My primary objection to statins are: is cholesterol the best measure for risk of CVD? Does lowering cholesterol necessarily lead to better health? I recall having read a study (can’t recall where or which one) that may have indicated that a very large numbers of people would need to be medicated in order to “save” the one individual from a heart attack. While I certainly understand that if I am the one saved, I’d be grateful to have taken the statin. But what about all the others who took the statin without any benefit? If someone can locate the article, it would be great.
The medical community is quite divided on the need to use statins to lower cholesterol to reduce CVD risks. IIRC several of the doctors who advocate LCHF have stated that there does not appear to be a strong correlation between reducing cholesterol and achieving good health. On the other hand, there appears to be a stronger correlation between high triglycerides and poor health.
Having said all this, my tendency is to avoid medication if at all possible. Achieve good health from diet, exercise, lifestyle change, meditate, tai chi, do yoga, or whatever and medicate almost as a last resort. This is just my opinion. I think that there are potential side effects from medications that big pharma do not share with the public. Do you recall Resulin? The “miracle” drug of today may be “determined” to be unsafe at a later point in time.
First, having a background working with cardiologists, this question is more settled than many would have you believe. Yes, there is a healthy debate in the scientific community about exactly who should benefit the most from statin therapy, but the research question of should I be using statin’s in most patients with elevated cholesterol has strong evidence behind it. see below:
Evidence Supporting Primary Prevention
The WOSCOPS enrolled 6595 men aged 45 to 64 years with no previous history of myocardial infarction and a mean (SD) plasma cholesterol level of 272 (23) mg/dL. Treatment with pravastatin, 40 mg, resulted in a 31% reduction in myocardial infarction and CHD-related death (248 vs 174 events and 135 vs 106 deaths for placebo vs pravastatin, respectively).2
Similarly, the AFCAPS/TexCAPS randomized 6605 asymptomatic adults with a mean (SD) LDL-C level of 221 (21) mg/dL and low HDL-C (36  mg/dL) to lovastatin, 20 to 40 mg, vs placebo. Treatment with lovastatin reduced the incidence of first major coronary events by 37% and myocardial infarction by 40% (183 vs 116 events and 95 vs 57 myocardial infarctions for placebo vs lovastatin, respectively).3
The JUPITER trial enrolled 17 802 healthy men and women with so-called normal LDL-C less than 130 mg/dL and elevated high-sensitivity C-reactive protein greater than 2.0 mg/L. Aggressive lowering of LDL-C in those randomized to receive rosuvastatin, 20 mg, reduced the risk of myocardial infarction, stroke, and revascularization by about 44% (251 vs 142 events for placebo vs rosuvastatin) and total mortality by 20% (247 vs 198 events, respectively). The effect of aggressive LDL-C lowering in JUPITER was substantial considering that the baseline median LDL-C was just 108 mg/dL.4 Subanalysis demonstrated the largest absolute reduction in patients with a FRS of 11% to 20% (145 vs 74 events for placebo vs rosuvastatin; hazard ratio [HR], 0.51; 95% CI, 0.39-0.68) followed by those with FRS of 5% to 10% (59 vs 32 events; HR, 0.55; 95% CI, 0.36-0.84).5
Finally, a study that shows how many patients you have to treat to get a life year saved is a financial analysis to ensure the therapy is cost effective and isn’t meant to help a clinician decide whether to treat or not. Without knowing the benchmarks for cost effectiveness you can’t use that data to help decide if you should be treated. Rather this information is used to help the medical community decide if they should offer the treatments widely or just to a few patients.
The question that is being debated currently, and where there are separate camps are what to do with an otherwise healthy 55 year old, with normal BMI, with high cholesterol and no family history of cardiovascular disease.
That is indeed a tough question and there are differences of opinion. If however, you aren’t at a normal BMI, or you have a family history of cardiovascular disease and you have high cholesterol, you should think real hard about why you aren’t using statins.
I suppose the big question on my mind is how having diabetes plays into all those variables. Am I at elevated cardiac risk because i have diabetes? Or are people just statistically at elevated cardiac risk with diabetes because they’re usually overweight, older, sedentary, poorly controlled blood sugars etc etc…
What’s surprised me is how much my own cholesterol levels fluctuate over time and with exercise trends… my bottom line is that when a doctor I have a long term doctor / patient relationship with says it’s time for statins, there will be no hesitation, no further research on my part or any of that… I’ll just take them.
The first and best endocrinologist I have seen, in 2000, did a few things for me. First he got me on MDI with Lantus and novolog. Then he put me on an ACE inhibitor not as an antihypertensive but for the kidney protection because I had diabetes. And even though my cholesterol was in the normal range he put me on a statin because I had diabetes
I personally am grateful for his deft use of these drugs.
I can’t say how having diabetes affects this other than it increases your risk for CVD and should be a consideration in whether you choose to use this therapy. After working in a Cath/EP lab environment for 6 years I can tell you that the physicians I worked with felt that family history (genetics) was by far the biggest driver. For every person that hit the table that you said, wow they look like they should have cardiovascular disease, there was another that was a thin marathon runner in their 40’s whose only sin was picking the wrong parents.
Here is one review of Type 1’s and the CVD risk factors:
This was an interesting quote from the article.
“In type 1 diabetes as compared to type 2 diabetes, the relationship of hyperglycemia with microangiopathy as well as macroangiopathy seems to be more significant [6, 7]. According to the results of a large Finnish database, CVD mortality in patients with type 1 diabetes aged from 45–64 years at baseline increases by about 50% with every 1% increase of glycated haemoglobin (HbA1c)” .
Juutilainen A, Lehto S, Ronnemaa T, Pyorala K, Laakso M: Similarity of the impact of type 1 and type 2 diabetes on cardiovascular mortality in middle-aged subjects. Diabetes Care. 2008, 31: 714-719. 10.2337/dc07-2124.
It just struck me as super over the top on some other forum how rabid some posters were about them Just because they had some side effects… instead of discussing the side effects with the doctor and make adjustments as appropriate, perhaps discontinue them if their benefit doesn’t outweigh the side effects— nope! That’s too reasonable! Instead let’s get on the Internet and convince the entire world they’re evil!! Maybe we can convince some people whose life depend on them to stop taking them! Utter absurdity…
I agree, the inability of people to discuss issues rationally is an ongoing problem that the internet only makes more common (IMHO), because you can find like minded individuals from any perspective and talk yourselves into believing each other and pretend other opinions don’t exist or aren’t worthy of discussion.
Yeah it’s rampant on the Internet… I’ve spent a fair bit of time pondering if the reason we’ve seen the first decline in life expectancy in a long, long time over the past couple years may have something to do with people across the board having become more willing to take their medical advice from the Internet than from doctors over the last few years… it’s a rather alarming trend
Yeah, hypercholesterolemia is lifesaving! There’s absolutely no relationship between hypercholesterolemia and CVD whatsoever. Hyperglycemia is the sole culprit.
You’re probably right. These days people believe anything they read on facebook. If some orthomolecular paleo therapist in Nowheresville says something it must be true, right? I think it’s the same with vaccination. Internet hoaxes are probably (at least in part) responsible for the declining immunization coverage in my country. People who are under the delusion that they’re ‘thinking for themselves’ are parroting horror stories about vaccine ingredients. News article about flu shots? Copy-paste the vaccine hoax! None of these people who think for themselves actually take the time to look up the package insert, which is freely available online, to find out what the actual ingredients of a flu shot are.
I ought to have clarified in my initial post, is 200 a good number for determining whether a patient be placed on statins? How did they arrive at the 200 number? I recall that the cause for concern for cholesterol level used to be a little higher previously, perhaps mid 200"s. Has the cholesterol been steadily increasing with time for the patient? It seems a bit simplistic if a doctor were to decide to prescribe statin because the cholesterol number is above 200.
@Sam - you pointed out that your cholesterol levels fluctuate over time and with exercise trends. Also, very good point about the trust established by a long good relationship with the doctor, as well as the impact of genetic factors on our individual risk profile. I certainly don’t mean to suggest that we can achieve BG control by ingesting cinnamon (that one is promoted on the internet alot, or a commercial version in a pill form or something- we all know how ineffective it is in controlling BG) and forget medications.
I’m advocating that we can afford to have healthy “skepticism” (unsure if this is the best choice of word) when it comes to healthcare. Years ago, my knee was bothering me. I went to see a knee specialist. He suggested surgery. It was his expert opinion that my meniscus was not good, he has performed hundreds of these surgeries with good results…etc. I sought out a second opinion and was recommended physical therapy. I’m fine now.
My healthy skepticism applies to medications/science/nature. Thomas stated it rather nicely:
Which is more effective in reducing CVD risk? Better BG management, or better cholesterol level management?
When dealing with a genetically controlled inflammatory disease on a global, not individual, basis we are more concerned with risk factors, not single mitigating factors. It’s like saying that “smoking will give you lung cancer”. That is patently untrue. Smoking certainly will drastically increase your risk of getting lung cancer, but it is dependent on other risk factors as well.
So if you are asking which risk factor should be eliminated, then the best answer is both.
Again, depends on other risk factors present. I have multiple risk factors for CVD (diabetes, my father had CVD). My astute endo placed me on a statin when my total cholesterol was 140. If those other risk factors were not present then a statin at 140 would be inappropriate.
If your doctor is putting you on a medicine based on a number without discussing your individual background profile and personal risk factors, find a new doctor. Bascially, everything in medicine as in life is a risk vs. reward. If you are clearly in a risk group i.e. @docslotnick then the decision is easy. If you are a 45 year old person with no risk factors and high cholesterol, the decision may well come down to your (patient) decision.
So if you’re 50 something, fat, diabetic, and have cholesterol of the charts, and a doctor recommended strongly that you take statins, would you get on the Internet and relentlessly trash them and the faulty system that led them to make that recommendation?