bottles of crestor lipitor and simvastatin cholesterol-lowering drugs, numbness in fingers and toes

In 2013 the American College of Cardiology (ACC) and the American Heart Association (AHA) issued new statin guidelines for physicians. The recommendations were based on the Heart Risk Calculator. Doctors or patients could plug data into the calculator and determine who should take a statin-type cholesterol-lowering drug. Based on the 2013 guidelines, experts estimated that roughly half of all adult Americans should be taking statins.

What if the risk calculator relied on old and potentially flawed data? That could have led to overprescribing of statins and other drugs like blood pressure medicines and aspirin. A new study published in the Annals of Internal Medicine (June 5, 2018) suggests that revised risk assessments would dramatically change the prescribing landscape. Millions of people could have been prescribed medications they didn’t really need. That’s because their actual risk was likely much lower than was predicted by the old model.

The Scary Power of Risk Calculators:

Many physicians prescribe based on recommendations from expert panels. That appears to be especially true for the statin guidelines from the ACC and the AHA.

The risk calculators are available online, on smart phones, computers and other electronic devices. They are baked into many electronic health records. That means a doctor could be dinged by a hospital or health system if she doesn’t follow the statin guidelines.

The new research from Stanford suggests that the underlying data that was used to formulate the algorithms may have been erroneous. These pooled cohort equations or PCEs were based in part upon information gathered from middle-aged individuals in 1948.

Sanjay Basu, MD, PhD, was one of the Stanford investigators. He summed up the new analysis this way:

“A lot has changed in terms of diets, environments and medical treatment since the 1940s. So, relying on our grandparents’ data to make our treatment choices is probably not the best idea.”

The researchers estimate that nearly 12 million Americans labeled high-risk by the previous risk calculators would be considered lower risk if updated equations were applied. That might mean they wouldn’t need to take a statin or a blood pressure pill.

Conversely, some people would have been undertreated.

Dr. Basu describes it this way:

“So while many Americans were being recommended aggressive treatments that they may not have needed according to current guidelines, some Americans — particularly African-Americans — may have been given false reassurance and probably need to start treatment given our findings.”

From the Stanford Medicine News Center

The People’s Pharmacy Perspective on Statin Guidelines:

Dr. Basu and his colleagues suggest that risk equations should be updated regularly. Doing so:

“…may substantially reduce the number of U.S. adults recommended for statin therapy.”

Testing the Old Risk Calculator:

We agree that the risk analyzer requires revisions. We have plugged data into the old risk calculator. Here is one hypothetical male subject. He is a runner, a vegetarian and is not overweight. We’ll call him Sidney. His mother lived to 92 with no signs of heart disease. Sidney’s dad made it to 86. He died from the consequences of a fall and a hip fracture.

Sidney’s age is 66

His total cholesterol level is 180

Sid has great HDL cholesterol levels: 60

Not surprisingly, Sidney’s systolic blood pressure is perfect at 120

His diastolic BP is also great at 75

The calculator reports that our Sidney has a 10.4% chance of developing heart disease or a stroke over the next decade. Really?

The statin guidelines from the cardiology experts conclude:

“On the basis of your age and risk for heart disease or stroke, the ACC/AHA guidelines suggest you should be on a moderate to high intensity statin.”

If you believe that, we have a bridge or two to sell you.

You may wish to read some of our other articles about the statin guidelines. Here are just a few:

Should Half of All Adult Americans Take Statins?

Should Half of All Adult Americans Take Statins?

New Analysis Disputes Dogma that All Seniors Need Statins

New Analysis Disputes Dogma that All Seniors Need Statins

Should Everyone Over 65 Take a Statin to Prevent a Heart Attack?

Share your own thoughts about the statin guidelines below in the comment section

Annals of Internal Medicine, June 5, 2018

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  1. Liz
    Canada
    Reply

    North Americans are the most overprescribed people in the world. It’s almost a badge of honor to have “meds”, and you’re seen as abnormal if you don’t take anything.

    Also, what happened to the discussion about there being bad, good cholesterol; and good, bad cholesterol? It was related to the size of the cholesterol particles, not just whether they were LDL or HDL. The human body is a real chemical soup & I believe North American medicine takes a MUCH too simplistic view of things. If it’s not understood, we seem to prescribe for it.

    Food is medicine is a good adage to maybe be reinvestigated…

  2. SUE
    Florida
    Reply

    We thought my husband was well into dementia but it literally went away within a week after we weaned him off Lipitor. Poison. That was 6 years ago. He is now alert and active at 80.

  3. Eleanor
    Australia
    Reply

    My husband was on Lipitor for 5 years and developed motor neuron disease, and was gone in 18 months. There are no family connections.

  4. KM
    Reply

    Isn’t there some evidence to suggest that people above a certain age NEED higher cholesterol?

  5. Tony
    Fl.
    Reply

    Interesting study of a report out of the British Medical Journal from 12/5/17..
    [BMJ report ONLY for Professionals] so I couldn’t currently find the report…
    Study was about Cholesterol, specifically focusing on High LDL-C…[the bad stuff]

    Their conclusion was that there is an ”inverse’ CV associated mortality in most people over 60 years…The finding is inconsistent with the cholesterol hypothesis that LDL-C is inherently atherogenic…

    The study covered 68,094 ‘elderly’ people ..in 30 different cohort studies
    Basically showing that CV mortality was actually highest in individuals with the lowest LDL-C quartile..

    “”OBVIOUSLY”” this report would never be published over here,,,As it is counter to everything the medical community is professing…
    Basically, saying that for older people, that your ‘lower’ LDL-C cholesterol is actually bad for you, and you may actually die earlier…

  6. Mary Ellen
    Garner NC
    Reply

    Fortunately, my numbers are within normal range (but that range seems to get lower and lower every year!). I have already told my Dr. that she should not even suggest that I take statins because I’d never fill the Rx, much less take them. She seems to tacitly agree with me. Hopefully, my numbers will never call for that showdown.

  7. Lee
    Fl
    Reply

    I am 80 years old and in good health but my LDL is 180.

    Now the question of statins has come up. The last time I tried them within one week I was having tingling in my feet. Within 2 weeks neuropathy started to set in.

    I went off statins but still have the side effects. I am active. Have good BP. And am take no prescription medicine. Enough already. Dr and big Pharmacy will not run my life.

  8. LaRae
    Reply

    The high cholesterol increased risk of heart attack dogma has never been proven but still with all of the hype about high cholesterol and heart health, I decided to get a complete blood work up. My cholesterol came back very high (over 260) but that also included very high HDL and very low triglycerides. My doctor also did a high sensitivity C-reactive protein test, insulin test, and HbA1c test. My HDL/Triglyceride ratio was extremely low and all the other numbers were also in the excellent range indicating very low inflammation. My doctor stated I am not at risk of heart attack or heart disease. Anytime one a takes a drug, it comes with a risk and most times, the risks do not outweigh the benefits.

  9. BBBob
    Buffalo
    Reply

    I’m 86. A few years back, due to slightly elevated cholesterol, my doctor prescribed one statin after another to lower the numbers. With each different statin, I had unpleasant and painful side effects. Finally, the doctor said that I probably shouldn’t take statins and not to worry about it. Funny thing is that the doctor is thin as a rail, weighs no more than 145 lb. and has been on statins himself for decades due to a family history of high cholesterol.

  10. Ruth H
    District of Columbia
    Reply

    I’ve had stent replacement on one heart artery,not main one, I’m taking pravastatin 10mg,bloodwork states my cholesterol 136,HDL 57,TRIGLYCERIDES 74,LDL64.

    I’ve been taking this on and off for the past 10 yrs sometimes Doctor takes me off because my cholesterol drops too low it depends on my diet well now I’m having muscle aches on my calves, knee,and wrist,I’m in question of whether to tell my doctor to take me off of these pills and go back to my low fat diet…Thanks for allowing me to share

  11. Tenno
    Reply

    The cynic in me suggests that some statistician in a Big Pharma company observed that the data upon which the calculator is based are old and outdated. S/he ran a regression on newer data and found that many many fewer people would be prescribed statins given the more current information, and promptly put the results into a folder with a password on it. Of course, s/he did not mention this independent effort to superiors lest s/he be cast out of the organization.

  12. Bill
    Katy, TX
    Reply

    I sound like a broken record, but the study People’s referenced in the BMJ, 3-13-18, “Lack of Association……” analyzed 68,000 patients 60 and over, and found that those with high LDL-C survived longer than those with low LDL-c. I’ll stick with that unless it gets refuted.

  13. Sarah
    USA
    Reply

    Statins are just big business for the big pharma. There was no “mistake” in prescribing them for everyone. They did exactly what they intended to do, fill their pockets and continue to fill their pockets. The mistake is if we follow the AMA recommendations to take more and more pills.

  14. Ken
    Warren Oh
    Reply

    My Doctor at the Cleveland Clinics and I were floored with my positive results taking a dietary fiber product called cholesterade.

  15. Bob
    South Carolina
    Reply

    My primary care doc said that 50% of his heart/stroke patients have normal cholesterol. My mother’s cholesterol was 192 and she lived to be 92 with zero heart issues. Another friend ate perfectly (no meats), had normal numbers and almost died of a massive heart attack. So what is the solution? Too many questions and not enough answers except Big Pharma wants to make $$$$ and too many doctors are buying into their hype.

  16. SuzieQue
    NC
    Reply

    All drugs have side effects. In my view, it’s better to avoid them if you can. A healthy lifestyle is probably better for you than drugs.

  17. Carol
    USA
    Reply

    I have tried to talk people out of taking statins for ov er 10 years based on my questioning of many people . My first question was “did your doctor tell you to take CoQ 10…..as this is depleted when on statins and aging?” Not ONE person said they were told that!!!!

    NOW for how they formulate your total cholesterol which masked most doctors prescribe a statin….andyou tell me if this m akes any sense at all. Add your GOOD and BAD cholesterol together and 20% of your triglycerides………WHAT?????

    Read up on it folks because your life depends on it!!!!! I know of one person who died of ALS because of long time statin use at a young age and a man with severe dementia who had been on statins since they first hit the market in 1987, I believe, and several other men in early stages of dementia because of this drug.

    All it has been is a huge money maker for Big Pharma. And by the way…..they do virtually no good for women. The info is out there…….READ IT!!!!!!

  18. Deborah
    Desloge, MO
    Reply

    As a home health nurse, it was frustrating when a patient with a diabetes diagnosis diligently followed the education we provided and uncontrolled blood sugar persisted. There is even a name and ICD-10 code for this. How simple to just stop the unnecessary statin to improve health status – now that we know the probable cause.

    I now can’t help but wonder (and will investigate) how many representatives of Big Pharma are representatives on the ACC and AHA.

    • Greg Pharmacy Student
      Toledo, OH
      Reply

      Deborah,

      How common do you think E09.65 — drug or chemical induced diabetes mellitus with hyperglycemia is? Many think that statin may only slightly raise the risk of diabetes / increase blood sugar. Of course there is never a good reason to take a medication where its benefits are out-weighed by its risks.

  19. Bobbie
    NC
    Reply

    What I don’t get is why anyone would think that 10% is a risk. Would you bet on something that had a 10% risk of succeeding? I’m confused. Especially when things work out to days or months of longer life. We are losing so much enjoyment to worrying about what will make us live longer if anything.

    • Greg Pharmacy Student
      Toledo, OH
      Reply

      Bobbie,

      They are talking about a 10 % risk of a potentially fatal / costly event. There is a lot more evidence that statins are effective and cost-effective if you’ve already had a heart attack. On a population level the increased benefit may be just weeks or months, but for individuals I think the benefit of not having a heart attack would be greater. Follow this link to get some perspective on what causes death and what the risk factors are: https://www.vox.com/2015/2/15/8028459/biggest-killers-war-murder

    • Janice
      CT
      Reply

      I agree. Look at the mammogram industry. There is a small chance of a woman developing breast cancer. No woaen in my family has ever had breast cancer.

      With regard to statins, I have been on them for over 30 years. I have peripheral neuropathy. I decided to see if quitting statins would help. Yes, it has. Unfortunately, I have such bad neuropathy that it is extremely painful to walk. I take Gabapentin. It helps, but not much. I also have “high normal” blood sugar. I am wondering how that will be after quitting. I am seeing a new doctor tomorrow.

  20. Bruce
    Madison, Wisconsin
    Reply

    My doctor brought this up to me when my stats were virtually identical to your hypothetical Sidney’s, except my dad lived to 100 with no evidence of heart disease or stroke. I told my doctor that a 10% risk in 10 years suggests that I have about a 1% risk in the next year of developing heart disease or stroke. I’m willing to live with that for a year, and at my physical next year, we can talk about what the latest research says at that time. I’ve done this now for three years and feel vindicated by the information in your article. Percentages can be skewed so many ways. The doctor could also have said – “In the next 40 years, you have a 40% (or some number) risk of heart disease, so you’d better start taking statins now, to which I’d reply, “Doc, I’ll be dead by then anyway, so why bother?”

  21. Alex
    Galveston
    Reply

    I am 87, not overweight, have blood pressure 120/80, and no chronic illnesses. My chloresteral was slightly elevated. My doc put me on a strong statin and an antihistamine. I saw a board certified internal medicine doc specializing in geriatric patients. He said to quit taking both at once. He said Big Pharma has snowed too many doctors. I agree.

    • Jennifer
      Reply

      Would recommend reading the book The Statin Disaster by Dr. David Brownstein before you agree to go on statin drugs of any kind.

  22. Teri
    VA
    Reply

    Amen to what C said above. Both my mother (87) and mother-in-law (92), among many other people I know had big problems with statins, mostly muscle related. MIL has permanent damage. These gals are both otherwise in great health for their ages.

    Now my mother has a new doc who has insisted on statins again. Right away, she started showing signs of dementia. I am heartbroken because she won’t listen to me and she thinks her new doc hung the moon.

    P.S. In all the research I’ve read (lots!), there is not a shred of proof that statins prevent heart attacks. Certainly it has been shown that many who died of heart attacks also had high cholesterol, but correlation does not equal causation. I will NEVER take that poison!

  23. SuzyQ
    Reply

    I am the bottom line on what I take or don’t take.

  24. Kevin
    reston, VA
    Reply

    If you’re going to base prescribing statins on age, cholesterol, and blood pressure; then I would NOT be prescribed a statin. Yet, I had an MI, a 100% clogged artery, while simultaneously having low LDL and low bp. I was 56 years old.

  25. Nancy
    Deer Park, TX
    Reply

    My best friend, at around age 67, was prescribed Crestor by the p.a. of her doctor on a visit for a sinus infection. She has always had high cholesterol, but her HDL is very high. She immediately began to have joint pain in thumbs and knees. A friend happened to mention that Crestor caused joint pain. . . She stopped the drug and pain improved, but I think it changed her body forever. She is 81 now, but extremely active, and I will always wonder if Crestor caused some other problems she has had since she took it years ago.

  26. Lionel
    Central Texas
    Reply

    I was on statins for some time. It made me feel sluggish with joint and muscle pain. I went off at age 79 and have felt great since even though my cholesterol is higher 220 with a 60 HDL. My family history suggests that everyone on my Mother’s side had high numbers but there is no stroke or heart attach history in any part of my family.

    The doctor didn’t like what I did and his computer analysis suggested that I had a 35% chance of having a stroke or heart attack in the next ten years. I’ll take those odds. Now at 83 I have a good life and feel strong and healthy with some muscle soreness after working out or other heavy activity..

  27. LeeLa
    Portland
    Reply

    I wish doctors would be more careful. A prescription for statins and blood pressure meds is a life sentence with doctors demanding that you stay on if life, even if you develop diabetes and other serious side effects.

    My numbers were creeping up, not yet in the bad zone, and my doctor insisted I start taking statins and BP drugs based on electronic medical record alerts. I refused and made modest lifestyle changes instead – as suggested on this website – diet, exercise, meditation. They worked with all of my numbers in the solidly good zone.

    That wasn’t good enough for the electronic medical record alerts or my doctor, so I found another provider who values me, not the algrothim. She agrees that overmedication can do more good than harm.

    I was motivated to make lifestyle changes after seeing my otherwise active and healthy older friends suffer from medication side effects that increase as they age.

  28. c
    Reply

    Ah ,the question should be do i want to live with muscle pain, possible brain fog and other disagreeable problems that I would be shelling out big bucks for, to have that priviledge, or do I live and eat right, taking care of and having respect for, the body that God gave me?. Easy choice!

    • Sherri
      Ohio
      Reply

      I have been researching this issue for years. This drug is another one of big Pharma’s poison pills. It is over prescribed and big pharma benefits to the tune of billions of dollars. I believe that one is genetically programed for good or bad cholesterol readings. There are many studies out there showing cholesterol is another scam of big pharma and the medical industry.

      So, I choose not to live with constant muscle cramps and the brain fog I get when I take this poison pill. In fact I have recently stopped taking a number of my meds and have felt better than I have for many years. I have more energy, my mind is clearer . So this begs the question. Do I want my conditions to kill me or do I want to pay Big Pharma to kill me. I will choose the former.

  29. George M.
    West Virginia
    Reply

    In Dr. David Perlmutter’s (he is a cardiologist) book “Grain Brain” he addresses the cholesterol myth. Everyone should read it.

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