Statin drugs are much more than cholesterol lowering agents…

Statin drugs are in the news.  The real truth is coming out.

The truth that statin drugs (Zocor, Lipitor, Crestor are a few of the more recognizable names) are much more than simple cholesterol lowering agents.

This very informative WSJ piece presents the thesis–first published by renowned experts in the Annals of Internal Medicine this January–that statin drugs benefit patients based on their cardiac risk profile rather than their cholesterol level.

In other words, the higher the cardiovascular risk, the more benefit statins confer, independent of the cholesterol level.  There are many studies to back this up, but since this is a blog, not a review article, I will present the simple DrJohnM explanation.

Heart disease stems from the acute and chronic effects of inflammation on the inside of the blood vessel, the endothelium.  Inflammation leads to roughening of the endothelium, proliferation of fatty deposits, sticky platelets, and a much higher likelihood that the artery will clog, sometimes abruptly.  High cholesterol is but one of these factors.  Inflammation of the endothelium comes from many other origins: your parents, smoking (this is a really bad one), diabetes, high blood pressure, obesity and the angry personality (politically correct terminology is “Type A”- personality).

Statins are basically anti-inflammatory agents that are especially effective in the blood vessel lining.  They are like smoothing agents.  They seem to work where the rubber hits the road–where the platelets hit the endothelium.

In fact, some of the most striking data on statins were done in high risk patients with normal cholesterol levels.  It turns out that statins were highly effective in preventing cardiovascular events despite completely normal cholesterol levels.

Take home messages on statin drugs:

• The cholesterol level is but a short chapter in heart disease prevention.
• Reducing inflammation is the key to healthy arteries.  Statins help in this regard, especially if their is prior heart disease or a high cardiovascular risk. How high a risk justifies statins is an open question.  This is where clinical judgement and skill enter the game. 
• Nothing in this news supports the notion that the anti-inflammatory effects of statins supplant the need for healthy living.  Patients can so reduce inflammation by making such simple choices.  They are too boring to name. We all know that processed hot dogs, donuts, pork-topped pizza, dairy-fat laden ice cream and finger-discoloring cheetos inflame the blood vessels. We know that mounting the bike after work is better for the arteries than dipping into the potato chip bag. And, obviously, screaming obscenities inflames the fragile blood vessel-platelet surface way more than practicing yoga.
• Nothing in this recent news supports using statins in very low-risk patients without prior heart disease. This is where statistics come into play.  Said simply, if the risk of an event is low, the benefit of the drug has to be low.  All drugs have risks, statins are no exception.  So, when the potential benefit is low, even the small risk of statin toxicity is amplified.  

Should you take a statin?

Ask an informed high quality doctor. How do you know if your doctor is statin-enlightened?  Ask about statin’s role in mitigating inflammation of the endothelium.  If your doctor beams, and says something like, that’s exactly why statin drugs are beneficial, than you likely have a good one.

JMM