Many doctors are now following recommendations set out by the American College of Cardiology and the American Heart Association. People over 65 with perfect cholesterol numbers, normal blood pressure and no family history of heart disease would be told to take statins to lower cholesterol. That would be true even if they ran marathons, followed a vegetarian diet and meditated three hours daily. This reader wanted to know why the doctor prescribes statins to every person over 65.
Q. I am 76. At my recent check-up, all my blood tests were within normal range, including triglycerides, HDL, LDL, total cholesterol and glucose. I take lisinopril for blood pressure and metformin for diabetes.
My doctor prescribed simvastatin “as a preventative to heart attack and/or stroke.” I’ve heard statins can have bad side effects such as liver damage or muscle pains and I do not want to take any more medication than is necessary. If all my numbers are within normal range, is it necessary to take a statin because my doctor said he “prescribes this to all his senior patients”?
A. People who have had a heart attack or a diagnosis of heart disease may need a statin, but there is a great deal of controversy over whether healthy older people such as yourself benefit from such medications.
There was a time when some cardiologists almost advocated putting statins in the water supply. They perceived statins as super safe with virtually no side effects and they were convinced that such drugs prevented many heart attacks and saved large numbers of lives, even for people with no obvious risk factor for heart disease.
Statins to Lower Cholesterol: AHA Recommendations
If you go to the American Heart Association “risk calculator” and put in the following numbers:
Total cholesterol: 180
HDL cholesterol: 85
Systolic blood pressure: 120
Diastolic blood pressure: 80
You would be advised:
“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 check the boxes that say “treated for high blood pressure and diabetes” the unequivocal recommendation is to take statins to lower cholesterol. What seems to be forgotten in this equation is something called the ACCORD trial.
In this large, well-controlled clinical experiment, people with type 2 diabetes were followed for about eight years to see what impact lowering systolic blood pressure to 120 and getting bad LDL cholesterol below 100 would have on important health outcomes.
The authors concluded that (JAMA, July 7, 2010):
“Tight control of systolic BP among patients with diabetes and CAD was not associated with improved cardiovascular outcomes compared with usual control.”
Another surprise: subjects with type 2 diabetes who got both blood pressure and blood cholesterol into the target range did not have better cognitive function than volunteers on placebo (JAMA Internal Medicine, online, Feb. 3, 2014).
What About Longevity when People Take Statins to Lower Cholesterol?
A review of research on statins and survival reveals that otherwise healthy people taking drugs like atorvastatin, pravastatin or simvastatin live roughly three extra days after several years of treatment (BMJ Open, Sept. 24, 2015).
The statistics on this are a bit complicated, but suffice it to say the benefits for older people may not be as great as your doctor thinks. If your blood pressure and blood sugar are well controlled, the benefits of adding statins to lower cholesterol remain confusing.
Statins and Blood Sugar:
One paradox that many health professionals have a hard time with involves the impact of statins on blood sugar. It took a long time for researchers to discover that statins increase the risk for developing type 2 diabetes. There is still controversy regarding the question of whether statins make it harder to control blood sugar in patients diagnosed with diabetes.
We have heard from visitors to this website that statins to lower cholesterol can disrupt blood sugar control.
A study from Finland (Diabetologia, May, 2015) reveals that the link between statins and type 2 diabetes may be stronger and more worrisome than most American cardiologists would like to believe. The study also confirmed what visitors to our website have been saying for a long time, i.e., that statins to lower cholesterol make it harder to control blood sugar. To us, this seems like a counterproductive exercise, a bit like trying to climb a very steep hill with lead overshoes on your feet.
What Else Can You Do?
Cholesterol is only one of over 240 other risk factors that contribute to heart disease. To learn more about how you can improve your odds of avoiding a heart attack, here is a link to our guide, Cholesterol Control and Heart Health.