If you did a straw poll of a group of cardiologists at a conference and asked how many were taking statins as a preventative, I would suggest that response would be well over 50 per cent. There is this increasing belief amongst many members of the medical profession that statin drugs to lower cholesterol should be a vital part of the armamentarium of almost everyone over the age of 50 and those at high risk below this age.
Some researchers are actually suggesting that a polypill containing various doses of blood pressure medications, low-dose aspirin and standard dose statin should be taken in all people over the age of 55, regardless of cardiac risk. Although there have been numerous extrapolations around these comments, there are no studies to show dramatic, robust and long-lasting benefits from this practice.
But, does the science match the hype and also, is there the potential for any long-term harm with the use of statins for all, rather than make individual decisions based on patient risk? At the recent European Society of Cardiology meeting in Paris, Professor Villines presented a paper which clearly showed that statins were of no value given to patients who had a coronary calcium score 100 or below. A coronary calcium score uses CT technology to take a snapshot of the coronary arteries without dye or injections and has been shown to be the best predictive test for cardiac risk. I have been saying for 20 years that all males over 50 and all females over 60 should have at least one coronary calcium score to determine their cardiac risk. It should be performed younger, in isolated cases, in those people who were deemed at much higher risk for a vascular event, such as those people with a strong family history of vascular disease i.e. first-degree relatives with a history of heart disease below the age of 60 for males and 65 for females.
Unfortunately, there is this widespread tendency in the medical profession that as soon as your cholesterol nudges up, regardless of any other factors, you are commenced on a statin purely to lower the number in your blood stream. But, as mentioned above, your cholesterol should only be lowered if you are at high risk for a vascular event, such as a coronary calcium score greater than 100 and the other strong evidence is for people with proven vascular disease i.e. those who have already suffered a heart attack, had a coronary stent implanted or had undergone coronary artery bypass grafting.
But, you may ask, what is the problem with being on long-term statins? The clinical trials will tell you that there is a very low risk for muscle problems, with minimal other side effects. But, it is my clinical experience that around 20 per cent of people who take statins on a long-term basis develop problems with muscle pain, stiffness, weakness, cramping and even loss of muscle bulk. It is also my clinical experience that around 20 per cent of people, especially those who take the fat-soluble statins-atorvastatin and simvastatin, experience problems with memory, concentration, depression, fatigue, irritability and poor sleep. There are some studies suggesting a significant increase in diabetic risk, possible liver abnormalities and there are some unsubstantiated claims suggesting a potential for increased cancer risk after many years of taking these drugs.
A recent report published in the Annals of Rheumatic Diseases examined almost the entire population of Austria and reviewed the statin use within this population. Interestingly, there were low rates of osteoporosis in those people taking lower doses of statins but really only the water-soluble statins-rosuvastatin and pravastatin. Any reasonable dose of fat-soluble statin i.e. atorvastatin and simvastatin appeared to significantly increase the risk for osteoporosis.
As I only prescribe water-soluble statins for my patients and only in those patients with high coronary calcium scores or established vascular disease, it has been my practice to run the statin dose as low as possible to achieve the desired result of lowering cholesterol below certain values, depending on risk. Unfortunately, over the past decade there have been a number of studies suggesting that those patients at very high risk benefit from rather large doses of rosuvastatin or atorvastatin.
I have been involved with the research on the excellent natural product Bergamet Pro plus. We published a study in the International Journal of Cardiology showing clearly that rosuvastatin 20 mg daily (a dose that increases osteoporosis risk) reduced LDL cholesterol by 56 per cent. When we reduced the dose of rosuvastatin to 10 mg daily (a dose that actually reduces osteoporosis risk) and added Bergamet Pro plus one tablet twice daily, we reduced LDL cholesterol by 52 per cent with a bigger rise in HDL cholesterol and a very significant drop in triglycerides i.e. a better overall fat profile than the high dose of statin with clearly less risk to the patient.
In my view, it is time the medical profession rethinks its attitude to the widespread prescription of statin drugs and clearly limits the use for people where the science shows a clear benefit. I am always reminded of the first line of the Hippocratic Oath which states, “First do no harm”. So, should statins be put in the drinking water – clearly not!
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