There were over 25 million people last year already taking statins when some new recommendations came out recommending them for 13 million more. They are wildly popular, probably in part because it’s so nice to have good results you can measure, and if you take statins, you’ll see very clear-cut, measurable results on your cholesterol numbers.
Whether they keep you healthy is less clear. They definitely do better than the non-statin cholesterol-lowering drugs like Zetia: Zetia definitely lowers your cholesterol but has not been shown in studies to actually reduce your risk of heart attacks or strokes. I mean, the reason you worry about cholesterol levels isn’t because having high cholesterol itself is going to have some sort of noticeable effect on your quality of life; it’s because having a high LDL (“bad cholesterol”) level causes heart disease. You would think, reasonably, that lowering someone’s cholesterol would reduce their risk of heart attacks, and this is such a reasonable assumption that Zetia remained quite popular even after a 2006 study concluded that it didn’t actually help with that in a measurable way.
But, all drugs have side effects, and all drugs have risks. Ten percent of people who use statins develop severe muscle pain (or even long-term muscle damage) and statins also appear to markedly raise your risk of Type II diabetes, especially if you’re female. A more recent study found that statins may raise your risk of Parkinson’s – though mostly what that study found was that statins definitely do not lower your risk of Parkinson’s.
If you take statins, you are less likely to die of a heart attack. But, if you didn’t already have heart disease (just precursors to it like high cholesterol), you’re not any less likely to die – because while you’re less likely to die of a heart attack you’re more likely to develop diabetes.
If you’ve already had a heart attack or clear indications of heart disease, statins are clearly beneficial: they reduce mortality. For that matter, if you already have diabetes, they also really want you to take statins, and I guess at that point the drugs definitely aren’t going to give you diabetes. A 2007 study found that statins “reduced all-cause mortality” in patients with diabetes – which is to say, the study participants, all of whom had diabetes, were overall less likely to die if they were taking statins. But, the study was done on veterans and the participants were overwhelmingly male. Seriously, I mean they were 98% male. Also 70% white.
There was a whole new family of drugs in the news the other week: Repatha and Praluent, both of which are in trials and expected to be approved and available in another two years or so. Though the focus of the completed trials was on determining whether the drugs lowered cholesterol (they do), researchers also tracked heart attacks and strokes, and the new drugs appeared to cut the risk in half. Still not known: whether they cut the overall risk of death. Also, it’s worth noting that the studies were small, and the testing was “open label,” which is to say, the people getting the experimental drug knew that they were getting an experimental drug. They also found that these drugs had a 1-2% chance of causing memory problems or other cognitive side effects. Cognitive side effects are up there with sexual dysfunction on the list of drug side effects a lot of people are not willing to live with, especially for a drug that treats a problem that doesn’t affect your day-to-day quality of life. They’re also extremely expensive compared to statins. Statins cost about $500/year and are available as pills; the new drugs require an injection and are expected to cost $7,000-$10,000 per year.
Clearly, statins help some people significantly; I imagine the new drugs will, too. I find it baffling that they give them to patients without established heart disease, though, given the findings that they hurt as many patients as they help. I’m sure in part this is because heart disease is the leading cause of death for both men and women, and there’s not a lot doctors can do about it – I mean, they can tell you to quit smoking if you smoke, and they can tell you to exercise if you don’t, and they can tell you to eat better food regardless of what you’re currently eating (it’s probably wrong), but they can’t make you do any of those things. They can’t make you take statins, either, but if they prescribe them for you, you probably will.
And to some extent I think it really does come down to numbers: there’s something deeply satisfying about seeing a number change, and with LDL, unlike so many other things, doctors really can just hand you a magic (-seeming) pill and turn the dial. If you have high LDL cholesterol and no established heart disease, though, maybe start by trying avocados?
[Image via Shutterstock]