PIC FOR REPRESENTATION Some studies suggest adverse effects of the cholesterol lowering drugs outweigh the benefit they offer. But there’s no conclusive evidence.
There’s a fresh debate over the value of statins, the drugs which act to reduce levels of cholesterol in people who have a risk of heart attack or stroke. Many patients have phoned me for advice in the past few weeks; this happens every time there’s a new research paper on this widely used group of drugs.
A study in the Annals of Internal Medicine weighs statin’s benefit against its risks (some harmful side effects). Dr Milo Puhan, an epidemiologist at the University of Zurich, and his colleagues believe that several patients are being prescribed statin unnecessarily, increasing their risk for diabetes and liver damage. Puhan’s own opinion is that perhaps 15 to 20 per cent of older adults should be taking statins, much less than the 30 or 40 per cent suggested by current medical guidelines. He also says that elderly patients don’t benefit from statin as much as previously thought.
Generally, doctors recommend statins if they think a patient has 7.5 per cent to 10 per cent chance of a heart attack or stroke in the next 10 years. Dr Puhan says that doctors should strike a balance between the benefits and harmful side effects of statins. The Swiss research team created a benefit-harm index to identify thresholds where positive effects exceed risk.
The American Heart Association has come up with new guidelines for managing cholesterol. Dr Scott Grundy, who chaired the taskforce that framed them, said people who fall in a grey area, where it is not clear whether they should take statins regularly or not, should get a CT scan which looks for calcium deposits in the heart, a possible sign of diseased arteries. If your calcium scoring is low, the chances of a heart attack for the next 10 years are also low.
Forty per cent of people who are prescribed statins based on their age, cholesterol levels and risk factors actually have clean arteries. But here, one must make a difference between primary prevention (preventing the first heart event in a person who has never had one) and secondary prevention (preventing another episode in a patient who has suffered an event before or has been diagnosed with symptoms of heart disease). Obviously, a physician would not deny a statin to patients falling in the second category except in unusual circumstances.
Some trials involving patients aged 65 or more revealed that statins don’t help a great deal in primary prevention. The ALLHAT trial studied the condition of 2,867 elderly patients, observing that moderate doses of statin for primary prevention did not provide a significant cardiovascular or mortality benefit. The all-cause mortality, in in fact, was higher in the group that took statin.
Physicians normally used a calculator called ‘QRISK’ to determine the risk of cardiovascular disease in a person. If your risk is 10 per cent or higher, then statin therapy is recommended. According to an estimate, 30 per cent of all adults over the age of 40 take the drugs. Since age is a risk factor, most men reach the threshold by the time they are 65 and women by the time they are 70.
A research article in the Pharmaceutical Journal tells us that taking a statin daily for five years after a heart attack extends your life by only four days. According to Rita Redberg, a professor at the University of California, out of 100 people who take statins for five years without suffering a heart attack or a stroke, at best one or two will avoid an event. Statin will have no impact on how long they live.
Yes, statins may cause some side effects, the most common being muscle pain. Different statins suit different people. Occasionally, there may be a case of breakdown of muscles resulting in kidney failure. The drugs can cause liver damage, but such instances are not common. They are also linked to higher blood sugar level and confusion and memory loss. Women with a small body frame are prone to the side effects if they are aged 65 or more, have pre-existing kidney or liver disease, or drink too much. Certain food items, beverages and antibiotics may interfere with statin.
Now let’s go through the beneficial aspects of the cholesterol-lowering drugs. They reduce inflammation of heart arteries, keep internal arterial lining healthy, stabilise blockages and prevent a rupture. They also lower the incidence of stroke and may offer some protection against Alzheimer’s disease and dementia. They have some effect on the platelets.
I think if you already have symptoms of cardiovascular disease or have suffered a heart event, statins are a must. For the purpose of primary prevention, the available evidence and data are contradictory, especially in the case of the aged. There’s no size that fits all, and a decision must be taken after consultations with the doctor.
Forty per cent of people who are prescribed statins based on their age, cholesterol levels and risk factors actually have clean arteries
Disclaimer : The views expressed here are the author’s own. The opinions and facts expressed here do not reflect the views of Mirror and Mirror does not assume any responsibility or liability for the same.
Click here to view original web page at How beneficial are statins?