Dr. Jacqueline Gerhart: Column On Statins Generates Discussion
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Readers: I had many replies regarding my recent column on statins. Many of you shared stories of your personal side effects from statins and were happy to see me discuss the risks and warnings. Others brought to my attention even more recent studies that reaffirm the effectiveness of statins.
One of these studies was highlighted in a January Cochrane Review article titled "Statins for the Primary Prevention of Cardiovascular Disease." This report analyzed 18 trials with more than 50,000 patients.
The conclusion: In both "high-risk" and "low-risk" individuals, statins reduced all-cause mortality, heart attack and stroke. In other words, they are beneficial in patients with high cholesterol, even with no other cardiovascular risk factors. In fact, the article's authors wrote, "the benefits are similar (in patients) at lower (1 percent per year) risk of a major cardiovascular event."
So does this mean everyone needs to start a statin? Well, not necessarily. Again, talk to your doctor.
We can estimate your numerical "risk" over the next 10 years of having a cardiovascular event - i.e. stroke or heart attack. And we can model how you can reduce that risk by controlling your risk factors, such as lowering your cholesterol, blood sugar and blood pressure, or by stopping smoking.
It's quite impressive to see in a model how one's percentage of cardiovascular risk decreases when a change - such as quitting smoking - takes place.
In my previous column, I emphasized that statins are most beneficial in patients who have known heart disease. This is true - statins are indicated for nearly all patients once they have had a heart attack. The point of this new data is to help you consider using statins as treatment for underlying risk factors, with the goal of preventing heart attack and stroke.
Interestingly, the study featured in the Cochrane Review also analyzed side effects and cost-effectiveness. The results showed that for the majority of people, the benefits of statins outweigh the risks, and that the cost-benefit ratio is favorable.
The study concluded that for every 1,000 patients who take statins for at least five years, 18 of them would dodge a cardiovascular event they otherwise would have. This percentage is about equivalent to other preventive strategies - such as controlling blood pressure or quitting smoking - that are well-established.
Every medical treatment comes with downsides, and statins are far from perfect. To all of you who replied regarding muscle pains, generalized fatigue, irritability, depression and other side effects, my heart goes out to you. I'm sure it is frustrating to hear us physicians promote using medications that make you feel worse.
Sometimes, the solution is as easy as changing the type of statin you are on, as we have multiple statin drugs from which to choose. Other times, it's a matter of starting low and increasing slowly, or altering when or how you take it.
And sometimes, patients simply are unable to tolerate statins, in which case we work with you to find other treatments.
Thanks to Dr. Pat McBride from UW Health Heart, Vascular and Thoracic Care, and to my other readers for their feedback.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 03/05/2013