The Statin Question: Can They Help?

Red heart in woman and man hands, on green background

I’ve been getting a lot of emails lately asking about statins. Statins are currently under fire and I want to set the record straight because I think the current negative media attention about statins could scare people away from a potential life-saving intervention.

Here’s what I think: There is conflicting data out there, and when people write about medical issues, they may oversimplify the results. It’s not easy to interpret the results of medical research, and the answers are rarely black and white. I do not dispute that statins have side effects (like many medications). These can include muscle aches, liver abnormalities, neuropathy and forgetfulness. However, these side effects don’t happen in everyone, and when a statin could save your life based on your individual symptoms and condition, they may be worth the risk.

Heart disease is the number one killer. We also know that the best treatment is prevention with lifestyle choices, like a healthy diet (I recommend a Mediterranean-style diet), regular exercise and effective stress management. The reality is that many people don’t live that way. Instead, they make choices that may promote the progression of disease. Many people live with elevated cholesterols and inflammation that lead to plaque in the arteries and heart attacks. We all know which lifestyle behaviors are good for our hearts, and if we all did them all the time, theoretically, we wouldn’t need medication.

In the real world, however, many people have heart disease, and we know the benefits of statins, especially following a heart event. What we know is based on multiple research trials. We know after someone suffers from a heart attack, statins can improve outcomes and prevent having another event.

The confusion towards statins comes in when we start trying to extrapolate data in ways that aren’t really relevant to individual studies. For example, when data showed that “Statins don’t help prevent heart attacks in women,” that was a misinterpretation. If you actually read the particular study, you see that what it actually showed was in women, statins did not prevent heart attacks that lead to full wall thickness damage.

However, what media reports of this study didn’t recognize or acknowledge was women are more likely to suffer “acute coronary syndromes,” which on the microvascular level kill off cells and not big wall segments. This nuance becomes important, because what was tested was the prevention of a disease process that doesn’t often take place in women. The effect of statins on the disease process that usually does the most damage in women, wasn’t even part of the study, so the conclusion people are drawing is for the most part an irrelevant one. It also doesn’t address or even question the affect of statins on improvement of life expectancy and morbidity.

Statins are not indicated for a person who is at low risk for heart disease with borderline elevated numbers. The guidelines do not recommend it. These are the people who can benefit quickly from dietary changes, exercise, and possibly supplement use, and whose cholesterol will likely go down with improved lifestyle choices. However, for those people who have had a heart event or a stroke, and/or those who have multiple risk factors for heart disease or diabetes, standard medical guidelines promote using statins, and so do I.

If you are ready, willing, and able, to change your life and decrease your LDL cholesterol to 50, reduce inflammation to less than 1.0, manage your stress, and start incorporating exercise into your life, then maybe the other options are enough. If you aren’t sure you can manage all of that, then you might want to consider the medication, in addition to changing those lifestyle habits you can manage.

I am not discounting those who demonstrate how their diets reduce heart disease. I am just reminding all of us that we are human and ometimes we make poor choices. If you are at risk for heart disease or already have it, statins might be the best choice for you.

Talk to your doctor, express your concerns, and know that if you have side effects, you can stop or change your medication. Lifestyle changes and pharmaceuticals can sometimes go hand in hand more effectively than either one alone. Just remember that statins are not the enemy, and in some cases, they could actually be your best friends.