By Dr Harold Gunatillake
FRCS, FACS (US), FIACS (US),
AM (SING), MBBS (Cey)
Most health professionals agree that it is vitally important that people who had suffered a heart attack or stroke should continue statin therapy
I bet that most of our readers are on some sort of statin to control their blood lipid levels (cholesterol and triglyceride), prescribed by their respective general practitioners. Statins like levacor, Zocor, Pravachol, Lipitor, Crestor and more, have been in the market for many years.
The sales of these drugs have escalated over the years, but the incidence of coronary heart disease, stroke, kidney disease and other diseases related to atherosclerosis; do not seem to have reduced the incidence. Cardiologists would disagree strongly and state that statins have served beneficially over the years, to minimise incidence of those diseases, especially heart attacks and stroke.
Statins inhibit HMG-CoA reductase (produced in the liver), that is they act by blocking the enzyme in your liver that is responsible for making cholesterol. A paper published in the American Journal of Cardiovascular Drugs cites nearly 900 studies on the adverse effects of HMG-CoA reductase inhibitors, also called statins. Statins also block CoQ10 nutrient which is vital for your mitochondrial health and provides energy for the workings of the heart muscles and brain. CoQ10 is considered as the vital heart nutrient that naturally prevents heart attacks and strokes. This is the reason why you should take CoQ10 if you are on statin medication. If statin medication makes you feel tired and show lack of energy it is due to the low levels of CoQ10 supply to feed the mitochondria in every cell in your body.
A recent study examined the effects of statin drugs on the likelihood of exercise-related injury. The researchers measured myoglobin and creatine kinase levels in subjects who were running the Boston marathon. Elevated creatine kinase is a sign of damage to muscles. Early signs of this development would be tiredness in the leg muscles on walking, and then leading to cramps and delay in the conduction in the nerves (neuropathy) supplying (innervating) these muscles. Muscles then start wasting
There can be cognitive loss, fatigue, neuropathy, anaemia, migraines, nausea and diarrhoea acidosis, frequent fevers, cataracts, and sexual dysfunctions, all related to taking statins in some people, also due to diminished levels of CoQ10. In some cases scalp baldness is related to statin therapy. There is also an increase in cancer risk due to immune system suppression. Statin drugs decrease heart muscle function and increase your risk of stroke. This may be due to elevated creatine kinase and lack of CoQ10 to supply sufficient energy for the workings of the heart.
There are two issues to be discussed here:-
(1). Is cholesterol a factor causing atherosclerosis leading to above-mentioned diseases, or is it inflammation of the inner lining of arteries (mucosa), the primary cause of atherosclerosis, and cholesterol only considered as an onlooker at the site of plaque formations?
The current view is that the cholesterol theory cannot be accepted as the cause for the above-mentioned diseases such as heart disease among others. Some believe that it is the low HDL (good) cholesterol responsible for heart disease, and the LDL (bad) cholesterol the major component of cholesterol circulating in the blood is as innocent and beneficial to the wellbeing, and that both forms of cholesterol transports fat to the muscles, heart, fat stores and other tissues and they too, functions as antioxidants.
(2). the other issue is should we take statins to bring down the cholesterol in the blood when it is supposed to serve a beneficial purpose. And should you take a statin even if you have normal cholesterol?
The JUPITER trial was a large international study that found that the statin drug rosuvastatin (Crestor) slashed the rate of heart attacks and strokes in people with normal LDL cholesterol who had elevated levels of C-reactive protein (CRP). CRP is a marker of inflammation, and there is increasing evidence that low-grade inflammation raises heart risk. The study involved 17,802 apparently healthy people from 26 countries. There were slightly more men than women – about a 60% – 40% split.
JUPITER was designed to last for four years, but it was halted just short of two years because the statin takers were doing so much better than those taking the placebo. For example, people taking a statin:
• were 54% less likely to have a stroke
• were 48% less likely to have a heart attack
• were 44% less likely to have any serious cardiovascular event, including cardiovascular death
• lowered their LDL levels by an average of 50%
• lowered their CRP levels by an average of 37%
These studies may be considered as sponsored research. There are also studies to show that statins should not be used to bring down the cholesterol level in the blood, after the age of 70. Studies done on old people in nursing homes, where statins were given to half the population having high cholesterol, and the other half no statins were given, though the cholesterol level was as high. At the end of a 10 year period, it was revealed that the latter group given no statins lived much longer than the other batch given statins for high cholesterol levels.
Statins linked with Diabetes
Recently, there was a circular sent by the US regulators (FDA) to state that people on statins must be warned about a small increased risk of diabetes or memory impairment as there is a pattern appearing to that effect. In most countries hundreds of thousands of people are believed to be using statins, including in Sri Lanka, to reduce their risk of heart disease, on recommendations of their family doctors and cardiologists.
Some health professionals and academics in most countries seems to think that the benefits of statins far outweigh the small risks identified and people on the drugs should not stop taking them unless they discussed with their practitioners.
Most health professionals agree that it is vitally important that people who had suffered a heart attack or stroke should continue statin therapy. Another issue identified by FDA in the US was the finding of higher blood sugars leading to diabetes on those who took statins. It is possible that Statins provoke diabetes by raising your blood sugar and insulin levels, and by robbing your body of certain valuable nutrients, such as vitamin D and CoQ10, which are both needed to maintain ideal blood glucose levels. Statins linked to high risk of dementia: Another risk factor observed by the FDA officials is that the concern related to memory and other brain function loss in some cases, but it was found that this could be reversed by stopping the drug.
The president of the Australasian Society for Clinical and Experimental Pharmacologists and Toxicologists, David Le Couteur, told Fairfax Media recently that people who were not at high risk of heart disease should reconsider using them. He said doctors and other health practitioners should focus on lifestyle interventions for people with high cholesterol but without other risks such as previous heart attacks, high blood pressure and smoking.
Statins linked with Asthma
A small study has revealed that people with asthma may find that their breathing may get worse after they start a statin drug.
The new study – being presented at the annual meeting of the American College of Allergy, Asthma, and Immunology in Boston – followed 40 asthma patients who were treated at the same California clinic for one year. After one year, patients taking statins performed 35% worse in a test of lung function than they did at the start of the study. Patients who were not taking statins also saw their lung function decline, but it was about 14% worse compared to how they performed at the start of the study. Patients on statins also reported that they had used their rescue medications [inhalers] 72% more often than they had at the start of the study. Those who weren’t taking statins used rescue medications 9% more than they had before.
Statins linked with liver and kidney problems
BBC News reports in 2010:
“Researchers looked at data from more than two million 30-84 year-olds from GP practices in England and Wales over a six-year period. Adverse effects identified in the study, published in the British Medical Journal, include liver problems, acute kidney failure, muscle weakness and cataracts.”
How to reduce side effects
You must understand the possible side effects before taking statins. Not everyone has side effects. Some researchers think it is genetic, and you are more likely to suffer from side effects if you are a female.
Discuss with your family doctor if you suspect any development of side effects after starting on a statin.
• The doctor may reduce the dose.
• He may request you to take the statin in the morning and not in the night time.
• If you still have side effects your doctor may change to another brand of statin.
More than taking statins, a change of lifestyle should be the ultimate aim.
• Always eat food with the least amount of saturated fat in them. Cut down your saturated fat content to less than 10 % by reducing the amount of meat consumed, including dairy products.
• Concentrate on eating salads, dark green vegetables and fish more frequently.
• One egg a day (190mg of cholesterol) has no effect on your serum cholesterol levels – (authors experience)
• Use coconut oil and polyunsaturated oils for cooking and use no more than a table spoonful at a time to prevent putting on weight. All good or bad oils tend to store in the body and lead to obesity.
• Exercise every day to keep fit and reduce cholesterol level in your blood.
If you are not certain whether to continue with statin medication, discuss the pros and cons with your family practitioner and also read health articles for better understanding.
To your good health!