What You Should Know About Statins

Google the word “Statin” and click on “news”. Somewhere on that screen is a post about the harmful effects of statins, and it is likely near the top. Today (early December 2018), you will find conflicting articles. Toward the top, a review on a new study questions the benefits of statins. Scroll down and you will find a review on another study telling us, higher doses of statins saves lives.

What are Statins?

In short, statins are cholesterol lowering drugs. WebMD lists simvastatin as the 2nd most prescribed drug, and Lipitor as the best selling drug. Both are statins. They have a long troubled history. First developed in the 1970’s, they were praised for saving the lives of millions. Here is a great article on the history of statins (A historical perspective on the discovery of statins). Today statins are continuously under attack. Their side effect profile is nothing to scoff about and has since become the focus of the “anti-statin” culture. Some accuse the drug companies (and even doctors) as pushing these drugs solely for financial gain.

How They Work

For the board exams, know that statins are HMG-CoA reductase inhibitors. If you’re interested in the chemical pathway, then finish reading about the history of statins. If you don’t care, then don’t worry. What you need to know is that by inhibiting this enzyme, statins lower cholesterol.

Cholesterol, specifically LDL (bad cholesterol), is what deposits on the inner walls of arteries and cause plaque. When the caliper of the artery is narrowed this is called atherosclerosis. We know through decades of research that atherosclerosis is the cause of heart attacks, ischemic strokes, and peripheral artery disease.

Logic would leave us to believe that statins therefore decrease incidence of heart attacks, strokes, and peripheral artery disease. Time and again, large cohort studies have reproduced similar findings (Heart Protection Study) (Scandinavian Simvastatin Survival Study)(CARE).

Muscle Aches

A common side effect of statins is myopathy. These muscle aches are the usual culprit for the discontinuation of statins. They also are a major source for the bad press that statins receive. While statins have a host of side effects, including mypopathy and rhabdomyolysis, they are generally well tolerated. It has been argued that there is likely a placebo effect when it comes to statin induced myopathies (Meta-analysis of Placebo-Controlled Randomized Controlled Trials on the Prevalence of Statin Intolerance).

Benefits of Statins

Heart disease continues to be the leading cause of death in the United States (CDC). There is a proven correlation with LDL (bad cholesterol) and atherosclerosis. Statins lower LDL.

Statins are also potent anti inflammatory agents. By lowering inflammation in the blood as well as lowering LDL, statins are considered plaque stabilizers (Mechanisms of plaque stabilization with statins). The direct cause of a heart attack or ischemic stroke, is the breaking off of a plaque which completely obstructs a smaller artery downstream. The targeted tissue is not oxygenated and in return dies. By stabilizing plaques, statins decrease the incidence of heart attacks and ischemic strokes.

Are Statins for You?

For over 4 decades, statins have been studied and tested. They are proven lipid lowering agents and proven life savers. It would be naive to believe there is not a financial motive in the development of any medication. There are certainly drugs that were once thought to be beneficial and later found to be nothing more than a fancy commercial. Statins however are likely the most tested drug class over the last 50 years. While side effects have to be considered, there has yet to be a reputable study contradicting their benefits.

Those at risk for coronary heart disease or atherosclerosis likely should have a discussion with their doctor and weigh out the risks and benefits of statins. It may save your life.

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