Dr. Steve Nissen is Chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic. He maintains that “56 million Americans are considered eligible for statin therapy, with about half actually receiving treatment.” That means that there is a very good possibility you need a statin based on the American Heart Association (AHA) recommendations.
Have You Used the Risk Calculator?
The American College of Cardiology and the AHA have created an electronic “Heart Risk Calculator.” You can visit this online resource (www.cvriskcalculator.com) to determine your 10-year risk of heart disease.
You enter your age, sex, race, total cholesterol, HDL cholesterol, blood pressure and whether you smoke or are being treated for high blood pressure or diabetes. At the end of the process you’ll be told whether:
“you should be on a moderate to high intensity statin”
“you have no indication to be on a statin.”
Just in case you have been hiding in a cave for a couple of decades, statins are used to lower cholesterol.
The Age Trap: All Seniors Need a Statin!
The problem with this seemingly scientific calculator is that it relies very heavily on age. A reader shared this experience:
“I am 64 and not on any medications. I am in great health except for a heart abnormality I was born with. Due to that, I see a cardiologist twice a year for a checkup. When I was young, a cardiologist warned me to avoid alcohol, drugs and tobacco and I have done so my whole life.
“All my lab values have always been at the low end of normal. Over the last 10 years, my cholesterol and lipids have been slowly creeping up. They now are all smack in the middle of the normal range. My blood pressure has never been above 115/90.
“At my last heart checkup, my cardiologist suggested he and I try the online heart risk calculator. He put in the numbers and it recommended I start a statin. We were both shocked.
“He had some time, so we played around with the numbers, reducing them category by category. Eventually we got all the numbers down to the lowest lab values that were considered to still be normal and my BP was entered as 95/70. With all these changes in place, the calculator still recommended I be on a statin!
“The only way we got the recommendation to change to ‘no statin recommended’ was to change my age to under 50. Is this a realistic estimator for people? Or is it influenced by the pharmaceutical industry’s need for sales? I suspect it is structured to ignore alternative approaches such as exercise or diet.”
Do You Need a Statin…Really?
Like this reader, we have discovered that the risk calculator recommends that virtually every man 64 or older and every woman 71 or older should take a statin. Even if you are a vegetarian, run 10 miles a day, have great cholesterol and blood pressure readings, accumulating too many birthdays puts you on the statin staircase. That’s true even if your parents lived into their 90s without heart disease.
was a question we asked last week after Dr. Nissen’s editorial in the Annals of Internal Medicine. Dr. Nissen titled his opinion piece: “Statin Denial: An Internet-Driven Cult With Deadly Consequences.” He suggests that many so-called statin side effects are due to the “nocebo effect.” That means that the complaints are not really attributable to statins and would have occurred if the patients were getting a sugar pill.
Dr. Nissen blames the Internet:
“Statins have developed a bad reputation with the public, a phenomenon driven largely by proliferation on the Internet of bizarre and unscientific but seemingly persuasive criticism of these drugs.”
You can read more about this controversial question: Will stopping statins kill people? at this link.
Not All Cardiologists Agree that You Need a Statin:
Dr. Rita Redberg is a cardiologist and editor of JAMA Internal Medicine. She and a colleague wrote an editorial about the use of statins in otherwise healthy people (JAMA Internal Medicine, Nov. 15, 2016):
“Statins for Primary Prevention
The Debate Is Intense, but the Data Are Weak”
“Using the current data, the decision aid shows that of 100 people who take a statin for 5 years, only 2 of 100 will avoid a myocardial infarction [heart attack], and 98 of the 100 will not experience any benefit. There will be no mortality benefit for any of the 100 people taking the medicine every day for 5 years. At the same time, 5 to 20 of the 100 will experience muscle aches, weakness, fatigue, cognitive dysfunction, and increased risk of diabetes.”
The doctors conclude their editorial with this advice to colleagues:
“it is in the interest of public health and the medical community to refocus efforts on promoting a heart healthy diet, regular physical activity, and not smoking.”
Kat took the drug company’s advice:
“When I was prescribed a statin I actually read the very small print in the brochure that accompanied the drug. It said that it would lower my cholestrol along with proper diet and exercise. I decided to just opt for the proper diet and exercise and lowered my cholestrol without any medication!”
Sally in Nevada reacts to the admonition that all older people need a statin:
“Stopping statins, even if someone is experiencing muscle pain or weakness, is considered counterproductive to heart health.” This is ridiculous – what about quality of life?
“So you have a healthy heart and are in a wheelchair from muscle weakness? Both of my parents stopped statins and did not suffer heart problems. Unfortunately, it was too late for my dad, who developed all of the horrible side effects from statins, including dementia and diabetes. These drugs should be used cautiously and short term.”
Anne in Bakersfield, CA is not a statin supporter:
“They almost killed my husband. He also was told that he would die if he went off them. They lied! If he had stayed on them he would have lost all of his muscle capacity, most of his brain agility, and been bed-bound.
“He refused to take them any more and is 100% better than when he was on them. Ask your doctor how many free vacations he has gotten from the pharmaceutical company that has him prescribing them to his patients.”
Joan in Florida shares an interesting story:
“There is nothing to do about the side effects of the statins. My cousin was having so much pain she could hardly walk. Why she was on a statin I don’t know. Her cholesterol (both) was very low. Her heart is good at age 71.
“The Dr told her she had to stay on it to help her heart and gave her an anti inflammatory [for pain] and that helped some. I did try to talk her out of taking the statin but she thinks because the Dr said take it she has to.
“Then there is my daughter who was on a statin for a year until she had to sit on the stairs to get up to her apartment because her legs no longer could climb. I told her…go off the statin. She tapered off but has lasting damage to her back muscles. She is 54.
“Then there is my husband who had a heart attack after being on Lipitor for under a week. I recently read on one of the Internet websites that it’s the fault of the Internet that people are going off statins. Who is paying them to say that? Big Pharma?
“Thanks People’s Pharmacy for telling us the truth.”
Do You Need A Statin?
We think using the risk calculator may be misleading. The only way to know if you really do need a statin is to have a heart-to-heart conversation with your physician. Ask your doctor to review the numbers so you can make an informed decision.
Questions to ask:
- Based on my family history, lifestyle, diet and medical assessment, what is my risk of developing heart disease over the next several years?
- How good is the evidence that a statin will reduce my risk of experiencing a heart attack or stroke. Put another way, how many people like me will experience a cardiovascular event over 5 years if they don’t take a statin. How many would experience an “event” if they do take a statin? Those numbers are available. Show your doctor Dr. Rita Redberg’s editorial in JAMA Internal Medicine. By the way, she is a cardiologist!
- Will a statin extend my life? If so, by how many days, weeks, months or years? That data is also available should your physician wish to look. Again, See Dr. Redberg’s article.
- What side effects should I be aware of?
- What should I do if my muscles start to hurt or become fatigued?
- What should I do if my blood sugar levels start to climb?
- Are there any alternatives to statins that you would find helpful?
Good luck and let us know how you make out. We recognize that some people absolutely do need a statin! Are you one of them? Comment below.