Whether or not you know what statins are may depend on your age. If you are over 40, your doctor has probably discussed them as a way of managing cholesterol. If you are under 40, the word may be alien to you. However, those who have knowledge of statins tend to fall in one of two camps: you know them as a drug that effectively helps manage cholesterol or you avoid them like the plague because of their perceived side effects.
A major new study published in Lancet might help alleviate any trepidation those who belong in the second camp may have, as it suggests the benefits of statins have been underestimated, while the perceived harms have been exaggerated.
What Are Statins?
Statins are a class of drugs used to reduce low-density lipoprotein (LDL) cholesterol and are commonly prescribed to the over 70 million adults in the US with high LDL cholesterol levels. In fact, 26% of adults in the US were using statins in 2012, according to the CDC
When LDL cholesterol levels are above two to three milliliters of cholesterol per liter of blood, the risk for stroke, vascular disease, and heart disease is significantly increased. Statins work by inhibiting the enzyme involved in the body's ability to produce LDL cholesterol, lowering the risk for catastrophic and life-threatening events.
The World Health Organization reports that raised cholesterol levels contribute to an estimated 2.6 million deaths worldwide annually. With so many global deaths attributed to high LDL cholesterol and 70 million adults in the US living with it, one might think that more people would be proactive in managing high LDL cholesterol. However, according to the CDC, only 1 in 3 adults with high LDL cholesterol has it under control and less than half who are living with it are getting adequate treatment.
These daunting numbers could be attributed partly to the reputation that precedes statins. People are often cautious about taking them, or even decline taking them based on reported side effects, without fully understanding the evidence driving their decision. This is understandable, as reported side effects include an increased risk of hemorrhagic stroke, muscle pain and weakness, and onset of diabetes.
To provide the evidence needed to help people make an informed decision, the study published in Lancet analyzed all available evidence concerning the safety and efficacy of statin therapy. The findings were decidedly in favor of their use.
The Benefits of Use
The study in Lancet reported a few key findings supporting use of statins. One finding focused on the daily use of 40 mg of atorvastatin by 10,000 patients for five years. Among these 10,000 patients, it was determined the drug would prevent 1,000 people who had pre-existing heart conditions from having major cardiovascular events such as heart attack or stroke.
For those who are at increased risk of cardiovascular events due to conditions such as diabetes and hypertension, but haven’t had a heart condition, the same regimen would prevent 500 catastrophic events.
Given that every year over 700,000 Americans have a heart attack, with over 200,000 happening in those who have had a previous event, statin therapy has the potential to prevent tens-of-thousands of cardiovascular events annually.
Further analysis revealed that for each 1 mmol/L reduction in LDL cholesterol made via statin therapy, risk of stroke and heart attack is reduced by around 25% for each year the drugs are taken following the first year.
Concerns do exist, however, in a potential rise in statin use to treat people who have high cholesterol, but do not have previous cardiovascular, diabetes, or hypertension. This could lead to more people taking them than is needed.
The debate is still out as to whether statins reduce the risk of cardiovascular diseases in healthy people with high cholesterol. However, for those diagnosed with cardiovascular disease or have had a previous cardiovascular event, statin therapy could prove highly beneficial.
What About the Harms?
The study also examined whether the controversies surrounding the use of statins are merited. Findings did reveal an occurrence of side effects, such as muscle pain, hemorrhagic stroke and diabetes; however, the rate of occurrence was relatively low.
Among the 10,000 patients studied, researchers found the drug would cause five to 10 hemorrhagic strokes, 50 to 100 new cases of diabetes, and up to 100 cases of symptomatic adverse events, such as muscle pain.
Harms should still be acknowledged and informed to patients, but attributed harms are tiny in comparison to the potential benefits of statin therapy.
Statin therapy has also been linked to an increased likelihood of a range of other conditions including liver disease, sleep disturbance, memory loss, cataracts, suicidal behavioral, neuropathy, and erectile disjunction. However, evidence for statin therapy causing them is not sufficient and occurrence is extremely rare.
There may still be more to learn concerning statin therapy, but the benefits seem to significantly outweigh the risks. They are probably a wise bet if you have high cholesterol and have been diagnosed with cardiovascular disease. As with any medication or decision concerning your health, you should discuss the matter with your doctor to ensure that you make an informed decision.