Suffice to say, this is one of the most polarizing topics in medicine, and rightfully so.
The debate is over primary prevention with statins. Primary prevention is treating people with high cholesterol and/or inflammation who may be at risk for a cardiovascular event, such as a stroke or heart attack.
Most physicians would agree that statins have their place in secondary prevention, or treating patients who have had a stroke or heart attack already or have coronary artery disease.
We are going to look at benefits and risks for those that could take statins for primary prevention. On one side, we have the statin as Rocky Balboa, fighting off cancer risk, as well as improving quality of life and glaucoma.
On the other, we have the statin as Evel Knievel, demonstrating that reckless heroics don’t provide longevity, but they do increase diabetes risk, promote fatigue and increase cataracts.
A meta-analysis of 13 observational studies showed that statins may play a role in reducing esophageal cancer risk. The results showed a 28 percent risk reduction.
The authors surmise that statins may have a protective effect. Although there is an association, these results need to be confirmed with a randomized controlled trial.
In two common eye diseases, glaucoma and cataracts, statins have vastly different results. In one study, statins were shown to decrease the risk of glaucoma by 5 percent over one year and 9 percent over two years. The longer the duration of use, the greater the positive effect on preventing glaucoma.
Statins also help to slow glaucoma progression in patients suspected of having early-stage disease at about the same rate. This was a retrospective study analyzing statin use with patients at risk for open-angle glaucoma.
With cataracts, it is a completely different story. Statins increase the risk of cataracts by over 50 percent, as shown in the Waterloo Eye Study. Statins exacerbate the risk of cataracts in an already high-risk group: diabetes patients.
Quality of life and longevity
In a meta-analysis involving 11 randomized controlled trials, statins did not reduce the risk of all-cause mortality in moderate to high-risk primary prevention participants. This study analysis involved over 65,000 participants with high cholesterol and at significant risk for heart disease.
However, in this same study, participants at high risk of coronary heart disease saw a substantial improvement in their quality of life with statins. In other words, the risk of a nonfatal heart attack was reduced by more than half and nonfatal strokes by almost half, avoiding the potentially disabling effects of these cardiovascular events.
A randomized controlled trial published in the Archives of Internal Medicine reinforces the idea that statins increase the possibility of fatigue.
Women, especially, complained of lower energy levels, both overall and on exertion, when they were blindly assigned to a statin-taking group. The trial was composed of three groups: two that took statins, simvastatin 20 mg and pravastatin 40 mg; and a placebo group.
The participants were at least 20 years old and had LDL (bad) cholesterol of 115 to 190 mg/dl, with less than 100 mg/dl considered ideal.
In conclusion, some individuals who are at high risk for cardiovascular disease may need a statin, but with the evidence presented, it is more likely that statins are overprescribed in primary prevention.
Evidence of the best results points to lifestyle modification, with or without statins, and all patients with elevated LDL (bad) cholesterol should make changes that include a nutrient-dense diet and a reduction in fat intake, as well as exercise.
For further information, visit medicalcompassmd.com or consult your personal physician.