Statins to lower cholesterol are now one of the most widely used drugs, and as the medication is prescribed more frequently, doctors and patients are asking questions about possible side effects. In response, Huseyin Naci, MHS at the London School of Economics and Political Science in London, along with other researchers, conducted a review of 100 studies and almost 250,000 patients. Although there are some problems associated with statins, the reviewers determined the overall benefits outweigh potential risks.
Mr. Naci and his team reviewed years of clinical research on seven statin drugs. They determined that side effects are not common among those taking statins in heart disease. They also learned:
- Users of statins have a 9 percent greater risk of developing diabetes.
- Users of statins have elevated liver enzymes, a risk for liver toxicity.
- Pravastatin and Simvastatin (Pravchol and Zocor) appear to be safer than other statins
- There is no evidence to indicate an increase in cancer risk.
Renowned Florida cardiologist Arthur Agatston, M.D. analyzed the results with Everyday Health. Dr. Agatston is co-developer of the Agatston Score (also called the calcium score), a way of screening for coronary calcium to determine the presence of atherosclerosis. The score is used all over the world and is widely-regarded as the best predictor of future heart attacks.
Agatston says 20 years experience with statins shows they are safe, but their use should be restricted to people who really need them. With regard to the risk of diabetes, Agatston says even in patients who already have the disease, some do not accumulate plaque. If plaque is present, the benefit of statin treatment outweighs its potential to increase blood sugar slightly.
Regarding which patients should be taking a statin, Agaston says:
Almost all people who have had a heart attack should be on a statin. Those who do not have established heart disease, but who have a family history of heart disease or any conventional cardiac risk factors (high cholesterol, diabetes, obesity, high blood pressure, smoking), should have a CT heart scan for a calcium score if they are men over age 40 or women over the age of 50. This test will let them know if they are accumulating plaque in their coronary arteries and are at risk for a future heart attack. The presence of plaque on a heart scan is a much better predictor than cholesterol levels of who is destined for a heart attack.
Each of us has our own level of cholesterol where it builds up in our vessel walls, causing the atherosclerotic plaque that can lead to a heart attack. If plaque is present, your cholesterol is too high for you and a statin is likely indicated.
Dr. Agatston says if a patient has plaque in the coronary arteries as revealed by a CT heart scan, or if a patient has had a heart attack or has been diagnosed with coronary artery disease, that patient should keep his or her LDL cholesterol, the so-called “bad cholesterol,” below 70.
For patients with no plaque and no known heart disease, Agatston says there is no single “right” threshold. Every individual is different. Many people with total cholesterol below 200 have heart attacks, and some people with much higher cholesterol have completely clear arteries.
He also says belly fat is clearly associated with heart disease. A waist circumference of more than 40 inches in men and 35 inches in women elevates cardiac risk. He considers waist size and a family history of diabetes more important that Body Mass Index. People can carry extra fat without being at risk for heart disease.