By Judy Rupp commentary
August 27, 2008 12:33 am
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If you’re one of the 12 million Americans now taking a cholesterol-lowering statin drug, you know the benefits. Your cholesterol undoubtedly has dropped, as has your risk of dying from a heart attack or stroke.
Statin drugs such as Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin) and Zocor (simvastatin) work by partially blocking an enzyme that controls how much cholesterol your body produces. They also help the body remove LDL (bad cholesterol) from the blood and, to a lesser degree, have positive effects on HDL (good cholesterol) and triglycerides.
There’s no question in anyone’s mind the best method of improving cholesterol and thereby lowering the risk of heart disease is through lifestyle measures — diet, exercise and not smoking. Yet the fact remains for the majority of Americans the most effective way to get their cholesterol to a healthy level is by combining these healthy habits with a cholesterol-lowering medication.
Studies consistently have found statins lower LDL cholesterol by 10 to 60 percent. As a consequence of that and other studies, doctors have been prescribing statins for patients considered at high risk of a heart attack. About 10 percent of American adults are now taking a statin.
As deaths from heart disease have fallen by 36 percent over the past decade, the case for statins has been made.
The evidence is clear. Nearly all doctors agree for high risk patients — particularly those who have had a heart attack — statins are an effective way to prevent a recurrence. Most doctors also prescribe statins for other persons considered to be high risk — those with very high cholesterol or blood pressure, for example, or those with a close family member who has had a relatively early heart attack or stroke.
Plaque deposits in arteries take years to develop and are not so easily broken down simply by removing some of the LDL cholesterol that feeds them. Studies have shown the effect of statins on plaque deposits is small compared to their effect on LDL cholesterol. Yet statins start to work within a matter of weeks.
Doctors now believe, in addition to lowering LDL cholesterol, these drugs may work by reducing inflammation and oxidation, improving the healthy dilation and contraction of blood vessels and preventing the breakdown of existing plaque deposits that often leads to the formation of blood clots.
Subjects in the west of Scotland study who took pravastatin had a reduced incidence of diabetes compared to those taking placebo. And women taking statins had greater bone density than other subjects. All of these possible “side benefits” are based on observational studies and must be confirmed by randomized, controlled studies.
More promising are results of a study of nearly 25,000 heart failure patients. Those who took statins over a two and one half year period were 43 percent less likely to die and 30 percent less likely to be hospitalized than patients not taking statins. In another study, patients with a dangerous heart arrhythmia taking statins were 78 percent less likely to die compared to those not taking statins.
Simvastatin has been used successfully in the treatment of multiple sclerosis. And a controlled study found atorvastatin superior to placebo for the treatment of rheumatoid arthritis. In all of these instances, the benefits attributed to statins were not because of their effects on LDL cholesterol.
With a growing list of potential benefits, some observers have begun to talk of statins as miracle drugs and to recommend widespread use. All drugs come with a risk of adverse, as well as beneficial, effects.
For statins, adverse effects include muscle pain and weakness and, in rare cases, a severe breakdown of muscle tissue that leads to kidney failure. The drugs can cause severe liver damage, and some recent reports have linked the use of one statin to neurological and memory problems. Statins also may slow the body’s production of coenzyme Q10, a substance that helps cells use energy. The most serious effects, of course, are rare.
While you should not be scared away from taking statins because of these potential problems, neither should you take lightly long-term use of any drug. Before prescribing a statin — or any drug — your doctor will carefully look at the risk-benefit profile of the drug being considered as it relates to your continued good health.
Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.
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