The Debate About Statin Medications

Statin debate

There have been a lot of articles in the webspace lately disputing the efficacy and safety of statin medications. There really isn't a clear line to draw when it comes to any medications, including statins.

The focus of this article is to assess the arguments on both sides. What it is not, however, is a completely non-biased, scientific review on statins medications efficacy. I am an individual writing a blog post, and not a team of scientists administering skeptical questioning at every turn, my opinion is going to come through at some point in this article but I will try my best to distribute both sides as evenly as possible and address the arguments so you can make your own opinions. 

What are Statins?

To start off with, its fitting to discuss what a statin actually is. Statins are a class of medications used for high cholesterol levels, and as a preventative for the development of future cardiovascular events.

The idea is that cholesterol plays a key role in the development of most cardiovascular diseases by forming thick artery clogging plaques. It's thought that by preventing the ability for cholesterol to be produced, heart disease can be avoided. Statins work to inhibit the creation of cholesterol by the liver. 

Statins don't remove any pre-existing cholesterol plaques. Instead they attempt to stabilize them, and prevent any further plaquing. This reduces the chances of clogged arteries in the future.

They've also been reported to reduce the level of circulating C-Reactive proteins, which are a key inflammatory mechanism in the development of atherosclerosis. Which in turn is a key driver towards cardiovascular disease and heart attacks. [1]. 

Are There Different Types of Statins?

There are several statins on the market today, including the semi-synthetic statins simvastatin and pravastatin, as well as the synthetic statins fluvastatin, rosuvastatin and pitavastatin and atorvastatin.

Currently the most popular statin is atorvastatin (Liptor). 

Are Statins Natural?

In 1976 a Japanese biochemist discovered a component from the fungus Penicillium citrinum that was able to block HMG-CoA reductase (the enzyme responsible for producing cholesterol in the liver). Over the next 11 years, it was tested, adapted, and tested again before finally finding approval by the FDA for use in humans.

Since this time, several semi-syhthetic and synthetic versions have been developed and are the majority of the statins found in medicine to this day. A good reason behind this is the profitability of patented synthetic derivatives over plant or animal extractions.

That said... statins are indeed found in nature.

 

Are Statins Really The Blockbusters Of Pharmaceutical Medications?

Yes. In fact, they make tens of billions per year.

After its discovery and subsequent testing, it was released to the general public. Upon its release, annual sales in the United States in the first year alone exceeded $1 Billion. In more modern times this number is closer to $20 billion per year. [1]. 

Are they brain washing tens of thousands of highly intelligent doctors worldwide to achieve this? Not as simple an answer and not something we can really test for... but i'm going to go out on a limb here and suggest that no, they are not. 

 

Do Statins Destroy Your Liver?

Statins are technically a reversible competitive HMG-CoA reductase inhibitor. This basically means it blocks the actions of the enzyme responsible for cholesterol production through competition. This is important to understand because their is a bit of a myth going round that statins work by destroying the part of your liver that creates cholesterol.

This is simply not true.

Rather they compete for the attention of these enzymes, taking the focus away from molecules that actually lead to the production of cholesterol. This is why statins are reversible, and will never be able to inhibit cholesterol 100%. If you were to stop taking them, normal liver function would be restored. [2]. 

Are Statins Effective?

Statins are effective at reducing cholesterol production, yes. Are they effective at preventing heart disease? This isn't as clear.

Statins reduce blood LDL levels by 10-45%, and increase HDL by 2-13%. The maximum therapeutic response occurs after about 4-6 weeks of use. [2]. These numbers look very good, but does this have as direct a link to cardiovascular disease mortality? A recent cochrane review suggests not. 

1000 people would need to be treated for an entire year to prevent a single death. Although there is an undeniable effect of statin medications, the controversy lies in the debate over whether this 1 in a thousand is worth the cost, side effects, and damage to other areas of the body also brought on by statins. 

An increasing number of doctors are saying no. That the damage statins have been found to cause to the muscular system, cognitive function, and libido don't outweigh the slight decrease in cardiovascular disease.

Other doctors instead dispute the conclusions drawn in the Cochrane review. Such an argument could be the lack of evidence in the review for side effects, despite a conclusion that the risk of statins doesn't outweigh the benefit. 

Again... this isn't a simple answer, and is one we need to discuss more openly.

Statins do work... at reducing cholesterol...

They do have side effects... some of them are fairly extreme...

Weighing out these options openly, and making a decision on an individual basis is the only way these medications are going to evade such a high degree of controversy. Slapping nearly everybody above the age of 50 on them just for good measure is illogical and harmful. 

What Are The Side Effects Of Statins?

Several major issues have come to light with the use of statins….

Some of milder side effects include: [1]. 

  • Rashes
  • Constipation
  • Diarrhea
  • Drowsiness
  • Memory loss
  • High blood sugar
  • Increase Lowered libido

Some of the more serious side effects include:

  • Myositis
  • Rhabdomyolysis
  • Can result in serious muscle damage, and kidney damage)
  • Cancer risk (especially cancers associated with sex hormones such as prostate cancer in men and breast or ovarian cancer in women),
  • Liver failure
  • Induced diabetes risk of type II diabetes


Many people write these side effects off as placebo or offering less damage than would occur if the drug was not taken. Let’s consider for a moment the most serious side effect of statin medications. Rhabdomyolysis.

 

Statin Induced Rhabdomyolysis

Rhabdomyolysis is a fancy term referring to the breakdown of muscle cells. This causes intense pain in the muscles, a sudden loss of strength, and an overwhelming amount of toxic cellular waste entering the blood. This needs to be filtered out by the kidneys. The sheer amount of damage reported with statin induced rhabdomyolysis is enough to overwhelm the kidneys with toxic cellular waste and can actually lead to kidney failure. [5]. 

This is a serious condition that can be fatal. Even in cases that are not life threatening will likely cause lifelong kidney damage and the need for regular medical support. 

 

So Are Statins Good Or Bad?

The answer to this question is far from simple. And is likely to get rejected no matter what way you suggest. It's easy to argue either way because it's very easy to find evidence supporting both sides.

Ultimately what it appears to come down to is the level of risk your cholesterol level poses on your individual cardiovascular health, and your ability to take health into your own hands. Will you commit to your health and change your diet, stop smoking, and exercise more?

If you answered no to any or all of those questions then statin medications are for you.

For those willing to change their lifestyle, eat vegetables, and quit smoking in order to restore good health and reduce cholesterol levels, then the answer may be a resounding no.  

References:

  1. Li, J. J. (2009). Triumph of the heart : The story of statins. Oxford: Oxford University Press. http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=269642
  2. Bryant, B. J., Knights, K. M., & Salerno, E. (2010). Pharmacology for health professionals. Chatswood, N.S.W: Elsevier Australia
  3. Ghirlanda, G; Oradei, A; Manto, A; Lippa, S; Uccioli, L; Caputo, S; Greco, AV; Littarru, GP (1993). "Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study". The Journal of Clinical Pharmacology. 33 (3): 226–9. doi:10.1002/j.1552-4604.1993.tb03948.x. PMID 8463436
  4. Ho, MJ; Li, EC; Wright, JM (March 3, 2016). "Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension.". The Cochrane database of systematic reviews (3): CD007435. doi:10.1002/14651858.CD007435.pub3
  5. Mendes, P., Robles, P. G., & Mathur, S. (2014). Statin-induced rhabdomyolysis: a comprehensive review of case reports. Physiotherapy Canada, 66(2), 124-132.