Statin drugs to lower cholesterol were first released in 1987. Since that time, these have become the mainstay of therapy for the management of elevated cholesterol. There have been numerous studies showing significant benefits in high-risk cardiac patients when treated with statin drugs.
However, over this time there has been a significant backlash from the public with significant concerns about the rather prominent side effect profile. Many of my patients have the misconception that I am anti-statin and often make an appointment to see me with the hope that I will stop their statin drugs.
My friend and colleague in the United Kingdom, Dr Aseem Malhotra recently wrote a book 'A Statin free life'. I wrote the forward to that book. My perspective on statins is that the medical profession gives these drugs far too much power while the public gives statins far too much pain.
As with most things in life, I believe the answer is somewhere in the middle. The evidence is very clear that cholesterol should not be treated, but rather a cardiac risk. The best assessment of cardiac risk is a coronary calcium score, not a fasting cholesterol level.
If you do not have a history of heart disease and you are a male over age 50 or a female over age 60 with a coronary calcium score less than 100, numerous studies over the past 20 years have shown clearly that there is no benefit from being on a statin drug regardless of your cholesterol levels.
Unfortunately, however, there are numerous misconceptions about the side effects of statins. There is no doubt that about 20% of people who take statin drugs have problems with muscle pain, stiffness, weakness, cramping and often loss of muscle bulk. It is my opinion that the use of Ubiquinol 100-150mg daily and magnesium orotate along with maintaining normal vitamin D levels may mitigate many of these symptoms.
Another major misconception is that statin drugs may contribute to dementia. A recent study from Norway published in the Journal of the American Medical Association Network Open demonstrated that there was no link between statin drugs and dementia, nor a link between people with hereditary hypercholesterolemia and dementia.
The link with dementia is with poor lifestyle and this is the topic for another discussion. It is my clinical experience, having prescribed statin drugs since the late 1980s that the fat-soluble statins, atorvastatin and simvastatin have about a 20% incidence of reversible memory loss, problems with concentration, fatigue, irritability and poor sleep. Because the blood-brain barrier is a fatty membrane, these drugs easily penetrate this membrane and may lead to these symptoms but once the drugs are stopped the symptoms are totally reversible. The water-soluble statins, rosuvastatin and pravastatin may still contribute to these symptoms, but less so. Thus when I prescribe a statin for appropriate patients, I routinely prescribe water-soluble statins.
Dementia, and in particular Alzheimer's disease, is typically a non-reversible, progressive disease and there is no doubt that it is not caused by statin therapy.
Although I strongly believe that statin drugs are overprescribed for people purely because they have elevated cholesterol, I also have no doubt there is a strong place for statin therapy in people with established heart disease and in those with a coronary calcium score, typically above 100.
It is important, however, that we do not overemphasize the importance of statin therapy. When you carefully examine all of the evidence, practicing the five keys to being healthy is 80% of the management of cardiovascular disease. Statin drugs and other pharmaceuticals would contribute about 10%, along with the appropriate use of evidence-based supplements, another 10%.
The problem for most human beings is that about 90% of the population does not have the discipline to practice healthy lifestyle principles. If everyone in society did practice the five keys to being healthy, people like me would be twiddling our thumbs all day with not much to do.