An optimally healthy diet and other lifestyle changes such as weight loss may be
able to bring about a healthy pattern of blood cholesterol without use of drugs and
their associated side effects and expense. But if diet and other lifestyle changes do
not work as well as needed, or are too difficult to be adhered to, therapy with statins
and other drugs are a good treatment choice for decreasing LDL-cholesterol and the
risk of CVDs.
Statins have been shown to reduce the risk of stroke and heart attack by about
one-quarter to one-third. They are now taken by more than one-quarter of Americans
age 45 and older. On average, statins bring about a 25% to 55% reduction
in LDL-C, a 5% to 10% increase in HDL-C, and a 10% to 20% decrease in triglycerides.
The more prolonged statin treatment is, the larger is the reduction in
CVD events. The downward trend in cardiovascular disease in the U.S. is attributed
in considerable part to the greatly increased use of statins. Studies have considered the benefits of statin therapy among healthy men and women with no previous history of CVD. One such study found a 31% reduction in
myocardial infarction and CHD-related death.
A meta-analysis of 27 randomized trials among people of low risk (a five-year risk of major vascular events lower than
10%) found that typical statin therapy reduced the risk of major vascular events by
about 20%. A meta-analysis review of statin therapy use among patients with
no history of CVD found a 12% reduction in deaths and a 25% reduction in CVD
events. A similar study found that treatment with a statin (lovastatin) reduced
the incidence of first major coronary events by 37% and myocardial infarction by
40%. The JUPITER trial among healthy men and women with a median LDL-C
of 108 mg/dl and elevated C-reactive protein found that aggressive lowering of
LDL- C reduced the risk of myocardial infarction, stroke, and revascularization.
In addition to the lipid-lowering effects of statins, they appear to improve the functioning
of arteries so they can carry more blood during exercise and reduce inflammation
as indicated by lowering C-reactive protein levels. Statins are usually trouble-
free, but at times they cause muscle aches, especially at the higher doses needed
for some people. There is also a small increased risk of developing diabetes, liver
damage, upset stomach, and reports of an increased risk of short-term memory loss
and confusion. A rare but serious side effect is muscle inflammation and damage
(rhabdomyolysis) that causes the release of a protein (myoglobin) from muscle cells
that can seriously impair kidney function.
Although some individuals report memory problems with certain statins, use of a
different statin may resolve the problem, and new data on the possible link between
statin use and memory is reassuring. It suggests that statins may even provide some
benefits for cognitive functioning. A six-year study found that statin ever-users and
never-users had no significant difference in the rate of decline in either memory or
global cognition. The study also found a protective interaction between statin
ever-use and the rate of decline in long-delayed recall performance for patients
carrying the APOE-4 genotype, the genotype with a high risk of Alzheimer disease.
A meta-analysis of 16 studies found no link between statin use and impaired cognition.
The study also found that in studies lasting three to 25 years, statins were
associated with a 29% decreased risk of dementia.
Statins are not a substitute for a healthy lifestyle. There is evidence that statin treatment
and increased fitness are each independently associated with lower mortality.
A study published in Lancet found that over a 10-year period, the risk of death was
18.5% in people taking statins versus 27.7% in those not taking statins. The mortality
of the fittest of those on statins was 70% lower than the least fit statin users.
The importance of fitness was shown by the finding that the fittest of the study subjects
who were not using statins had lower mortality than the least fit statin users.
The combination of statin treatment and increased fitness resulted in substantially
lower mortality risk than either alone, reinforcing the importance of physical activity
for all individuals, including those with high cholesterol.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel