Statins: the truth
JEROME BURNE - More by this author »
Last updated at 22:00pm on 29th January 2007
Those who are taking statins to lower their cholesterol may well be confused about whether it is worth it and how safe they are.
Last week an article in the medical journal The Lancet claimed the drugs don't benefit women or elderly men if they don't have a cardiovascular problem, while for younger men, taking statins only slightly reduces the risk of heart attack if they'd never had an attack.
• Have we been conned about cholesterol?
• Statins won't prevent women getting heart disease, claim doctors
• Are statins really the wonder-drug that everyone says they are?
And then Dr Malcolm Kendrick claimed in these pages that statins were useless because, he argued, heart disease isn't caused by raised cholesterol. He also warned they could have side-effects.
The medical establishment, however, insists that statins are important in combatting heart disease.
It argues that more of us should take statins -and that the benefits outweigh the marginal risk of adverse effects. To help you make sense of all this, JEROME BURNE addresses the vital questions...
Should I be taking a statin?
All the experts agree that if you've had a cardiovascular problem, such as a heart attack, taking statins is worthwhile because it does reduce your chances of having another one.
Statins are designed to reduce levels of lowdensity lipoproteins(LDLs) or 'bad' cholesterol - which fur up the arteries and lead to heart disease (although Dr Kendrick believes statins are effective for different reasons, most likely by reducing inflammation).
About four million Britons are taking statins. GPs are recommended to prescribe the drugs to anyone with a 20per cent risk of having a heart attack or stroke in the next ten years.
Then last November researchers at Oxford University recommended mass prescription of statins - claiming that people as young as 35 with even just a one per cent risk of a heart attack or stroke could benefit, gaining an extra nine months of life expectancy.
Two million more people would then be taking the pills.
At this point sceptics point to the risk of side-effects - this is known as risks-benefits analysis. If your chance of having heart disease is very small then the risks of sideeffects from a drug to stop it should also be very low.
So if you have some risk factors for heart disease - such as being overweight, having raised cholesterol, or if you are a man over 55 - is it worth getting low-dose statins from your local pharmacy?
With The Lancet research suggesting the benefits of statins for women and older men are almost non-existent, we need to consider if the risks still outweigh the benefits.
The two widely-recognised risks are muscle pain and weakness (myopathy) and damage to the liver, but these are said to be very rare; a small risk far outweighed by the benefits. A study by Dr Jane Armitage of Oxford University, involving 20,000 UK volunteers, found 'no significant side-effects at all'.
But Professor Beatrice Golomb of the University of California San Diego disagrees.
She found that muscle symptoms are common with statin drugs.
"There's a multibillion-dollar industry ensuring that you hear all the good things about statins," she says.
"But no interest group ensuring that you hear the other side."
She is particularly concerned with the effect of statins on our moods and memory.
"It's common to find patients on the drugs who report trouble finding the right word or forgetting what task they are supposed to be doing," she says.
In a recent paper, Professor Golomb also described patients who were irritable, hostile and had short tempers while taking statins.
Some even had road rage or homicidal impulses. She has also dealt with patients who developed temporary amnesia and cognitive problems.
"After a couple of months of statin use," she says, "one top accountant could no longer balance a cheque book and was fired."
To find out how common these side-effects are and who's likely to suffer from them, Professor Golomb launched a website last autumn on which she's posted a questionnaire called the Statin Effects Survey. She wants patients to report their experiences of statins, good or bad.
She believes that data on sideeffects is lacking because trials are designed to show the benefits of the drugs, not to detect problems.
Her concerns are shared by Swedish physician and cholesterol expert Dr Uffe Ravnskov.
Writing in the British Medical Journal last year, he noted that two of the big statin trials deliberately excluded patients who had suffered side-effects in pre-trial tests, and then claimed that the number of side-effects reported was low.
Earlier this month American research suggested that statins, because they lower cholesterol, could put patients at greater risk of Parkinson's disease.
But it's not all negative. It was recently reported that statins could be a potential treatment for virulent flu strains such as H5N1, which has killed 148 people in Asia.
At one point it was also suggested that statins might reduce the risk of Alzheimer's disease, although this has not been proven.
More recently statins were found to slow smokinginduced lung damage.
How do I reduce the statin risks?
The official line is that patients should not stop taking statins. As Professor Peter Weissberg, medical director of the British Heart Foundation, said last week: 'There is overwhelming evidence that statins save lives by preventing heart attacks and strokes.'
But what if you are taking statins because you've had a heart attack and are worried about potential side-effects? Dr Peter Langsjoen, a researcher at East Texas Medical Center in Tyler, Texas, believes he has a simple and practical solution.
Ever since statins were launched, it's been known that they have also dampened production of a vital enzyme called CoQ10 (also known as Q10); like cholesterol, it's made in the liver. Q10 is found in almost every cell in the body and is essential for energy production in the muscles.
So giving patients a supplement of Q10 could reduce side-effects.
Several years ago Langsjoen published a study in which patients with high levels of cholesterol but no evidence of heart disease were given the best-selling statin Lipitor.
A staggering 71 per cent of them developed a problem with their heart muscle that goes with heart failure.
Giving them a supplement of 300mg of Q10 reversed the problem for over half of them.
Many people now take Q10 along with statins as a precaution. If you are on statins and feel they may be causing muscle-related problems or brain fog, Professor Golomb suggests asking your doctor about stopping the drug or reducing the dose.
"If he or she won't do that," she says, "you could agree to increasing the dose for a little while and observe what happens to your symptoms." What if I'm not in a high-risk group?
For those not at a high risk of heart attack there are plenty of diet and lifestyle options for improving the health of your heart. The first is exercise - universally recommended for reducing the risks.
Next, get your doctor to check your levels of an amino acid called homocysteine. High levels are a risk factor for heart disease, independent of cholesterol.
To reduce homocysteine, increase your intake of B vitamins with green vegetables, or look for a supplement containing B6, folic acid and B12.
You could also increase your intake of plant sterols, found in seeds, nuts, and beans, as well as soluble fibre found in oats barley and aubergines - these also lower cholesterol.
A small study in the American Journal Of Clinical Nutrition last year found that plant sterols lowered cholesterol more effectively than statins.
The B vitamin niacin has also been shown to lower LDL cholesterol, along with two other markers for heart disease - lipoprotein (a) and fibrinogen - and raise the supposedly beneficial HDL cholesterol.
Omega-3 fatty acids are also important for the heart. Many studies show they bring down cholesterol and reduce inflammation linked with heart disease.
Finally, try curcumin found in the spice turmeric. Curcumin has been found to reduce the stickiness of platelets in the blood and relax arteries.
Several trials are currently testing its effectiveness.
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