Statin-Free and Still Ticking: The New Guide to Heart Health


This little drama plays itself out in doctors’ offices thousands of times every day. After your annual physical, your blood work comes back from the lab with a cholesterol reading above 160, the high range for the “lousy” cholesterol, LDL (low-density lipoprotein). Even though it seems you’re in good health – your blood pressure is in order, and there are no other flag-raising lab results – your internist fixes you with a look of concern and strongly advises you to go on statins to drop that LDL number. If you do, you’ll be in good company: One in four men over age 45 takes the medication, the most prescribed class of drugs in America. Statins are a $14-billion-a-year industry, accounting for 215 million prescriptions filled annually.

Or you could just say no.

In the past few years, three major research reviews have arrived at the same conclusion: Statins provide real benefits to those who already have heart disease, but for those whose only risk factor is high LDL, not so much. How is it that one of the most popular prescription drugs for men is potentially ineffective? Statins interfere with the liver’s ability to produce cholesterol, and less LDL in the blood means there’s less available to accumulate as plaque that clogs up arteries, increasing the risk of heart attack. But for people without evidence of heart disease, their risk of keeling over from a heart attack is already so low that the statins don’t seem to buy much extra protection. Dr. David Newman, head of clinical research in emergency medicine at Mount Sinai, has crunched the numbers for 25,000 to 30,000 people with no known heart disease who have been on statins for five years. The drugs saved no lives, but they did help prevent nonfatal heart attacks in 1.6 percent of this group. That’s not nothing, but it’s got to be weighed against the 10 percent who developed muscle problems caused by side effects from the drugs and the 1.5 percent who developed statin-driven type 2 diabetes.

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Odds are this news has not reached your primary care physician – or if it has, it likely didn’t cause him to change his prescription-­writing habits. “Doctors often think they’re dispensing magic, which just reflects their poor understanding of the research data,” Newman says. Statins are serious drugs that fight a serious disease, but if you’ve got high LDL, not cardiovascular disease, they shouldn’t be your first line of defense.

So what to do? The boilerplate, but no less true, answer is to change your diet. The Mediterranean diet, rich in fresh vegetables, fruits, olive oil, and fish, is one of the most effective for heart health, shown to reduce heart attacks by 30 percent, according to a landmark study in the New England Journal of Medicine this past February – more than any drug on the market. While reducing heart attacks beats reducing LDL any day, if you or your doctor is worried about those cholesterol numbers, simply substituting those types of foods for carbohydrates and trans fats can drop your LDL cholesterol by 10 percent. If you lose five pounds and add regular exercise to dietary changes, you might get a 15 to 20 percent reduction – on par with the results from taking statins. “If you have a choice, Mother Nature will always trump Mother Pharmaceutical Industry,” says preventive cardiologist Dr. Michael Ozner, author of Heart Attack Proof.

You can also take a more targeted dietary approach. A 2011 multicenter study published in the Journal of the American Medical Association found that people who received counseling about eating a handful of specific cholesterol-lowering foods (see next page) dropped their LDL numbers by 10 percent more than a group on a standard heart-healthy diet low in saturated fat. One big caveat here, for the men whose livers are genetically programmed to produce high amounts of cholesterol: “There’s a limit to how much diet and exercise can do for them,” says Dr. Dennis Goodman, clinical associate professor of medicine at New York University, “and they actually are good candidates for statins.”



Statin’s Latest Side Effect

 618_348_the-blurry-side-effect-of-statinsStudy links statins to increased.


It seems as though every other week, we learn of another just-discovered side effect of statins. Now, a new study has connected the commonly prescribed cholesterol-lowering drugs to a heightened risk of cataracts, a clouding of the eye’s lens.

In a trial of more than 46,000 adults, statin users had a 27 percent greater risk of developing the vision-skewing condition than nonusers. Although previous statin-cataract research has turned up conflicting results – no surprise, given this study’s giant sample size – this study reveals a legit link. However, it’s too early to tell whether statins actually cause cataracts.


Experts aren’t sure why statins affect cataract risk, either, but they have a few theories. “The lens epithelial cells are very sensitive to changes in oxidative stress,” says Dr. Daniel Briceland, spokesperson for the American Academy of Ophthalmology. Since statins interfere with oxidation processes, the eye cells might not regenerate properly to clear away cataracts.

“We know that statins inhibit a process that dissolves collagen and other fibrous tissue, so it could be that this interferes with eyes’ ability to repair damaged tissue,” says Dr. Paul Thompson, chief of cardiology at Harvard Hospital in Connecticut.

But should a higher cataract risk scare you away from statins? That depends. “Statins save lives, but if your risk of heart disease is extremely low, the risks of statins may outweigh the benefits,” Thompson says. “On the other hand, I don’t know many cardiologists who are not on a statin.”


Briceland – the eye doctor – says to always put your heart before your eyes. “Cardiovascular disease is the number-one cause of death among U.S. men,” he says. “So we should be looking at statins’ effectiveness at reducing heart disease risk – not at the relatively small cost of potential cataract surgery.”



Can Statins Cause Diabetes?


Statins may increase your risk of type 2 diabetes by 46 percent, a new study finds. Finnish researchers tracked the health of nearly 9,000 men, none of whom had diabetes at the beginning of the study. But after six years, those who took Zocor or Lipitor were significantly more likely to develop the disease than the guys who weren’t on a cholesterol-lowering drug.

There are multiple ways in which statins can heighten diabetes risk. “Statins have been shown to make insulin less effective at keeping blood sugar normal,” says Dr. Robert Eckel, former president of the American Heart Association and professor of medicine at the University of Colorado. “These drugs also may make the pancreas less able to produce insulin. Moreover, statins are associated with some weight gain — and carrying additional weight is another important risk factor for type 2 diabetes.”

But it works the other way too. Although these guys’ statin use likely contributed to their increased diabetes risk, there’s a good chance that some of them had been more prone to diabetes in the first place. “Typically, we see statin-induced diabetes in people who are already at high risk,” says Dr. Robert Ratner, chief scientific and medical officer of the American Diabetes Association. “If your blood sugar is elevated to a pre-diabetes state, or if you are overweight or have a family history of diabetes, statins can tip you over the edge.” Even so, Ratner says that if you’re flirting with diabetes, your main mission should be eating right, exercising, and taking overall better care of yourself, rather than worrying about a statin’s effect.

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Although statins can make diabetes much more likely, both doctors insist that, in many cases, the drugs’ potential life-saving benefits are more important. “Even if statin therapy is associated with new-onset type 2 diabetes, the heart disease benefits outweigh the risk of diabetes,” says Eckel.

But regardless, you should be aware of the upsides and downsides of statins so that you can discuss them in detail with your doctor should he be considering putting you on one. “We try to individualize all medical care to the benefits and harms than each person might attain from a particular therapy,” Ratner says. “Clearly, there are people who don’t need a statin, such as those with no family history of heart disease or very low LDL cholesterol. For these people, you can make the argument that the drugs have very little benefit. But for those at high risk, the increased diabetes risk is a reasonable tradeoff.”



Can Statins Lower Sleep Apnea Risks? What You Need to Know


Lately, statins, the common cholesterol-lowering drug, have been getting some bad press. There’s the research linking its use to the development of diabetes, cataracts, muscle pain, and fatigue, not to mention one study suggesting a type of fat-soluble statin can contribute to sleep disorders. Some doctors say they’re overprescribed and that many patients told to take them could just as effectively lower their heart disease risk with diet and exercise changes without the risk of statin side effects.

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Well, here’s some good news about the drug: Research just published in the journal Science Translational Medicine suggests that statin use might help lower the considerable heart disease risk of people with obstructive sleep apnea (OSA). This could be a big deal, since almost a quarter of men in the U.S. suffer from obstructive sleep apnea and it triples risk for stroke, high blood pressure, and cardiovascular disease. People with OSA stop breathing for 10 seconds or longer repeatedly during sleep, reducing the flow of oxygen in their bodies. The reduction in oxygen flow to tissues leads to a condition called hypoxia, which can damage organs over time.

To help them understand how hypoxia increases the risk of stroke and heart attacks, researchers studied protein, peptide, and DNA interaction via a laboratory technique called phage display in 76 patients at the Sleep Disorder Center at Columbia University. OSA sufferers appear to have higher amounts of a protein called CD59 inside rather than outside their endothelial cells, cells that play a major role in regulating blood flow. The decreased amount of CD59 suggests reduced immunity protection from attack, the authors wrote in their paper.

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They also determined that patients who were taking statins had normal levels of surface CD59 compared to patients not taking the drug. “Our results [therefore] are likely cholesterol dependent, but we did not perform experiments that would delineate whether these effects are cholesterol-dependent or independent (pleiotropic),” says study co-author Dr. Sanja Jelic, associate professor of medicine at the Columbia University Medical Center.

In addition, statins appear to reduce the chance of attack on cell membranes, which causes inflammation that can lead to disease. Determining the precise mechanisms requires further research, however, Jelic says.

“OSA is an independent cardiovascular risk factor similar to diabetes, elevated LDL cholesterol, and smoking,” he says. “If the beneficial effect of statins on blood-vessel health in OSA patients is confirmed in larger clinical trials, OSA may become an indication for statin therapy similar to diabetes.”

Their research is likely to fuel the ongoing debate about whether the benefits of statins outweigh their risks. After years of urging caution, some doctors now say that many people who might benefit from the cholesterol-lowering drug aren’t taking it, putting them at unneeded risk for cardiovascular problems.