Dr. David: Cholestrol-Lowering Drugs
Statins: The Drugs People Love to Hate
Some people continue to question the use of statins (cholesterol-lowering drugs) in primary and secondary prevention in patients with a history of documented cardiovascular disease (CVD). Although some researchers still question statins’ usefulness in primary prevention, there is no shortage of clinical data supporting the benefit of secondary prevention in patients who have suffered heart attacks or strokes.
The importance of secondary prevention in patients with CVD cannot be overstated. Cardiovascular disease remains the number one cause of morbidity and mortality in the United States. It affects 6.5 percent of the population and results in heart attacks and strokes. Although the incidence has declined over the past decade, it remains the number one cause of death, particularly in patients over 65, an age group in which 19.8 percent of people have documented CVD. Therefore, it should be understood that any treatment that can reduce the risk of heart attack or stroke should be welcomed.
Typical strategies used to reduce risk in these patients include weight loss, exercise, cessation of smoking, management of diabetes and aggressive cholesterol reduction. For patients with CVD, guidelines from the National Cholesterol Education Program recommend total cholesterol less than 200 dl/L and LDL cholesterol less than 70 dl/L. Most of the risk-factor modifications require lifestyle changes, which can be difficult and elusive for many patients. Cholesterol reduction, on the other hand, can be obtained with statin therapy or in combination with diet, which is recommended.
So why the resistance to statin drugs if they have proven to be an effective means of reducing heart attacks and strokes? Most of the hesitancy is related to misinformation from the media, which is then propagated to the general population. Then when patients are advised by their doctors that they need statin therapy, they resist. Some say, “I heard it can damage my liver (or my muscles),” or that it is just not an effective therapy. Certainly there are rare occasions in which life-threatening side effects can occur. This is true for any medication and statins are not exempt. Such cases are rare. If patients are monitored closely by their physicians, side effects can be kept to a minimum, which allows patients to benefit from a therapy that has been shown to reduce risk by 12 to 17 percent.
One common side effect of statins is generalized muscle ache and weakness. This is not related to damage to the muscles, but is a consequence of the reduction of a key co-enzyme called Co-enzyme Q10, which plays an important role in energy transfer within muscles. By supplementing patients with Co-enzyme Q10, most of these minor side effects can be avoided, allowing the patient to continue on statin therapy and obtain the necessary benefit.
The fight against cardiovascular disease is complicated and fraught with difficulties. Certainly risk-factor modification, including behavioral changes, is recommended, though people sometimes find the changes difficult to maintain and/or resist them. Clearly an easy and effective strategy for secondary prevention is statin therapy, which has been demonstrated by many large clinical trials to reduce heart attack and stroke in patients who are at risk. These drugs should, therefore, continue to be used in the front line of the battle against cardiovascular disease. Research is ongoing to produce a better drug, but a major breakthrough is probably still years away. Statins should remain one of the primary drugs in the fight against CVD.
William J. David, MD, FACC, is a Lake Mary resident practicing interventional cardiology at The Cardiovascular Center P.A., with offices in Lake Mary and Deltona. He is board-certified in the fields of internal medicine and cardiovascular disease.
