Doctors debate use of statins

December 30, 2011 5:10:31 AM PST
Portia Tibbs is taking steps to help control her cholesterol. She's also taking cholesterol-lowering statins, just like millions of other people.

"I don't really like taking medicine, but I have to," she said.

Now because of the so-called Jupiter Study, many doctors are urging some people with normal cholesterol to start taking them, too. Jupiter tested more than 15,000 who had normal LDL levels and high levels of an inflammation biomarker. For the group taking statins, "there was between a 40 and 50 percent reduction in the risk of the things we really care about, like death, stroke, heart attack," said Dr. Steven Nissen, doctor of cardiovascular medicine at the Cleveland Clinic

After less than two years, the five-year study was cut short because of those findings. Nissen said the study changed the way he practices medicine.

He said that before the results, he and a lot of doctors occasionally did blood tests for inflammation.

"Well, we're making that measurement more often now," he said.

Doctors may use the results to prescribe statins to prevent heart disease.

But University of California-San Diego Dr. Beatrice Golomb questions longer-term use and in real world users whether the benefits outweigh the real risks.

"Portrayed as being so fantastically safe it should be put in the water supply," she said. "In real world use this drug causes problems not infrequently." Other research has raised concerns about the results and calls into question the involvement of drug companies in such trials.

Golomb and Dr. Matthew Sorrentino, a cardiologist at the University of Chicago Medical Center, say while some people benefit from statins, others have reported symptoms similar to Alzheimer's.

Muscle weakness, nerve damage, and cognitive problems have also been issues.

"I do not think we should automatically give statins to everyone at a certain age," Sorrentino said.

He said the use of statins needs to be based on an individual patient's medical needs.

Most people tolerate statins very well but they still need to be monitored carefully.

He also said patients should have a thoughtful conversation with their doctor about their overall risk factors.

"There may be some patients who don't need them and they will get harmed," he said. "Again, statins need to be part of a full program."

Some classic risk factors a doctor should be discussing include family history of heart disease, age, blood pressure and weight.

"The first thing to do is access what a patients risk is," Sorrentino said. "If it is higher because of high blood pressure or pre-diabetes, we many use a statin with normal cholesterol levels. You could easily prevent the benefit by eating all of the wrong foods not exercising gaining more weight so its only part of a well designed program to reduce cardiovascular risk."


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