Statins, while having been shown to prevent second heart attacks, have not been conclusively demonstrated to prevent first heart attacks. While it would seem reasonable that someone with a higher risk for heart disease would take a statin preventatively, studies have not shown that to be a conclusive finding. Interestingly, the Jupiter5 study (Justification for the Use of Statins in Prevention) showed that lowering LDL, or bad cholesterol, without subsequently reducing inflammation, as measured by C-reactive protein, did not prevent heart attacks or death. This study and others were a confirmation that statin drugs probably work, in part, by reducing inflammation in the body instead of the assumed mechanism of lowering cholesterol. However, there are many variables associated with a reduction of inflammation. Many nutritional factors, such as antioxidant rich fruits and vegetables and omega-3 fatty acids have been shown to reduce inflammation. Omega-3 fatty acids have also been shown to have a favorable impact on cardiovascular health.
In another trial called the Enhance trial, a combination medicine trial was done using two cholesterol-modifying drugs, Zocor and Zetia. Both drugs in combination lower cholesterol much more than one drug. In this study, the combination actually led to more arterial plaque development and no fewer heart attacks. In addition, there may be risks of lowering cholesterol excessively. Some studies suggest potential risks may include an increased risk of Parkinson’s disease, autoimmune problems, cancers of various types, memory, neurologic deficits, diabetes, and death from other causes. These potential risks would be in addition to well-known side effects of Statin drugs. These would include forgetfulness, decreased libido, fatigue, muscle and joint pain, and potential liver complications. Some of which, while rare, can be fatal.
Additionally, other studies also show essentially no disease reduction, especially in select groups. Women, for example, in terms of mortality, have demonstrated little benefit in some studies. One example would be the study authored by Judith Walsh, M.D., in the Journal of the American Medical Association in 2004.
Evaluating heart disease risk beyond cholesterol, it is preferable to develop a comprehensive analysis through objective clinical lab work. Factors beyond cholesterol would include fractionated HDL and LDL, lipoprotein(a), fibrinogen, clotting chemistry, genetic profiles, homocysteine, inflammation markers, such as CRP, in addition to the obvious risk factors of diet, diabetes, and a sedentary lifestyle, to name a few considerations.
Understanding all of the facts synergistically, and individualizing therapy, would seem to be offer more precise discernment in decision making. It would not be helpful, for example, to think that everybody should be on a statin drug just because their cholesterol level is slightly high. It should be a conversation with broad considerations between the individual and their medical practitioner.
– Dr. Guyer
