Who Should Take Statins?

This is the first in a four-part video
series on cholesterol-lowering statin drugs. In these videos, I look at the effectiveness of statins,
who should take them, and what the true risks and benefits
are, so people can make a fully informed choice.
Check it out. “Who Should Take Statins?” The muscle-related side effects from
cholesterol-lowering statin drugs are often severe enough to make
patients stop taking them. Of course, the side effects could be
coincidental or psychosomatic and have nothing to do with the drug, given that many clinical trials show
such side effects are rare. Of course, it’s also possible that
those clinical trials, funded by the drug companies themselves,
under-reported the side effects. The bottom line is that there’s
an urgent need to establish the true incidence
of statin side effects. What proportion of symptomatic side
effects in patients taking statins are genuinely caused by the drug? Even in Big Pharma-funded trials
that found only a small minority of symptoms to be attributable
to statins, researchers found that those taking statins were significantly
more likely to develop type 2 diabetes than those
randomized to placebo sugar pills. Why? We’re still not exactly sure, but
statins may have the double-whammy effect of impairing insulin secretion
from the pancreas as well as diminishing insulin’s effectiveness
by increasing insulin resistance. Even short-term statin use may
approximately double the odds of developing diabetes
and diabetic complications. Here are the graphs. Those developing
diabetes and diabetic complications off of statins over a period
of about five years, and the development
of diabetes on statins. And if that’s not bad enough, this
increased risk persists for years even after the statins were stopped. Now, in view of the overwhelming
benefit of statins in the reduction of cardiovascular events, the
#1 killer of men and women, any increase in risk of diabetes,
only our 7th leading cause of death, would be outweighed by the
cardiovascular benefits, right? That’s a false dichotomy. We don’ t have to choose between
heart disease and diabetes. We can treat the cause of both with
the same diet and lifestyle changes. The diet that can not only stop
but reverse heart disease is the same one that can also
reverse type 2 diabetes. But what if, for whatever reason,
you refuse to change your diet and lifestyle? In that case, what are the risks
and benefits of starting statins? Don’t expect to get the full scoop from
your doctor, as most seemed clueless about the causal link with diabetes, so only a small fraction even
bring it up with their patients. Overall, in patients for whom statin
treatment is recommended by current guidelines, the benefits
are said to greatly outweigh the risks. But that’s for you to decide. Before we quantify exactly what
the risks and benefits are, what exactly are the current
guideline recommendations? How should you decide
if a statin is right for you? If you have a history of heart disease
or stroke, taking a statin medication is recommended. Period, full stop,
no discussion needed. If you do not yet have any known
cardiovascular disease, then the decision should be based
on calculating your own personal risk, which you can easily do online if
you know your cholesterol and blood pressure numbers with the
American College of Cardiology Risk Estimator, the Framingham Risk Profiler, or the Reynolds Risk Score.
Those are the direct links, but you can also use these shortened links. My favorite is the ACC one,
since it not only gives your current 10-year risk,
but also your lifetime risk. So for this person, for example,
even though their risk of having a heart attack or stroke within
the next decade is less than 10%, but if they don’t clean up
their act with those numbers it’s going to be nearly
a flip of the coin; whereas if you improved your
cholesterol and blood pressure, you could drop that risk
by more than tenfold. But the statin decision is
based on your 10-year risk, so what do you do
with that number? Well, under the current guidelines,
if your 10-year risk is under 5%, then unless there are extenuating
circumstances you should just stick to diet, exercise, and smoking cessation
to bring down your numbers. In contrast, if your 10-year risk hits
20%, then the recommendation is for you to add a statin drug on top
of making lifestyle modifications. Under 7.5%, unless there
are risk-enhancing factors, the tendency is to just
stick with lifestyle changes, and over 7.5% to move
towards adding drugs. Here’s a list of risk-enhancing
factors that your doctor should take into account when
helping you make the decision: a bad family history, really
high LDL, metabolic syndrome, chronic kidney or
inflammatory conditions, persistently high triglycerides,
or C-reactive protein, or LP(a). If you’re still not sure, these
guidelines suggest you consider getting a coronary artery calcium score, but
even though the radiation exposure from that test is relatively low
these days, the U.S. Preventive Services Task Force has
explicitly concluded that the current evidence is insufficient to conclude that the benefits
outweigh the harms.
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