Patients and doctors alike are understandably nervous about taking/prescribing any of the cholesterol-lowering drugs known as statins. You as a patient especially don’t want to hear “You’ll be on this pill for the rest of your life.” And if you’ve followed some of the recent articles on statins, you’ve likely felt annoyance at the mixed messages from the medical community. For example, I recently wrote that 40 years ago the sugar industry suppressed data proving sugar was a major cause of heart disease. Big Sugar went on to sponsor a deliberate campaign of misinformation that shifted the spotlight to fats and high cholesterol.
Assuming cholesterol was the sole culprit behind heart disease, an array of drugs were quickly developed and they’ve always been problematic. The original ones, like clofibrate (Atromid-S) worked by blocking absorption of fat into the bloodstream. Clofibrate was replete with side effects like diarrhea, abdominal pain, and even inflammation of the pancreas. Worse yet, clofibrate scored zero when it came to preventing heart disease.
The B vitamin niacin, with its facial flushing side effect, didn’t fare much better. After years of clinical trials, with side effects always outweighing benefits, Northwestern cardiologist Clyde Yancy, MD, said of niacin “It is no longer relevant in today’s world.”
This left everyone with the statins, the largest group of prescribed meds in the world. Statins interfere with your body’s ability to manufacture cholesterol, and yes, your cholesterol will drop when you take them. What doctors too often forget is that patients are only supposed to start taking statins if lifestyle changes (healthful diet, weight loss, smoking cessation, exercise) have failed to lower risk factors for heart disease.
But again, the big question is whether or not statins actually prevent heart disease. The debate continues, and recently took a nasty turn. A recent review in the British medical journal Lancet looked at more than 10,000 statin users, declared that side effects were minimal, and urged continued aggressive statin use.
Wait just a minute, said other researchers just a few days later. They claimed the Lancet group had misrepresented data: statins had plenty of side effects, and while statins were helpful in some situations, for the most part they weren’t all that good at heart disease prevention. One anti-statin correspondent reminded everyone that Oxford University (which had released the thumbs-up statins study) had, over the years, received “hundreds of millions of pounds from Big Pharma.”
This leaves you in a bind
“Okay,” you’re thinking. “My cholesterol is high and while I try to avoid my dietary preference of deep fried elephant ears and eat enough Mediterranean until I’m speaking Corsican, my cholesterol doesn’t budge. Do I really need the statin I was just prescribed?”
Good news. There are two tests you can take to find out. One is so inexpensive ($49) that you might as well pay cash and not bother to submit for reimbursement. The second, though a bit more expensive, is usually covered.
Test 1: CT scan of your heart If you have high cholesterol but no history of actual heart disease, consider a CT scan of your heart to measure the calcium in your coronary arteries. You can get this scan at many hospitals, the best price being here. Although scanning your heart for calcium has been around for years, it’s been so overpriced that health insurers weren’t paying for it, claiming it was unproven. But over the years, more and more data emerged showing that patients with low calcium scores on their scans actually did not go on to develop heart disease, regardless of their cholesterol levels. A study in last month’s JAMA reconfirmed what cardiologists had suspected for years: low calcium=low heart risk. What I conclude from this is unless you have a significant family history of early heart disease (heart attacks or bypass surgery before age 70), I wouldn’t bother with statins.
Test #2: Corus CAD If you have high cholesterol and some puzzling symptoms that are not actual heart symptoms (like chest pain with exertion) but can’t be completely ignored (like tightness in your throat, jaw, or abdomen), have your doctor order the Corus CAD test (I wrote about Corus CAD in a Health Tip a few years ago). It’s especially useful for women because their symptoms of heart blockage can be quite different from those of men. Using a blood sample, this test looks at your actual genetic risks for developing coronary artery disease. Here’s a sample report of a woman with symptoms whose doctor was likely debating whether or not to place her on statins or schedule a stress test. As you can see, the likelihood of actual heart blockage is minimal—just 3%. The combination of a low Corus CAD test result and a low calcium score can offer great reassurance to both patient and doctor.
So let’s take the worst-case scenario: people in your family develop heart disease during mid-life. You yourself have high cholesterol, and a lot of it is the bad LDL type. You have a high calcium score on the CT scan of your coronary arteries. You have a high percent risk on your Corus CAD.
You’re the one who needs a statin as part of your overall plan for prevention. You should also have regular visits with a cardiologist, preferably one who emphasizes prevention. In addition, take seriously all the recommended prevention efforts—healthful weight and blood pressure control, no smoking, regular exercise, a daily low-dose aspirin.
Because let’s face it. With information we can now obtain from a CT scan and a Corus CAD test, giving everyone with elevated cholesterol a statin seems just plain silly.
David Edelberg, MD