Saturday, April 13, 2024

Patients static about statin medications

Controversies surrounding statin medication use are being played out in the news, leaving people who have borderline or high cholesterol confused about whether or not they should be taking the cholesterol-lowering medications. I’ve asked one local expert, who has done substantial research on the topic, to put statin use in perspective for Fit Life readers.

Dr. Charles H. Hennekens, researcher, physician, professor and senior academic adviser to the dean of the Charles E. Schmidt College of Medicine at Florida Atlantic University, coauthored an editorial in the May 2015 issue of the scientific journal “Trends in Cardiovascular Medicine.” In it, Hennekens refers to the latest body of evidence to help guide physicians in their use of statins for treating unhealthy cholesterol levels in patients.

Here’s what Hennekens had to say:

Fit Life: Statins have been in the news lately as being overprescribed. Could you comment?

Hennekens: The facts are that statins have net benefits from the highest risk patient who has had an occlusion in the heart or brain to the low risk subjects previously thought to not require the drug. In this wide range of [people], there is still underutilization of statins, which produce statistically significant and clinically important reductions in heart attacks and strokes, as well as deaths, from cardiovascular causes and total mortality.

Fit Life: The role of cholesterol in heart disease also seems to be evolving. Do you believe it is cholesterol or inflammation that clogs the arteries?

Hennekens: Atherosclerosis is the principal underlying cause and thrombosis [blood clots] is the principal proximate cause of occlusions in the heart or brain. Almost one in two men and women will die from these causes. In lay terms, inflammation initiates the damage and deposition of lipid in the plaques of the arteries and promotes the damage leading to a heart attack or occlusive stroke.

Fit Life: In a recent FAU press release, you address that clinicians should consider the ‘totality of evidence, which includes the entire risk profile of the patient as well as the benefits and risks of the drug’ when deciding whether to prescribe statins. Could you give me a real-world example of how clinicians should look at a person’s risk profile and benefits/risks of using statins?

Hennekens: Most risk calculators do not include such factors as obesity and physical inactivity. Thus, a patient who is a borderline candidate for a statin based on the risk calculator, who is obese and physically inactive, has a much higher actual risk than predicted. Further, most of the data, such as the landmark Framingham Heart Study, comprise middle class white populations, so blacks and Hispanics are also likely to have higher actual than predicted risks. Finally, family history of a premature event doubles the risk beyond the risk calculator prediction.

Fit Life: Are there strict definitions on what constitutes high cholesterol? Is it the ratio? The LDL? The particle size?

Hennekens: There are over 210,000 subjects randomized to statins and treated, ranging from the highest risk secondary prevention patients to lowest risk primary prevention subjects.  In these trials, there is no threshold for LDL below which statins do not confer a net incremental benefit.  These trials include placebo control as well as more versus less intensive statins. Thus, other modalities such as particle size may help clinicians who are not sure of what to do based on all the available evidence but, for the vast majority of subjects, LDL will suffice.

Fit Life: How much impact can diet have on cholesterol lowering? And are there some people with genetically high cholesterol who are immune to the benefits from diet?

Hennekens: Therapeutic lifestyle changes should be the mainstay of the treatment and prevention of cardiovascular disease, and diet is extremely important. The good news is that a proper diet can lower LDL by 30 to 40 percent. The bad news is that in clinical practice, a five percent lowering is usually achieved, creating the need for adjunctive therapy with a statin as the first-line drug for virtually all [patients] who require drug therapy.

Fit Life: Finally, what is one piece of advice you can offer my readers who are in their middle ages, reasonably fit and might have mildly high cholesterol? Should they jump on the statin bandwagon or ask specific questions before starting on the drugs?

Hennekens: The bad news is that most people prefer the prescription of pills to the proscription of unhealthy life styles. The good news is that a proper diet and increased physical activity will avoid the need for statins in many [people]. It is also true, however, that the statin will provide lifesaving benefits, even to those who do not practice the therapeutic lifestyle changes. The good news is that the U.S. is experiencing its greatest life expectancy ever. The bad news is that in the last decade, it is largely due to better living through chemistry, which means the judicious use of statins, aspirin, angiotensin converting enzyme inhibitors and receptor blockers, as well as beta-blockers. If you consume a healthy Mediterranean type diet, lose weight, increase daily activity to about a 20-minute brisk walk, avoid or stop smoking, control blood pressure and lipids and avoid or keep alcohol consumption to one drink per day, the quality and quantity of your life will be increased.

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About Lisette

Lisette Hilton, president of Words Come Alive, has had the luxury of reporting on health, fitness and other hot topics for more than 23 years. The longtime Boca Raton resident, University of Florida graduate and fitness buff writes for local, regional and national publications and websites. Find out more on wordscomealive.com.

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