetually peeved, quixotic nutcase (ok, it did occur to me but I didn’t want to let it in). My fear is that this ‘just below the surface’ tendency might come into sharp relief when I take on the subject of statins.

Quick primer on statins to the 5% my readers not old enough to have had this modern medical miracle come into their consciousness. Put simply, statins are a class of pharmaceutical drugs that focus on limiting the synthesis of cholesterol in the blood based on the premise that it is the presence of high concentrations of cholesterol (low-density lipoprotein, to be more precise) that is the primary causative risk factor for atherosclerosis (or ischemic heart disease) which leads to heart attacks and brain attacks (strokes).

More recently, the clever folks who brought you endless lifestyle drug commercials (with their sometimes howlingly funny litany of side effects) have come up with the bright idea that these miracle statins should be prescribed to an enormous swatch of human population. I find the very idea of this more than a little disturbing. First off, the entire premise upon which the ‘lower cholesterol to reduce heart attacks’ premise is highly questionable (see The International Network of Cholesterol Skeptics for more). Secondly, the proof for the effectiveness of statins is limited to a relatively small set of patients (primarily men under 65 who have already had heart attacks). Thirdly, the just-recently observed side-effect of statin use that reduces inflammation (as measured by C-Reactive Protein) has never been studied as an independent factor.

More recently, though, a spate of clinical trials has called the whole game into question. Thanks to a fantastic synopsis at the Healthy Skeptic blog, there’s a one-page summary that tears down the presumptions that statins are clinically useful. It’s an extremely important reference when having that all-important discussion with your doctor about statins. To say nothing of the many side-effects common with statins and that we don’t have any conclusive data about long-term use of statins (which seems important given they are being prescribed *for life*).

Now comes the all-out pressure to allow for prescribing statins as ‘preventative’ measures in a wide swath of the population.

Please be extra vigilant if your doctor proposes putting you on a statin. Educate yourself and ask really probing questions before just taking what you’re being told at face value.

Better to use diet and exercise the obviate the need for these hazardous drugs all together.

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