I feel compelled to do a post today in response to medical news that
is all over the news wires today about statin drugs, that's the class
of drugs that lower your cholesterol levels. The LA Times Headline
says "about 70 million Americans could take statins under new
guidelines"
Let me just read the first few paragraphs of the article,
"The number of Americans taking cholesterol-lowering statin drugs is
set to double under new guidelines unveiled Tuesday by the American
College of Cardiology and the American Heart Assn.
The goal of prescribing statins to as many as 70 million people is to
reduce the incidence of heart attacks and strokes in the United
States, not merely to get patient's LDL cholesterol – the "bad" kind
that's most closely linked to disease risk – into an ideal range,
experts said.
The new game plan for statins represents a stark shift from approaches
embraced by cardiologists and primary care physicians for most of the
past decade. Now, doctors will be urged to treat a wider range of
healthier patients, including those likely to suffer stroke or heart
disease as they age.
The new guidelines distinguish between patients who would benefit most
from high-dose statin therapy and those who can take a lower dose less
likely to cause side effects, such as muscle fatigue, a slight rise in
blood sugar and, in rare cases, hemorrhagic strokes and a toxic
breakdown of muscle tissue called rhabdomyolysis.
Cholesterol is essential for digestion, hormonal balance and cell
function, but at high concentrations can gum up arteries. Statins
reduce cholesterol by blocking the liver's production of the waxy
substance. Americans spent $21.3 billion on cholesterol-lowering
medications in 2010, including statins marketed under such brand names
as Crestor, Lipitor and Zocor.
Under the new guidelines, physicians should prescribe statin
medications to all patients with high odds of suffering a heart attack
or stroke in the short-term — that is, those who have had such an
event already, patients with Type 2 diabetes, and those with
exceptionally high levels of LDL cholesterol linked to familial risk.
But the guidelines also recommend that patients with a 7.5% risk of
suffering a stroke or heart attack over the next decade be prescribed
statin medication as well."
Not surprising the Wall Street Journal reports "AstraZeneca Applauds
the Release of New US Guideline for Management of Blood Cholesterol"
It's not surprising because according to WebMD AstraZeneca's Crestor
was the number 1 most prescribed drug last year with 23.7 million
prescriptions and total sales of $5.3 billion dollars. These new
guidelines are expected to double the number of prescriptions for the
statin drug class having a major positive impact on AstraZeneca's
bottom line.
Another amazing development, in a story reported in Endocrinology
Update on Nov 4 past American Medical Association president Professor
Kerryn Phelps advised the public via her Twitter account to consider
stopping their statins. She twitted her comment while watching ABCs
series called Heart of the Matter Part 2: Cholesterol Drug War which
claimed that the medical profession and the public had been duped into
believing that statins were essential for preventing death from heart
disease.
One of the studies that they used to come up with these guidelines is
a meta analysis by the Cochrane group that added up results from 18
different trials to conclude that statins reduced deaths from all
causes in people with low risk of heart disease. Their conclusion was
that if 1000 people took a statin over 5 years, 18 of them would avoid
a major cardiovascular event. The British Medical Journal in October
of this year argues that the "events" in the trials included
procedures to improve blood flow to the heart and who knows if the
person would have had a heart attack if this hadn't been done? It also
says that the side-effects of statins such as increased risk of
developing diabetes (about 10%) and muscle pain (50% more common) were
not adequately reported. It further points out that all of the
randomized trials in the Cochrane review were funded by the
manufacturers of the statins being studied. Interestingly, another
Cochrane review unrelated to this story showed that industry-sponsored
studies are more likely to find positive results than non-commercial
trials.
Let me review with you some articles that have been published in the
last few months about the risks associated with statins.
Oct 25, 2013 the Men's Journal had an article called Statin's Latest
Side Effects. In this article they pointed out that in a trial of more
than 46,000 adults, statin users had a 27 percent greater risk of
developing vision-skewing conditions than non users. According to Dr
Daniel Briceland, spokesperson for the American Academy of
Ophthalmology "The lens epithelial cells are very sensitive to changes
in oxidative stress" Since statins interfere with oxidation processes
the eye cells might not regenerate properly to clear away cataracts.
According to Dr Paul Thompson, chief of cardiology at Harvard Hospital
in Connecticut, "We know that statins inhibit a process that dissolves
collagen and other fibrous tissue, so it could be that this interferes
with the eye's ability to repair damaged tissue."
According to the Chicago Tribune Oct 30, 2013, when Mevacor also known
as lovastatin, the first statin drug, was being developed, animal
studies suggested that cataracts might be a side effect. On May 21,
2010 a British study reported in the British Medical Journal online
showed that statins increased the risk of cataracts and the risk
returned to normal within a year of stopping the statin medication.
A new study reported in JAMA Ophtamology online on Sept 19, 2013
showed that cataracts are more common in statin users than non users.
Diabetes, according to Renal and Urology News, atrovastin had no
significant affect on a combined endpoint of cardiovascular death,
myocardial infarction also known as MI and stroke among diabetic
patients on hemodialysis. After 11.5 years of follow up in both
groups, daily atrovastin or placebo, 90% of the patients had died
despite the fact that the patients who were given atrovastin during
the trial had an average reduction in LDL cholesterol levels by 42%.
In the New York Times October 22, 2013 Dr Hosam Kamel, the vice
chairman of the American Medical Directors Association, a group
representing physicians in nursing home practice, said there was
scarce scientific evidence supporting the use of statins in 70 to 80
year olds in their care. He said that the results don't conclusively
establish the benefits of using statins for seniors and he went on to
say there is evidence of harm linked to statin use in seniors
including muscle aches, liver toxicity, gastrointestinal distress, and
growing evidence of impaired memory, heightened risk of diabetes and
increased risk of cancer.
According to Dr Rita Redberg, cardiologist at the University of
California San Francisco Medical Center and editor in chief of JAMA
the side effects associated with statin use was not reported in
studies. According to her summary of the evidence for using statins to
prevent heart disease, heart attacks will be prevented in only 1 or 2
out of every 100 healthy people with high cholesterol who take statins
for 5 years while 1 person out of those 100 will develop diabetes and
older people are much more vulnerable to the side effects of the
medications. She also says there is some evidence that low cholesterol
is associated with higher mortality at an older age.
Back in 2009 I appeared on KSCO Radio's The Wellness Hour with Bernie
Owens. (link is coming soon) Back then on that show I laid out the
facts about cholesterol and statin drugs as I saw them using the drug
manufacturers own research to back up my opinions.
I pointed out back then that inflammation was a better predictor of
cardiovascular events than cholesterol. In fact I stated on that show
that cholesterol had NOTHING TO DO WITH HEART DISEASE, that it was
actually a warning sign.
I laid out how, when you actually look at a lot of the research on
statin drugs and look at the raw numbers, not the conclusions at the
beginning and end of the articles but the raw numbers, many times
there wasn't any real significant, statistical difference in outcomes
of cholesterol lowering from the placebo groups.
I showed that statin drugs actually do 2 things.
- it's true they lower cholesterol but
- they are actually anti-inflammatory as well and it was this property
that produced the positive cardiovascular benefits.
I showed that lowering cholesterol numbers actually caused many other
problems ranging from issues with muscles because of co Q 10
depletion, low testosterone, low vitamin d, increased risk of cancer,
and increase risk of Alzheimer disease. So it is really refreshing now
to have a well-known cardiologist back up some of what I said back
then.
See my blog post, "Truth About Cholesterol"
http://pharmacistkeith.blogspot.com/2011/09/truth-about-cholesterol.html
http://keithabell.info/2013/10/are-your-prescriptions-making-you-sicker.html
