Statins: Yes or No?

A patient asks: Isn’t it better to take something “natural” like red yeast rice instead of statins?

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The doctor answers: No. First there are natural products like red yeast rice that contain substances that lower LDL cholesterol — the bad cholesterol — but are not very powerful, and are mixed in with other compounds that have unknown effects.

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Starting 30 years ago, the pharmaceutical industry isolated the active compounds in so-called natural substances like red yeast, for example, then modified the compounds to make them much more effective in lowering LDL and eliminating off-target effects — that is, effects on other parts of the body.

These purified, modified compounds are commonly available by names we all recognize — Lipitor, Zocor and Crestor. A large body of evidence has shown that individuals with elevated cholesterol and risk factors for heart attack and stroke, such as obesity, diabetes and hypertension, will benefit from statins by reducing the risk of heart attack and stroke by 25-50 percent compared to placebo.

The side effects most commonly include muscle aches in pains in 5-8 percent percent of the patients. Rarely, there can be short-term side effects to the liver.

All of these adverse effects have been shown to be completely reversible when the drugs are stopped.

I am not aware of any evidence that any longer-term irreversible damage can occur with use of statins.

I take a statin myself. Though I’ve never had a heart attack, I’m taking it because I have a family history. My father died of a massive heart attack at 68. Following a heart attack in her 70s, my mother was placed on the maximum dose of Lipitor and didn’t have another heart problem till she died of stroke at 100 years old. I put my wife on a low dose of statins as well. And I put the majority of my patients on statins.

Related: Something Fishy Going On

The majority of my patients come to me because they’ve either had a heart attack, or they’ve just turned 65 and their brother just had a heart attack at 66. They want to know is this is something that’s likely to happen to them, and can they prevent it?

I measure their cholesterol and I do six months of lifestyle intervention — heart-healthy diet and exercise — and if they can produce a good effect with this, that’s great. But the majority of the patients I see are not overweight. They’re already exercising and following a heart healthy diet, or so they tell me! Regardless, if they don’t produce effects with diet and lifestyle changes, I put them on statins, and they nearly all have an excellent effect.

It’s natural to be concerned about taking medications unnecessarily and not try to take shortcuts with your health when important lifestyle changes are in order. But for the vast majority of people I care for, statins are remarkably effective and more. To many patients, they’re a lifesaver.