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The Care Group, P.C.
Statins: In the News Again
By Gerard Guillory, M.D.
Statin Cholesterol Drugs
Statins are in the news again and, again, the news about these cholesterol-reducing drugs isn't encouraging. You may recall an article that I wrote recently, highlighting health risks posed by statins, which are marketed under such brand names as Lipitor, Mevacor, Zocor, Pravachol, Lescol and Crestor. See the article at: The Care Group Archives
Statins inhibit the body's production of low-density lipoproteins, or LDL—the "bad" cholesterol commonly associated with plaque-clogged arteries and heart attacks. However, they also have some unfortunate side-effects, including muscle aches and other unpleasant symptoms.
Now researchers are raising other serious questions about statins. An excellent overview of their concerns appears in the Jan. 17 Business Week Do Cholesterol Drugs Do Any Good? This is a must read for anyone taking statins or considering taking statins.
Business Week takes pains to point out that statins can be life-saving for patients who already have had heart attacks. It is important not to lose sight of that. But for patients who haven't had heart attacks, the benefits of statins appear to be debatable at best.
In the vast majority of such cases, statins apparently don't deliver any health benefit beyond simply reducing cholesterol. Dr. James Wright, a Canadian researcher who analyzed the results of numerous studies conducted by statin manufacturers, concluded that "most people (on statins) are taking something with no chance of a benefit and a risk of harm." In a Pfizer, Inc., study, for example, only one in 100 patients who took statins benefited from them. That doesn't mean that statins have no value—again, they have helped many people. But how do they actually work? Dr. James Liao, a researcher at Brigham & Women's Hospital of Cambridge, Mass., has evaluated statins and concluded that the drugs' beneficial effects are derived not from their ability to reduce cholesterol, but from their ability to reduce inflammation in the arteries.
Inflammation has been linked to a wide range of diseases, including many varieties of cancer. Reducing inflammation can slow or even reverse the biological clock and can be achieved through changes in lifestyle—notably, exercise, diet, nutrition, and stress management. For example, taking Omega-3 fatty acids, derived from fish oil, has been shown to be effective in reducing inflammation and in preventing heart attacks. Omega-3 fatty acids deliver a multitude of additional benefits as well. Reducing Inflammation Can Slow the Biological Clock
It may be heresy to say it, but an overly aggressive focus on reducing cholesterol may prove counter-productive for some patients. That's because cholesterol is essential to such functions as memory, synthesis of vitamin D and production of many important hormones such as testosterone, estrogen and DHEA. As statins attack cholesterol production, they inevitably affect these related bodily functions as well. Another unintended consequence of taking statins is a lowering of the vital anti-oxidant coenzyme Q10, which helps produce energy in the body's cells.
I believe that instead of focusing solely on lowering bad cholesterol, many patients would benefit from focusing as well on raising "good" cholesterol (referred to as high-density lipoprotein, or HDL, cholesterol) and making appropriate lifestyle changes. Taking the vitamin niacin (nicotinic acid) is a cost-effective approach to raising HDL cholesterol. These are decisions, however, that should be made in consultation with a physician.
To complicate matters, a study released in January suggested that Vytorin, a combination of the statin Zocor and another cholesterol-lowering drug, Zetia, offered no additional benefit over Zocor alone. At The Care Group, we have been receiving a large number of calls from patients who are taking Vytorin and wondering what they should do.
What does all the recent news mean for you? If you are taking statins, including Vytorin, this doesn't mean you should just stop. Remember that all treatment recommendations must be individualized. We would suggest making an appointment so we can discuss these important issues and decide what is best for you. As is often the case in medicine, recommendations may change in light of new information.
Gerard L. Guillory, M.D., is board-certified in internal medicine and has been practicing in Aurora, Colo., since July 1985. As an assistant clinical professor of medicine at the University of Colorado Health Sciences Center, Dr. Guillory is actively involved in teaching medical students, resident physicians, and nurse practitioner students. He has lectured extensively on the role of nutrition and disease. Over the years, he has fostered an interest in patient education and has authored three books on digestive troubles. He also has served as medical director of a Colorado-based health plan and as a health consultant to employer groups.
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