Cholesterol Drugs: To Take or Not to Take
A few years ago, with my LDL cholesterol pushing 125, I decided to start myself on Lipitor with the approval of my own internist. Despite the fact that my father has heart disease, I knew that I was in the category of patients where there were no clearcut guidelines. In fact I knew at the time that most cardiologists would probably say that I was jumping the gun and erring on the side of overtreating. But the latest research would suggest that I was probably right.
As most of my readers know by now, a new landmark study just published in the New England Journal of Medicine, Known as JUPITER, looked at more than 17,000 healthy men and women at multiple centers in the U.S. and Europe with normal cholesterols (LDL less than 130 mg/dl) but with elevated C-Reactive Protein levels. Many scientists believe that high levels of this protein correlates with a high risk of heart disease, though there is by no means a consensus on this.
Previous studies who shown that patients with multiple cardiac risk factors have less heart attacks and strokes when taking a statin drug, but this is the FIRST large study in people with relatively normal cholesterol where taking a statin dramatically affected outcome.
The JUPITER trial was stopped after 2 years because the results were so dramatic – there were half as many heart attacks and almost half as many strokes and unstable angina in the group which received Rosuvastatin (Crestor). I’m sure that these results will lead more doctors to prescribe more statin drugs, expecially Crestor. But the real question is, who should receive the drug and who shouldn’t? Detractors of the study will point out that Astra Zeneca, which makes Crestor, was a sponsor of the study and that it was only two years long. But this doesn’t take away from the dramatic results.
Patients and their doctors who have previously been very conscious of muscle aches that they ascribe to the drug, or are now aware of the possible slight increase risk of diabetes that the study detected, will still have to consider the fact that Crestor and likely other statin drugs appear to dramatically decrease cardiac risk. Here is my take:
* I will have a much lower threshold for prescribing statin drugs, especially in patients older than 50. (the study looked at men in their 50s and women in their 60s).
* I will be more inclined to prescribe statins for primary prevention (patients who have no known heart disease) on the basis of cardiac risk factors (family history, smoking, high blood pressure, etc) even when their cholesterol is only mildly elevated (LDL cholesterol between 110 and 130).
* I will follow CRP levels in patients over 50 years old, especially in those with cardiac risk factors, but I continue to reserve judgment on the specific significance of these results.
* I will continue to emphasize diet modification, stress reduction, and increased exercise as mainstays of primary prevention of heart disease.
* I will be glad to see further longer studies on statins, though I recognize the importance of JUPITER.
Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com
Tags: cardiac risk factors, cholesterol, Cholesterol Drugs, Crestor, Dr. Marc Siegel, JUPITER, Lipitor, New England Journal of Medicine, statins
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The participants in the study were not healthy and while they maybe considered as low-risk by some standards I look at the numbers and see high risk individuals. The average hsCRP was 4 times the recommended level. The average BMI was 28, meaning these people were overweight. 41% of them had metabolic syndrome. Their CRP is not elevated because they didn’t take a statin, it’s most likely elevated because they are consuming too many calories, have excess body fat, eat inflammatory foods such as grains and grain fed, fatty meat, and rarely exercise. They are consuming excess omega-6 fatty acids, and low omega-3 fatty acids, probably in the typical highly inflammatory ratio of 20:1 and never get enough vitamin D due to staying inside all day long.
Just wanted to share my experience. My Cholesterol was 238 and I can’t take the medication for it so I tried Choles Off which is sold over the counter. After taking four pills per day which consisted of two bottles of 30 tablets each, my chlosterol was reduced to 139. My doctor was impressed with the result even though she hadn’t recommended it. We were both pleased.
Sorry, have to make a correction. My cholesterol went from 238 to 195.
What are you thoughts about taking Niacin (not niacinimide) and Red Yeast Rice? I’ve been taking Nicin (1 gram twice daily) for over twenty years and my HDL is 78. My LDL (110-120) is high but from what I have heard the LDL/HDL ratio is a factor as well. I heard that Red Yeast Rice helps to lower the LDL so I’ve started taking that in the last month.
This is another great example of only looking at the reported good for statin drugs and completely ignoring the bad. Crestor was one of 5 drugs mentioned by FDA scientist, David Graham, as posing serious safety concerns due to secondary kidney failure and increased occurance of a serious muscle disease known as rhabdomyolysis. What about the reduction of CoQ10 due to statins, Dr. Siegel? I strongly suggest people question their doctors regarding the negatives when taking statins. If they cannot list them…beware.
Read the actual studies. Statins do not work. the NNT is well over 100 if you know what that means.
I just can’t believe that bad science info you give out with only the drug company interpretation of the data.
Take the time and read a well conducted trial.
I have tried taking about every statin on the market. Read the information sheet early on but soon forgot the side effects listed. My cholesterol went down to 130s. I soon began having muscle and joint pain just about everywhere. Remember lying in bed one night because my right hip socket area was aching and it made me wonder if I would someday be needing a hip replacement. A few days later I was getting my hair cut and the receptionist (a senior citizen) was telling someone how she was forced to discontinue her statin use because of all the pain, especially in her arms and hands. I decided to stopped taking the statin. The pain went away
and my cholesterol went right back to where it started.
Interesting that “Dr.” Zimmer above is a chiropractor with a website that sells natural health alternative products (which are not FDA regulated). Yes, buyer beware indeed.
I’m a 61 year old male with 1 stent due to cath look and see after my heart saver CT scan showed 1300+ calcium score. Before the CT I was put on the stress test and all: doctor doubles my prevacid for the GERD, not angina (which he correct after I showed him the heart saver test). Why did my stress test look great – I was doing 8 miles a day, mostly walking; 6′ 180. Doctor starts me on Lipitor, my muscles aches etc.; My total life long chlosteror total 150?, but we discovered the calcium problem was hereditary. Droped Lipitor, started Vitorin, dropped it due to negative research. I moved and new family doctor starts me on Crestor (Jan, 08) and got some muscle aches but also a peripheral neuropathy. Dropped Crestor until new Cardiologist puts me back on it. LDL dropped from 108 to 47; muscles hurt and neuropathy got worse (not a diabetic), presently still on. Cardiologist adds supplements 6000 mg Omega 3/day and 150 mg CoQ10/day.
Question is did his neuropathy show up in the JUPITER studies??
Suggestions – everyone talk the heartsaver test (although insurances will not pay for it – THEY SHOULD!) it will save lives and chatch a potental stoke or MI before the occurance
I took Statins for several years, and all seemed to be well, but several months ago, I started getting disabling back pain. I suffered with that problem for almost a month or more, so decided to look on the Internet about the side effect of statins, and that is where I learned about the possibility of muscle pain. I stopped the statins, and after about 3 or 4 additional weeks the pain stopped. I do not want to go back to a medicine that can cause as much pain as a Statin. I now take CoQ10 and that has raised my energy level significantly. My energy level was significantly decreased while I was taking Zocor (simvastatin). If you are having muscle pain while using statins, check out the Internet for additional information.
I was one of the people with the “serious muscle aches” who was taking Zocor. When my left arm and right knee stopped moving and I woke up covered in huge bruises I began to realize where my severe mental disorientation was coming from and stopped taking it immediately. While the mental fuzziness cleared up very quickly it was a month before my arm would hold any weight and my knee was too weeak to hold my weight going up and down stairs for more than 6 months. In my circle of acquaintences I was 1 of 6 people with that severe a reaction – and I don’t think I know an unusual number of people! One of my Mother’s friends was putting her house up for sale and choosing a nursing home until she heard what happened to me and went off Crestor. It took a long time for her to recover, but now she’s as sharp and active as she was before and not in a nursing home. Statins are over-prescribed and I can’t believe they are fully safety-tested. What’s more, I can say from experience that once the mental fuzziness sets in it’s almost impossible to recognize that your muscle ache should have stopped weeks ago and you reaction is getting more severe!
My husband took Crestor for 2 weeks…he got very ill on it…total muscle pain…problems with his kidneys, and other things…the list goes on and on…I took Lipitor, and had the muscle problems..it took me a month to get over it, my husband was sick for a very long time and we had a lot of medical bills…
Never would I suggest anyone to take either of these…we started to take red rice yeast…both of our cholesterol counts are normal now with none of the horrible side effects of the Rx drugs
I’m a 51 year old male, cholesterol around 220. I’ve been on Zocor, Pravachol, and Lipitor. Each one made be feel like I’d just run a marathon and then spent the rest of the day with an axe splitting wood. I’ll take a SLIGHT increase in risk of heart disease over a 100% guarantee of feeling like hell any day.
My mom is 77 and was a very active, slim lady. She had a huge garden, — canned and froze bushels of fruit and vegetables (no exaggeration) and entertained 12+ people for Sunday dinners on a regular basis.
She was found to have high cholesterol and blood pressure 15+ years ago. She was very careful with her diet. She has been on Cozaar and Crestor.
She is now in the nursing home “very” mixed up.
Would omitting either of these meds help her? I asked a CCAC worker about it recently, but she didn’t think it had anything to do with her meds.
After reading this, I wonder.
Comments?
I realize that people with bad experiences are more likely to comment in a forum such as this but does anyone have anything positive to say about these drugs?
The previous comment that these patients were not healthy is absolutely correct. Additionally, the average age of the participants was well above 60. The press releases insinuate that statins should be considered for otherwise healthy patients to prevent heart disease. This is hardly even close to the truth. These drugs have serious side effects and should be prescribed only very judiciously.
Also, besides the obvious conflict of the drug manufacturer being the sponsor of the study, another potential serious conflict is that I believe the chief investigator of the study holds patents on the c-reactive protein test that would be used to determine the “need” for the statins.
Sounds quite suspicious to me.