Heart health: Should you be taking statins? How to talk to your doctor about whether to take cholesterol-lowering statins.


Special Contributor

The Dallas Morning News
Feb. 1, 2011
Statins are almost as ubiquitous as aspirin.

One group of British researchers went so far as to propose that fast food restaurants hand out packets of statin, along with ketchup and mustard, to offset the heart health risks of a cheeseburger and fries. (In Great Britain, you can already buy the cholesterol-lowering medication over the counter in low doses.)

Many doctors prescribe statins readily and enthusiastically, because the medication is effective — it clearly lowers LDL (“bad” cholesterol) and reduces the risk of heart attack among people with heart disease. Plus, most statins are relatively safe and inexpensive.

“Statins lower cholesterol so well, they have revolutionized our treatment of heart disease,” said Dr. James Park, an interventional cardiologist at Texas Health Presbyterian Hospital Dallas. “As a result, some doctors have started to prescribe them prophylactically.”

And that’s where the debate begins.

Last year, the FDA approved the use of one statin drug, Crestor, for people who don’t have heart disease and don’t have high cholesterol — but do have high levels of CRP; a marker for inflammation, and at least one other risk factor. That came after a 2008 trial that concluded that the drug lowered the combined risks of heart attack, stroke or other “heart events” by 47 percent in patients in that group.

So, is it time to start thinking about adding statins to the water supply?

Not so fast.

Another study, released last summer, questioned the conclusions of the 2008 trial. And some doctors, like Dr. Howard Brody, point to statins as a poster pill for overmedicated America.

“Tens of millions are prescribed statins for which there is no clear benefit to offset the risk of adverse reactions,” says Brody, who is director of the Institute for Medical Humanities at the University of Texas Medical Branch in Galveston. “Patients should at least know there’s another viewpoint.”

Before you say, “Please pass the statin,” Park advises, remember that every medication, even aspirin, involves some risk. Not everyone can tolerate statins, which can cause muscle and joint pain, and the drug can cause liver damage.

Confused yet? New studies seem to emerge every week highlighting a new benefit — or danger — associated with statins. One recent study suggested that statins might actually increase the risk of stroke among patients who’ve already had strokes. Others have suggested that statins may reduce the risk for some types of cancer. Much like the debate over hormone replacement therapy for women, the research often appears to contradict itself.

If you’re the average layperson, how do you weigh the data? Well, you may not want to try this at home. Instead, ask intelligent questions if your doctor proposes statins for you — or if you think you might benefit from them.

Such as: What are my risk factors for heart disease? What are the odds of having a heart attack or other “heart incident”? Statistically speaking, how much is statin therapy likely to reduce the risk? And how does that benefit stack up against the cost of the medication and the risk of adverse reactions?

And before starting on statins, Park says, patients should at least ask their doctors whether lifestyle changes — exercise and a healthier diet — are an option for reducing cholesterol levels, without medication.

Embarking on statin therapy is typically a lifelong commitment, says Dr. Dan Rader, director of Preventive Cardiovascular Medicine at the University of Pennsylvania School of Medicine. “Patients should be thinking in terms of the next 20 to 30 or even 40 years,” he said, because the benefits last only as long as you take the medicine.

And know that many medical professionals do lean toward prescribing the drug as a preventive measure — even for themselves. Park remembers sharing a table at a medical conference dinner in Las Vegas, where nine out of 10 of his tablemates — all physicians and pharmacists — were taking statins, even though most had no risk factors for heart disease.

But Park, the cardiologist, wasn’t one of them.

“I’m a little adverse to taking any drugs, unless I really need them,” he said.