Should You Take Statins?

Cholesterol is only one of several factors that affect the risk of heart disease. Others include high blood pressure, smoking, lack of exercise, family history, poor diet, and being overweight or obese. One study estimated that 80 percent of heart disease could be prevented by changes in three lifestyle factors- diet, exercise and smoking. And yet the medical establishment remains focused on cholesterol levels and taking statins.

When I was in medical school, a total cholesterol below 240 mg/dL was considered acceptable, but over the years that was lowered to 220 and then to 200 by various advisory groups. In 2004, new guidelines that made LDL cholesterol the primary factor in deciding to prescribe statins were so stringent that millions more Americans were prescribed these drugs. Subsequently, it was reported that all but one of the nine members of the panel that wrote the guidelines had received funding from statin manufacturers.

A consortium of heart organizations came out with yet a new set of guidelines in 2013, based on your risk of heart attack in the next ten years, determined by an online calculator. You should take a statin, they advised, if your risk is 7.5 percent or more. Using the results of the online calculator, upwards of 70 million Americans, including almost everyone over age sixty-five, should be taking these drugs. Fortunately, a recently revised calculator (https://sanjaybasu.shinyapps.io/ascvd/) dials back the number of people advised to take statins.

Missing from these advisories is any consideration of the dangers of taking statins:

-One in five patients taking statins have side effects, with muscle pain being the most common.
-The FDA has issued safety announcements cautioning statin users about memory problems, diabetes, and liver function.
-Acute memory loss is four times more common in statin users in the first days of treatment.
-People taking statins have nearly a 50 percent higher risk of developing type 2 diabetes.
-Other side effects include cataracts, liver and kidney damage, fatigue, and mood disorders.

If you have had a previous heart attack or stroke and/or if you have a 20 percent risk of having one in the next ten years using the new calculator, you should consider taking a statin if you are not able to reduce your ten-year risk using lifestyle methods alone. In people with familial hypercholesterolemia, a genetic defect causing high levels of LDL cholesterol, statins are usually recommended. These people can also lower their risk of heart disease, as well as the dosage of statins needed, by diet, exercise, and smoking cessation.

While it is easier to take a pill, most of us could take a thirty-minute walk three times a week, up our intake of fruits and vegetables to five servings daily, and cut down on highly refined carbohydrates. Losing weight and stopping smoking are more difficult but can be done with proper motivation. Given the choice, what would you do? Change your lifestyle or take a pill? As the evidence of serious side effects from statins continues to grow—diabetes, cataracts, muscle damage, even dementia—the risk benefit equation tilts dramatically toward not taking them at all.

New Studies on Preventing Alzheimer’s

The Alzheimer’s Association estimates that one in eight people over age sixty-five has this disease and that the number will triple by 2050 to 16 million people. This would take a huge toll on our health care system, as well as on each family that would be burdened financially and emotionally dealing with their loved one. All of us, especially those approaching their “golden years,” want to do everything possible to avoid this fate.

Two new studies offer simple ways to prevent or treat what is called cognitive impairment, mild to moderate memory problems that can be early signs of dementia. The first study assigned participants with early memory impairment to either listen to music or to meditate for 12 minutes each day for three months. At the end of that time, both groups showed significant improvements in tests measuring memory and thinking ability. These gains were maintained or improved after another three months. Easy to do, cost-effective, and without side effects, these are activities that most of us can do on our own. (Journal of Alzheimer’s Disease, January 18, 2017)

You probably know that keeping active mentally is one way to prevent dementia. A recently-published study followed elderly people (ages 74-82) for four years to see how various activities affected their memory and thinking ability. Out of the 1929 people who were mentally normal at the beginning of the study, 456 developed cognitive impairment. Those who reported playing games, doing crafts, using a computer, or participating in social activities 1-2 times a week had a significantly lower risk of developing this problem than those who did them only 2-3 times a month. My bridge partner will be happy to hear this. (JAMA Neurology, January 30, 2017)

Finally, a provocative new study suggests that those people who develop high blood pressure late in life—age 80 or beyond—have a significantly lower risk of dementia. This is compatible with several other studies that found more cognitive impairment in seniors with a systolic blood pressure (the top number) below 130 and better mental functioning in those with values above 160. The authors of the new study theorize that higher blood pressure is needed in the elderly to force adequate blood flow to the brain due to age-associated hardening of the arteries. (Alzheimers Dement, January 17, 2017) On the other hand, high blood pressure earlier in life is thought to contribute to dementia, due to damage of the arteries leading to the brain.

There is also research linking many common drugs—statins, acid-reflux drugs, anti-histamines, tranquilizers, anti-depressants—with mental impairment and dementia. More about that in my book, coming June, 2018.

Is Exercise Better Than Statins?

If you are one of the 36 million Americans taking a statin drug, or if you have been advised to take one, you should know about a new study that compares statins to exercise. Statins (Lipitor, Zocor, Crestor) are the most widely used drugs in the world, with $29 billion in sales in 2013. They are prescribed to lower cholesterol, which most doctors think contributes to heart disease.

Whether or not to take a statin is a dilemma for many, since official guidelines recommend them for virtually everyone over age 65. But as many as one in five people taking statins develop muscle aches and pains, which causes them to stop exercising. This is bad news, since exercise is important for preventing heart disease. So a group of researchers looked at ways that people taking statins could avoid muscle problems and continue to exercise.

Their surprising conclusion after analyzing dozens of studies? People are better off stopping their statins and exercising instead! The researchers reported that:

Exercise is equivalent to statins in preventing heart attacks and strokes, but it is better in reducing overall deaths.
Exercise can delay or prevent diabetes while statins increase the risk of diabetes.
Exercise is associated with decreased obesity while statins sometimes cause weight gain.
Exercise has been shown to increase quality of life, while statins have not.
Exercise benefits the elderly (over age 75) while statins have not been shown to do so.
There is more evidence of the benefits of exercise over the long-term (more than 10 years) than with statins

Not mentioned in the study were the many other side effects of statins, including memory loss and dementia, cataracts, liver and kidney damage, excessive fatigue, mood and sleep disorders, and sexual dysfunction. You can read more about these in my book.

How much exercise is enough? The authors were not specific, but a minimum of 30 minutes of moderate exercise (fast walking, biking, dancing, swimming, running) three times a week is the recommendation by many expert groups.

For those of you interested in more details about the study, it was published in the Journal of the American Board of Family Medicine in 2016, Volume 29, pages 727-740.

The Top Five Drugs To Avoid

While researching my book, Do You Really Need That Pill?, I came upon many drugs that can cause more harm than good. But there are five specific types that I think most people should avoid, due to their questionable effectiveness and potential side effects. Many of these are blockbusters heavily advertised by Big Pharma. Of course, there are people who actually need these drugs, but they are few and far between.

My book covers these drugs in much greater detail and I will focus on each one more specifically in a later post. But for now, here is the nitty gritty on the top five types of drugs to avoid, if you can:

Statins (Lipitor, Zocor, Crestor) are prescribed to lower cholesterol. Current guidelines advise that nearly everyone over age 65 take them but there is little evidence that they actually prevent heart disease in people without risk factors or a previous heart attack or stroke. One out of every five people taking them experiences muscle damage and they can double the risk of diabetes. Statins have also been associated with memory loss, dementia, and impaired liver function.

Acid Reflux Drugs (Nexium, Prilosec, Prevacid) were approved by the FDA to be taken for only 2 weeks, yet many people take them for months or even years. They suppress stomach acid, which prevents the body from absorbing essential nutrients such as calcium, iron, and Vitamin B12. This leads to such problems as anemia, depression, bone fractures, and dementia.

Osteoporosis drugs (Fosamax, Reclast) are unnecessary for the vast majority of women who take them. There is little evidence that they strengthen bones or prevent hip fractures and there are several dangerous side effects. Exercising, getting plenty of calcium and Vitamin D in your diet, and avoiding excess alcohol and caffeine are better ways to improve your bone health.

Anti-depressants (Prozac, Paxil, Zoloft, Effexor) are effective in as few as one out of seven people with mild to moderate depression. Side effects include sexual dysfunction, suicide, bleeding disorders, and diabetes. Psychotherapy, exercise, meditation, yoga, and alternative therapies such as acupuncture and homeopathy can alleviate depression.

Opioid pain relievers (morphine, codeine, OxyContin, Vicodin, Percocet) caused more than 30,000 overdose deaths in 2017 despite research showing they are no more effective than over-the-counter pain pills like ibuprofen. Another nearly 30,000 deaths were attributed to synthetic opioids such as fentanyl. Because of their potential for addiction, the FDA now recommends that prescriptions for opioids be limited to seven days.