It should come as no big shock that I am certainly not an advocate of the statin class of drugs to lower cholesterol. There are many reasons why I am so vehemently opposed to the use of this drugs. How could this be, when it cuts the risk of a cardiac event by 50%??
For primary prevention (meaning we are trying to prevent a first heart attack), in almost all studies I’ve read, regardless of what value you look at (cholesterol, hsCRP, LDL), a statin will cut the RELATIVE RISK down by 50%. If you are a physician that does not understand research and take the drug company’s headline as gospel, this seems like a godsend. Every patient walking through the door is going to get their blood pressure checked and get a prescription for a statin, thinking that you are doing wonders for your patients.
However, before we jump up and down in excitement, we need to understand relative vs absolute risk. In most of the studies, the numbers are pretty consistent. Treat 100 people for 3 years and, instead of 2 people having a heart attack, only 1 does. The RELATIVE drop from 2 to 1 is a 50% reduction and sounds great. But since the overall risk is pretty low in this population (typically referred to as a 10 yr risk), the absolute risk reduction is a paltry 1%. This flat out sucks.
There are some lifestyle interventions or supplements that fall into the same category. The relative risk reductions may appear more powerful than if you put it into absolute risk reductions. Here’s the difference. Statins are very expensive (although with the loss of the patent on Lipitor the prices will drop substantially) and have a long list of side effects. Muscle damage (the damage is present even if someone taking statins does not have muscle pain). Depletion of CoQ10. Probably the greatest scare is the increased risk of diabetes.
But, the biggest, staring you right in the face, answer is that I have NEVER not had a patient bring their cholesterol levels in line with the right lifestyle choices. This is and will always be the only appropriate way to handle lipid issues. The vast majority of patients with lipid (total cholesterol, triglycerides, HDL, VLDL) problems are pre-diabetic. So giving these patients a drug that will worsen the physiological state that is making the number off kilter is just plain bad medicine.
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