Do You Take Statin Drugs?
Statin drug side effects are commonplace. In the previous Cholesterol article, we looked at cholesterol: the “believers versus the non-believers” in terms of lowering the “bad” cholesterol in the body. This month we look at the various approaches to conventional cholesterol lowering therapy and the potential side-effects they produce, and explain some more ways you can test to find out what is a more comprehensive way to more fully assess your risk of a stroke or heart attack, other than just checking the cholesterol levels.
Let’s take a closer look at cholesterol itself
Because cholesterol is not soluble in your blood, it is transported in your blood stream inside microscopic particles which are composed of fats (lipids) and proteins, the “lipoproteins”. Like miniscule submarines, lipoproteins travel in an ocean, the ocean of your blood stream where they can carry cholesterol in the body wherever there is a supply of blood – including your brain, heart, and even into the tiniest of blood vessels like your eyes.
These lipoproteins, have various names according to their density. The best known are HDL (High Density Lipoprotein), and LDL (Low Density Lipoprotein). The main task of HDL is to carry cholesterol from the periphery of your tissues, including the artery walls, the brain, and from all over the body to the liver for processing. Here LDL is excreted with the bile, and then out through the bowel or used for other purposes, for instance as a starting point for the manufacture of important hormones. Now you know why it is so important to have adequate fibre in your diet, so that your body has a substance with which it can bind the LDL to and adequately excrete it.
The LDL trucks mainly transport cholesterol in the opposite direction. They carry it from the liver, where most of our body’s cholesterol is produced, to the peripheral tissues, including the vascular walls. When cells need cholesterol, they call for the LDL submarines, which then deliver cholesterol into the interior of the cells. Most of the cholesterol in the blood, between 60 and 80 per cent, is transported by LDL and is called”bad” cholesterol, for reasons that I shall explain soon. Only 15-20 percent is transported by HDL and called ”good” cholesterol. A small part of the circulating cholesterol is transported by other lipoproteins.
You may ask why a natural substance in our blood, with important biologic functions, is called ”bad” when it is transported from the liver to the peripheral tissues by LDL, but ”good” when it is transported the other way by HDL. The reason is that a number of follow-up studies have shown that a lower-than-normal level of HDL-cholesterol and a higher than-normal level of LDL-cholesterol are associated with a greater risk of having a heart attack, and conversely, that a higher-than-normal level of HDL-cholesterol and a lower-than normal LDL-cholesterol are associated with a smaller risk. Or, said in another way, a low HDL/LDL ratio is a risk factor for coronary heart. Having a “high” cholesterol level is in itself NOT a risk factor, having a very low HDL and a very high LDL can be, however. Look at the ratios, not the numbers.
Oats, oat bran and barley are formidable LDL removers.
A study published in an American medical journal in 2002 found that the oats group experienced a significant reduction in both total cholesterol (9%) and low-density lipoprotein cholesterol (14%). The addition of oat cereals to the normal diet of patients with high blood pressure reduced blood pressure as well. Systolic and diastolic blood pressure dropped between 5 – 7% respectively, not bad for a bowl of porridge in the morning? Soluble fiber-rich whole oats may well be an effective dietary therapy in the prevention and adjunct treatment of hypertension. Grandma was right all along, a bowl of porridge in the morning keeps the cardiologist away. I always try to mention to patients what Hippocrates said many years ago, the “Food shall be your medicine, and medicine shall be your food”. Barley may also lower serum LDL cholesterol levels by up to 18%, due to barley’s beta-glucans content). It is interesting to mention that the sales of cholesterol-lowering drugs like statins are highest in the developed world, where we have forgotten that you need to eat plenty of fresh fruits and vegetables, and prefer to rely on foods in packets, boxes, tins and bags. May I suggest to the manufacturers of such highly processed products that they not only mention: “contains no sugar and low fat”, but also state “this low fibre food may require you to take a drug which lowers your cholesterol”.
The best fruits to lower LDL are apples, bananas, blackberries, blueberries, grapefruit, pomegranate and prunes. A study at School of Human Life Sciences, University of Tasmania, found that a chick pea diet lowered the “bad” cholesterol by almost 5%. As you can see, if you change your diet you don’t really need these Statin drugs. But optimal results will come by increasing your activity levels, reduce weight AND by eating the right foods as well. If we all did this, the 640, 000 who currently take a cholesterol lowering drug in New Zealand could be looking at a whole lot less pill popping and side-effects.
Are Statin drugs Really Necessary?
For healthy folk without major risk factors for heart disease (smoking, high blood pressure, family history of heart disease, family history of high cholesterol (with family members dying young of heart disease, high blood pressure, obesity and diabetes), there isn’t any solid concrete evidence that cholesterol lowering drugs are actually all that helpful in terms of preventing heart attacks and strokes. For men with risk factors, the majority of the studies show that they may prevent heart attacks but that they don’t actually decrease your risk of dying. Cholesterol lowering drugs do not prevent heart attacks in women without heart disease or in men without heart disease who are over the age of 70. And because studies have shown that cholesterol lowering drugs may reduce your risk of heart disease or stroke by about 0.2%, I am not really that hung-up on telling each and every patient with elevated cholesterol that I see to go straight to the doctor for a prescription of cholesterol lowering drugs. In my opinion, it is far more important to look at the whole picture when it comes to heart disease and stroke risk management, not just purely cholesterol. I have to give doctors some credit, they do tend to tell you to make some changes to your diet and lifestyle initially. And if your cholesterol levels have not dropped after about 6 weeks, they will recommend a drug to lower it.
Statins is the name for a particular class of medications designed to lower cholesterol. The statins commonly available in New Zealand are Lipitor (atorvastatin), and Lipex or Zocor (simvastatin). Doctors sometimes also refer to this group of medications as the HMG CoA reductase inhibitors. Statins work by interfering with an enzyme the body uses to make cholesterol so that it can’t make as much. They also increase the amount of cholesterol the liver takes up and removes from the blood. The result is that they can reduce the amount of LDL (the “bad”) cholesterol by about 20% to about 55%, depending on the dose and the type of statin being taken. They can also produce a small increase (5% to 15%) in ‘good’ cholesterol, that is, HDL cholesterol, depending on the dose and type of statin. The problem is – it all comes at a price, all pharmaceutical drugs generally do. And it is at a nice price for the share holders of these huge drug companies, the use of the cholesterol-lowering drugs called Statins rose by 156 percent between 2000 and 2005, rising from 15.8 million people to 29.7 million people in the USA. Spending on the drugs jumped from $7.7 billion to $19.7 billion annually in America over the same period. But it is not enough, and as you will see below they now want kids as young as 8 yrs old to start on these drugs!
I have given up counting how many patients I see regularly with tiredness and fatigue who have been placed on Statin drugs. This seems quite silly in one way, because if one gets tired, it does make it harder to exercise and stay motivated enough to maintain regular exercise – the very thing which encourages an increase in the “good” cholesterol (HDL) in the first place. Sore muscles, tiredness and a feeling of feeling vague are the more common side effects. Statins can cause liver damage, depression, memory problems, and joint pain. They can also cause damage to the muscle tissue which results in muscle pain. In rare cases this can lead to a breakdown of the muscle tissue which results in kidney failure.
Other common side effects of the statin drugs are stomach upset, bloating, flatus and headache, and in a minority of patients tenderness and actually a “wasting away” of muscle tissue. If you take a cholesterol lowering drug and develop pain in your muscles or any tenderness or weakness, please make an appointment to see your doctor as soon as possible. Your GP may also want you to have some blood tests when you start treatment with statins so that your progress can be monitored, I would suggest that you ask for a LFT (liver function test) as well after being on these drugs, just to make sure the drug is not interfering with your liver function, which they can do on occasion.
Have a good think: did you feel tired, have memory problems or have sore muscles before you went onto that Statin drug? If you have developed ANY of the above mentioned symptoms, it is time to visit your doctor and see what alternatives you have, don’t take no for an answer if you ask to come of the Statin drugs to see if your symptoms are really linked with his pill.. Ask your self is it really worth the small percentage chance that you may avert the risk of a heart attack or a stroke by being on a Statin? I’d like you to look at other ways of balancing your blood fats before you resort to drugs, such as weight management particularly, and also getting your liver in shape. My mother-in-law spoke with me about her experiences with Lipitor, her husband said that her memory was “shot” and that she was always complaining of being tired. She felt somewhat pressured by her GP to stay on medications, like all too many people in their 60’s commonly are. But when mum lost 15 kilos, her cholesterol levels became normal and when she came of the drugs her energy improved so much it was remarkable. It does concern me that so many people are on these drugs to “lower” cholesterol, and many are quite content to remain on them without realizing how unnatural it is to take a pill which creates side-effects and reduces the quality of one’s life – all in the crazy notion to “prevent” a heart attack or stroke. This to me is a bit like arming yourself with a handgun to “protect” oneself against crime. The message should be clear: you are on your own and when you are given a prescription by your doctor for cholesterol lowering drugs, and be especially tuned to potentially harmful side effects and please do trust your own intuition.
Plavix, which is manufactured by Bristol-Myers Squibb and used to help prevent strokes and heart attacks, has serious side effects you many not be aware of. When combined with aspirin, the drug nearly doubled the death rate from heart disease among patients who had not had heart attacks but were at risk for them. New England Journal of Medicine March 12, 2006
Is half a percent risk reduction really worth the bother – and side effects?
A prospective study (primarily on the use of statins) on CHD (coronary heart disease) lasting five years. Published all over the place, and trumpeted as proof of the wonderous effect of statins revealed a shocking 0.5% reduction in absolute risk of CV events – worth it for you, a half a percent risk reduction? This is apparently enough for your doctor to recommend this drug for you to take, and often for the “rest of your natural life”. An interesting PubMEd abstract you can read is: A systematic review and economic evaluation of statins for the prevention of coronary events.This paper evaluates the clinical effectiveness and cost-effectiveness of statin drugs for the primary and secondary prevention of cardiovascular events in adults with, or at risk of, coronary heart disease (CHD). Essentially, those with little evidence or risk have a 0.5% risk reduction, and I have seen countless patients over the years who fall into this category. The doctor authorises a blood test and bingo, the LDL is found to be “elevated” and the solution is automatically a statin drug. But hang on, the blood pressure is ok, the patient’s BMI is ok, their disposition is fine. Just the cholesterol, it’s up a little.
If you go to the Lipitor website, www.lipitor.com, you will read that the “common” side effects of this drug are: headache, constipation, diarrhea, gas, upset tummy and tummy pain, skin rashes and muscle and joint pains. Well, thanks for telling me. My doctor prescribed me a drug I have to take daily for “the term of my natural life”, and now the company who makes this drug I tells me that I can commonly find that I may experience a sub-standard health for the rest of my life as well. Great, I think I’d rather live with the increased tiny risk of developing a heart attack or stroke thanks, but I can make this risk miniscule by trying to adopt a healthy diet and lifestyle. If not and I stay on this drug, I’ll probably end up getting several other drug prescriptions no doubt for the headaches, the bowel problems, the fatigue, the skin rashes and most probably also for the depression I have developed along the way!
Should children be given drugs to lower their cholesterol?
Because Statin drugs have only really been around since the mid 1980’s, there is absolutely no evidence to show whether giving cholesterol lowering drugs to kids will actually lower their risk for a heart attack in middle age. New guidelines issued by the American Academy of Pediatrics in July this year are recommending a push to aggressively screen and medicate kids for high cholesterol levels with statin drugs, even as young as 8 years of age. This push is creating a real debate about the use (and abuse) of pharmaceutical drugs in children in general. Those who are for the idea say that there is a growing body of evidence that the very first signs of heart disease show up in childhood, and with over 30% of the American and Australian children now being classified as being overweight or obese, many health professionals are fearing an epidemic of heart disease and diabetes is just on the horizon. Come on people, let’s be real make some serious changes here. We need to see the real causes of obesity – the junk culture that we have created. It is time for the governments to tackle this problem seriously, as I have mentioned once before, through the media. Advertisements for cigarettes are not permitted on the box at night anymore, but we still allow pharmaceutical drugs, alcohol and those high fat take away foods to be promoted paraded shamelessly in advertisements alongside cars, bank loans and all those chemically concocted skin creams which are supposed to make you look gorgeous!
Kids spend too much time in front of a screen today, and it is this low level of activity coupled with high fat convenience lifestyle that desperately needs sorting. Drugs are again clearly not the answer; it is all about diet and lifestyle once again.
Real case study – Gary
Look at this cholesterol drug-induced problem a patient presented with a few years ago, let’s call this patient Gary (not his real name but the case was very real). Gary having had no previous experience with natural medicine, came with so many symptoms which his doctor was at a loss to help, that he would give anything a try. At about the age of 50 he was diagnosed as having a mild arthritic condition for which he was prescribed daily the anti-inflammatory drug Voltaren ® (diclofenac). At the age of 55, Gary developed chest pains that resulted in 5 stents eventually being placed in his upper chest, and was then promptly placed on one aspirin and Lipitor ® (a statin drug) daily. A stent is a tube that is inserted into the body, generally a tiny coronary artery near the heart, to prevent or counteract a disease-induced localised flow constriction such as narrowing of the arteries. By the age of 65, Gary was experiencing quite severe cramps in his feet at night, sharp gout like joint pains, very tight and sore muscles in the lower back which were causing a loss of flexibility. Soon after, several muscles in his body started to develop weakness, which his friends passed off as “old age”. It was when he developed memory loss and major tiredness affecting the quality of his life that he sought help from me.
On the morning of the 10th day of treatment, Gary called me with excitement and mentioned that he had experienced a huge change in his mobility, and most all the above muscular symptoms had disappeared! Gary has not taken one pharmaceutical pill for 2 years now and has never looked back. Lipitor is not for him, it simply did not suit him. The interesting point also is that Gary’s cholesterol levels were not really that far off the mark before his stent operation, and whilst his cholesterol was kept low on Lipitor, he had another cardiovascular risk marker called Lipoprotein A, which was found to be as high as 1370mg per litre of blood. The correct range for Lipoprotein A is from 0-200mg/L. His doctor had never even heard of Lipoprotein A. This is the cardiovascular blood marker probably which has contributed more likely to his angina (and consequent placing of the stents in his chest) than the actual cholesterol levels. There is no real pharmaceutical intervention for Lipoprotein A, and hence no real interest to pursue it in modern medicine.
Next article is the final in the cholesterol series, I’ll offer some sensible ideas about maintain healthy blood fats, and I’ll try to drive the real causes home a bit more about heart disease.
- Dr. Uffe Ravnskov : http://www.ravnskov.nu/uffe.htm
- The International Network of Cholesterol Skeptics (THINCS): http://www.thincs.org
- Qureshi, A. A., et al. Suppression of cholesterogenesis by plant constituents: review of Wisconsin contributions to NC-167. Lipids. 20(11):817-824, 1985.
- Keenan, J. M., et al. Oat ingestion reduces systolic and diastolic blood pressure in patients with mild hypertension: A pilot trial. Journal of Family Practice. 51(4):369, 2002.
- Pittaway, J. K., et al. The effect of chickpeas on human serum lipids and lipoproteins. Asia Pac J Clin Nutr. 13(Supplement):S70, 2004.
- New Ethical Drug Compendium 8th Edition ISSN 0113-9916 Adis International Ltd 2004