Should we be using statins more than we already are?
New research published in the American Journal of Medicine has sparked more debate on this hotly discussed topic.
Researchers from Harvard Medical School and the Charles E. Schmidt College of Medicine at Florida Atlantic University have called for wider prescriptions of statins, arguing that the drugs are underutilized.
“The totality of evidence clearly indicates that the more widespread and appropriate utilization of statins, as adjuncts, not alternatives to therapeutic lifestyle changes, will yield net benefits in the treatment and primary prevention of heart attacks and strokes, including among high, medium, and low risk patients,” Dr. Charles H. Hennekens, professor and senior academic advisor to the dean at the Charles E. Schmidt College of Medicine, said in a press release.
The researchers explored the link between diabetes and the use of statins, and concluded that the possible (but unproven) link between statins and newly diagnosed diabetes is insignificant compared with the benefits of the drug on vascular diseases.
“Our grave concern is that there will be many needless premature deaths, as well as preventable heart attacks and strokes, if patients who would clearly benefit from statins are not prescribed the drug, refuse to take the drug, or stop using the drug because of ill-advised adverse publicity about benefits and risks,” Hennekens told Healthline.
Disagreement among experts
Not all cardiologists are in agreement with Hennekens and his team.
Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, says the call for wider prescription of statins is lacking in evidence.
“I find it remarkable that a drug which has been the number one seller worldwide for many years [$20 billion in sales in both 2011 and 2012], could be called underutilized. The problem is that he [Hennekens] thinks many people who have much more chance of being harmed by statins and would get little to no benefit should take them, which is not based on any evidence,” she told Healthline.
Statins lower cholesterol by blocking the substance in the body that makes it. The drug also assists with re-absorption of cholesterol that may have built up on the artery walls.
According to the Mayo Clinic, side effects from the drug can include muscle pain, digestive problems, mental fuzziness, and in rare cases, liver damage.
Redberg argues that despite the side effects, those with known heart disease should take statins.
“The adverse event rate is significant for statins, but in this group [secondary prevention] the benefits generally outweigh the harms,” she said.
But Hennekens believes statins can be used in a much wider group.
“In a worldwide meta analysis of 22 randomized trials involving 134,537 subjects treated and followed for five years, those assigned to statins had significant reductions in subsequent heart attacks, strokes, and cardiovascular deaths. There was no level of LDL cholesterol [bad cholesterol] below which benefits were not apparent,” he said.
In a 2013 opinion piece for The New York Times, Redberg, alongside Dr. John Abramson from Harvard Medical school, argued that “statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease.”
Four years later, Redberg still has the same concerns.
“Research shows that in the last decade, people taking statins grew more sedentary and more obese than people not taking statins, likely because people taking a pill ‘to be healthy’ are less motivated to watch their diet and get regular exercise,” Redberg told Healthline.
Lifestyle vs. drugs
Hennekens and his team reason that statins should be the “first-line drugs of choice” and act as adjuncts, not alternatives to therapeutic lifestyle changes.
However, the researchers write there is “evidence for benefits of statins even among subjects who are unwilling or unable to adopt therapeutic lifestyle changes.”
So where does this leave people wondering whether or not statins are a safe choice for them?
Redberg suggests people could utilize online decision aids provided by the Mayo Clinic, so they can understand their chance of benefit from taking statins.
In the meantime, Redberg argues maintaining a healthy lifestyle is of critical importance.
“Eating a bit more fruits and vegetables daily, eating less red meat, cutting out processed foods, and getting regular physical activity, such as walking, have huge benefits on health,” she said. “Such lifestyle measures have been shown in large epidemiological studies to reduce the rate of heart problems by up to 50 percent and to be associated with living longer. And people feel better when they make even small healthy lifestyle changes. That cannot be said for statins.”