Our Statin Nation

Although they don’t know who they are, 11 million Americans awakened last week as victims of a new disease, the dreaded “statin deficiency disorder,” or SDD. It’s not easy to diagnose because there are no symptoms. Even the lab test once closely linked to the word “statin”—cholesterol measuring–may miss SDD. In fact, with no symptoms and no positive test results, you might need the expertise of Dr. House.

Here’s an overview of the report, including a link to the apparently inoperative online screening guide.

The cure for SDD is, of course, as close as your drugstore, that cheerless building at the corner of Happy and Healthy. The same location is also the neighborhood’s prime outlet for cigarettes, liquor, salty snacks, and endless bags of candy. Way in the back, though, her head peering over a high countertop, is your statin distributor. She’s taking her orders from the man via phone or on a scrap of paper. Just swallow one statin daily and your SDD is history.

In fact, so prevalent is SDD that some researchers have suggested statins be made available over the counter and be taken by everyone over 21 along with a tiny heart-saver aspirin. For convenience, bags of statins could be displayed at the checkout counter. (“Let me have a lottery ticket, a TV Guide, two Kit-Kats, a pack of Marlboro lights, a half pint of peppermint schnapps, and a small bag of Lipitor.”)

Preventive medicine, American style

The New York Times (always a font of useful health information) expresses the situation in a comic strip that should be reprinted repeatedly until the travesty of pharmaceutical self-interest finally sinks in. Clearly, wiping out our national epidemic of SDD isn’t the same as eliminating AIDS or curing cancer. But I guess we should start somewhere.

Lest you worry you’re a walking time bomb, your SDD ticking away, here’s what happened last week. To great fanfare, an immense report (85 pages, to be exact) was jointly released in the US and Europe by the American Heart Association (AHA) and the American College of Cardiologists (ACC). To condense it into a two or three sentences (not a great challenge, by the way), the report identifies four major groups of people who should receive statin drugs to lower their cholesterol.

Of these, we knew the first three already:

(1) People with known coronary heart disease (including those with angina pectoris), people who have already had a heart attack, as well as patients after coronary angioplasty, a stent insertion, or coronary bypass grafts.

(2) People with (bad) LDL cholesterol of 190 or greater.

(3) Those between ages 40 and 75 who have diabetes.

It’s the fourth group that causing controversy:
(4) “Anyone between age 40 and 75 with an estimate risk of 7.5% of developing heart disease over ten years.” The report supplies formulas for calculating 10-year risks, but (not unlike the online insurance exchanges) I couldn’t get the system to work properly. Maybe you can.

The risk factors involved in making the calculation are all the usual suspects: high blood pressure, obesity, smoking, diabetes, inactivity, total cholesterol, race, age, and gender. Researchers are perfectly willing for you to try to make the lifestyle changes needed to reverse the first six of these, but they assume you won’t. And since you’re not going to get off your duff and toss out the Marlboros and chicken-fried steak, they suggest you ask your doctor for a statin.

Bought by Big Pharma?

Of course, the real beneficiary of this report is the pharmaceutical industry, with a potential 11 million new customers in the US alone. Also—and please try not to think about this too much–both the ACC and the AHA as well as a majority of the researchers listed as authors of the report are all beneficiaries of the industry’s generous financial largesse.

You might be surprised to learn that an indirect beneficiary of SDD treatment is the health insurance industry. They’d much rather cover the cost of generic statins (at pennies a day) than pay for some serious preventive medicine like nutritional counseling or fitness training. And what they’d really hate to do is pay for the genetic test I described last week (Corus CAD), which can show those diagnosed with SDD if they really are at risk for heart disease.

One major objection to treating SDD is that doing so overly simplifies more complex health issues facing us all. Basically, we’re using a potentially harmful drug (for some people, at least) to cover our national and individual failures to acknowledge that cigarettes still exist, food can be disgustingly unhealthy, and our children are getting fatter and sicker.

Instead, we’re inclined to do as an old friend of mine (not a patient) does when we go out to eat together, ordering his creme brulee, popping a Crestor, and giving me the sly wink that says he’s covered himself, healthwise.

Have you been diagnosed with SDD?

To some extent, if you’ve been diagnosed with statin deficiency disorder and you’re leaving your doctor’s office with a prescription in hand you’ve shirked some fundamental responsibilities and placed blind trust in the pharmaceutical industry. Let’s face facts: behavioral changes can make the vast majority of statin prescriptions irrelevant. That’s right, and in fact a second study that’s certainly as important as the statin study was virtually ignored by the media.

In this week’s Annals of Internal Medicine, researchers from the National Institutes of Health and the National Cancer Institute, with no Big Pharma funding, reported their findings after tracking the dietary patterns and health status of more than 10,000 nurses (via a series of questionnaires) starting in middle age (late 50s to early 60s) and ending 15 years later.

Their goal was to find out if a healthful diet, even one starting in middle age, could prevent chronic illness down the road. And not just heart disease, but also diabetes, strokes, kidney and lung disease, and even cancer, dementia, and Parkinson’s. Their conclusion? I’m guessing you’ve already deduced: healthy eating was associated with overall healthier aging and fewer chronic illnesses of all stripes. People who reported no tobacco use, regular exercise, and weight control fared even better.

And whether or not the nurses were victims of statin deficiency disorder wasn’t even brought up.

Be well,
David Edelberg, MD

PS: The title for this week’s health tip comes from a documentary of the same name. You can watch a preview here.