Are statins worth taking for high cholesterol? (2023)

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Research has shown that statins are very effective in reducing the risk of fatal heart attack and stroke. But some people are hesitant to take these life-saving drugs. They fear having to take medication every day for the rest of their lives or have been told that statins have unwanted side effects. What does science have to say about these and other concerns about statins? We spoke with the interventional cardiologist at HUDr. Ian Neeland, director of the Center for Cardiovascular Prevention at University Hospitals, for more information.

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matt jepson

High cholesterol. You know, I always thought that eventually I would find out. And then I would officially say that I am old.

pedro kenworth

Yes. Well, I'm not that old. And I have high cholesterol. In fact, I have had high cholesterol for years. And we both know it's not just about age, right? I mean, genetics also play a role in high cholesterol. Now I want it to be smaller, but I'm also not sure I want to take medication for the rest of my life. Hi, I'm Pete Kenworthy.

matt jepson

And I am Macie Jepson. And that's Healthy@UH. You know it's interesting. I found quite a bit about this drug. Before we go any further, it's worth mentioning that we're on Zoom for this podcast. We are doing everything we can to stay safe and stay away from each other. So please bear with us if the quality is a bit over the top. There is a lot of information available that would encourage people to avoid statins. I've heard they affect your memory, your muscles, and even your chances of getting diabetes. These are commonly prescribed drugs, but the more I researched them, I began to wonder if they really should be. We are joined today by Dr. Ian Neland. He is Director of the Cardiovascular Prevention Center of the University Hospitals. First of all, thanks for joining us, Dr. Holland.

Dr. Ian Neeland

Thanks for your invitation.

matt jepson

Let's talk about what exactly cholesterol is. I mean, we all do. What is it used for in our body?

Dr. Ian Neeland

Well, cholesterol is a waxy, fat-like substance that helps the body make cell membranes, many hormones, and vitamin D. Therefore, it is a very important part of the body's metabolism. And blood cholesterol comes from two sources: the food you eat and your liver. In fact, your liver makes all the cholesterol your body needs. Thus, the excess cholesterol that you consume in your diet is above your real needs. Now, cholesterol and other fats are carried in the bloodstream as round particles called lipoproteins. And the two most well-known lipoproteins are low-density lipoproteins, or LDL, and high-density lipoproteins, or HDL. Now you may have heard of these terms. LDL, or bad cholesterol, contributes to the buildup of plaque in the arteries. This is called atherosclerosis. And this is linked to an increased risk of heart disease and stroke. On the other hand, HDL stands for high-density lipoprotein and is considered the good cholesterol. Now, a person's HDL level should be around 50 milligrams per deciliter, but there are a number of ways to increase your HDL, including exercising for at least 30 minutes five times a week, quitting smoking, avoiding saturated fat and lose weight. .

pedro kenworth

So the big concern, I guess, is LDL, right?

Dr. Ian Neeland

This right.

pedro kenworth

Right. So there are drugs that can sometimes lower our LDL cholesterol, or bad cholesterol, by 50%. Right? So I guess the question is, why shouldn't we take these drugs? I heard in one of your presentations that an internet search on statin myths returned 30 million results online. So before I debunk some of these myths, I think the first question is, why is there so much negativity about them?

Dr. Ian Neeland

Well, you know, I think there's a lot of misinformation on the internet. And people are really confused about what is true and what is a myth. And so they don't necessarily talk to their doctors about these issues all the time. So I think it's very important to get the facts straight. Well, I think for most people there is generally a low desire to take medication long term. And also, I heard, you know, why should I take it if the medicine doesn't make you feel any different? Many people have this myth. And the other thing is that a lot of people think that once their cholesterol levels improve with a statin, they can stop taking it. Unfortunately, in many situations your cholesterol levels will return to their previous level. And you know, you're no better than when you started.

matt jepson

And perhaps the biggest myth of all is that they don't work when it comes to preventing heart attacks. Doctor, you obviously don't agree. But what is the science behind this disagreement?

Dr. Ian Neeland

Yeah. So that's definitely myth number one. We know from decades of research that statins and other lipid-lowering therapies are highly effective in reducing the risk of major vascular events, such as death from cardiovascular causes, myocardial infarction, i.e., heart attack, stroke, or the need for a coronary stent or bypass surgery. We now have data from more than 20 statin studies involving more than 135,000 patients showing that compared to placebo or no drug, statins resulted in a 23% reduction in heart attacks, a 17% reduction in fatal and nonfatal stroke deaths and a 19 percent reduction in cardiovascular deaths and a 12 percent reduction in all-cause mortality. So they definitely work. They are definitely effective in heart disease and death. And they are data that have always existed. And I think this myth definitely needs to be dispelled.

pedro kenworth

So it looks like someone with high cholesterol, my cholesterol is 220, 230 for example, that's considered high. It sounds like people should just take statins, but I suspect there are people who should avoid statins who shouldn't be taking statins. Right? You know, there's a lot of other stuff out there, right? Like statins cause dementia, or maybe people with a family history of dementia should avoid taking statins. Are there people who shouldn't, who have high cholesterol, who shouldn't be taking statins?

Dr. Ian Neeland

You know, if you are allergic to a statin or statin drug components, this is definitely a situation where you should choose an alternative drug. He has mentioned memory or dementia. Well, you know, the truth is that memory problems in people who take statins tend to occur in the same age group. So it's very difficult to know if it's the statin or other factors. Initial concerns about dementia came from self-reports to the Food and Drug Administration, but many reports came from people who actually took the drug for only one day. Therefore, it is unlikely that the drug had any effect. And we know we have more reliable data from other studies, including more than 20,000 people taking statins. And the bottom line is that statins really have no effect on thinking or memory problems. While statins do have some potential long-term side effects, in most cases, once your doctor has determined that you have high cholesterol and need a statin, the risks far outweigh the risks, or sorry, the risks. benefits far outweigh the risks.

matt jepson

It really amazes me how many people are choosing statins based on what you're telling us right now. But the fact is that they are. I mean, we've already touched on that. But I want to ask you again, doctor, why is that? Why is there so much negative information?

Dr. Ian Neeland

Well, I think many people have some questionable side effects that come with starting a statin and have heard negative reports or anecdotal information or stories from friends and family. And very often it comes to muscle pain. So, you know, in general, muscle pain is not dangerous and there is really only a degree of discomfort. There are rare cases of severe muscle breakdown that can be dangerous for organs like the kidneys, but these cases are extremely rare. And I haven't seen a case since medical school many years ago. There is now some compelling evidence that vitamin D supplementation, thyroid regulation, and perhaps the drug coenzyme Q-10 can help reduce the muscular side effects of statins. And while it certainly makes sense to try them, we know that most of the suspected side effects of statins aren't actually statin related. According to a recently published studyNew England Journal of Medicinelast month it was shown that in patients who discontinued statin therapy because of reported side effects, 90% of the symptom burden caused by a statin challenge was actually also caused by placebo. Therefore, most people who reported a statin side effect symptom had the same side effect as the placebo. And half of the patients in the study were able to successfully resume their statins. So this data really shows that while there are side effects, they are very rare as they are actually related to statins and most people can get past them and take a certain dose of a statin for long term benefit. .

pedro kenworth

As with many things in medicine, the benefits far outweigh the risks. And it seems to be the case here too. You just mentioned that you talked about the possible long-term side effects of statins. Who are they? For example, what are the… They talk about a lot of the myths that are out there, but are there real side effects that, whether they should be a concern or not, what are they?

Dr. Ian Neeland

So, as with any medication, as I mentioned before, you have to weigh the potential risk against the benefit. I mentioned that the only side effect will be muscle pain. This is called myalgia. And we know that statins in general have multiple benefits, and the longer you use them and lower your cholesterol, the greater the benefit and the lower your risk of developing heart disease. On the other hand, as you said, there are small potential risks. One of those risks, for example, is the development of diabetes. What we do know, however, is that out of 255 patients who receive a statin for four years, only one of those patients may be diagnosed with new diabetes. And this usually occurs in people who are already at risk of diabetes. Well, they could have prediabetes, for example, or be very overweight, and that could have happened over time anyway, regardless of the statin medication. So aside from the possibility of muscle pain, the remote possibility of diabetes, there really aren't any significant side effects of statins that most people experience. Situations of liver or muscle damage are rare, but even these cases are extremely rare. And certainly, in people who are at high risk of heart attack and stroke, who have high cholesterol, and may have a family history of heart disease, the benefits will definitely outweigh these long-term risks. You know, what we know from genetic studies is that the longer your LDL cholesterol is as low as possible, the higher the risk, the lower the risk of heart disease. For example, taking a statin drug that lowers LDL cholesterol for 10 years can reduce your risk by 20%; 30 years in 40%; 50 years at 60%. For this reason, there are people and families with genetic alterations that lead them to have very low LDL cholesterol, less than 20.

These people almost never have heart disease. We know, we know that if we could put statins in the water and everyone could tolerate them, the risk of heart disease would drop significantly. So the longer you take the statin, which translates to lower cholesterol over time, the lower your risk. So if someone in their 30s really wants to lower their risk long-term, especially if they have a family history or maybe have borderline risk factors, those are the people who are going to get the most benefit over time as they move forward. Changes in heart disease will dramatically change and dramatically lower LDL cholesterol.

matt jepson

Is discontinuation of these prescription drugs during treatment, or even without consulting a doctor, a big problem in the medical community?

Dr. Ian Neeland

I think this is a big problem. I mean, people often stop taking medications without talking to their doctor. You know, the most important thing is to discuss your questions and concerns with your doctor. And even if you're thinking about side effects, talk to your doctor about it. There are things your doctor may recommend, such as: This includes checking and restoring your vitamin D and thyroid blood levels, adjusting your statin dose, or switching to a different statin that may have different effects. And many of these things can fix the side effects you're worried about. But most importantly, continue to take your statin if your doctor determines that it will benefit you in the long term. I always say that prevention is the best medicine. And statins are certainly one of the most important tools that we have in cardiology to prevent heart attacks and strokes.

pedro kenworth

Which is the magic number? Right? I mean, we know that you can lower your cholesterol by changing your diet or by exercising. Of course, genetics play a role. And sometimes you just have a little bad luck. But is there a magical age? Is there a magic number? Okay, now I'm 49. Right? And my cholesterol is 220, 230. No doctor has ever told me I need a statin. Right? Every time I go to the doctor, which is not as often as it should be, but once a year, they tell me, you know, change your diet a little or exercise a little more. But no one ever said you should take a statin. And then I think I'm not old enough. Or my cholesterol is not very high. There must be some factor.

Dr. Ian Neeland

Well I guess it starts with suspicion and knowledge. You know, I'm a preventative cardiologist, so I'm very focused on risk and long-term risk. So to have a statin indication, you have to understand it in the context of a person's risk. So, you know, people who already have heart disease, people with diabetes, people who have very high LDL cholesterol, this is called severe hyperlipidemia, so it would be LDL cholesterol greater than equal to 190. And then people with precoronary problems. history of heart disease, such as familial hypercholesterolemia, these people should really be taking a statin. So the people who don't, you know, if the patients don't meet those criteria, then it's all a matter of how long is the risk of developing a heart attack or stroke. And that helps us decide whether or not you should take a statin. So in general, you know that younger people who don't have risk factors for heart disease usually get away with lifestyle changes, diet, and exercise. But as you get older or develop risk factors like high blood pressure, diabetes, obesity, inflammatory diseases like lupus or rheumatoid arthritis, all of these things can increase your risk of heart disease and would be indications to take a statin. Well, you mentioned, you know, diet and exercise. So you know, to some extent, changing your eating habits and getting some exercise can lower your bad cholesterol, specifically lower saturated fat in your diet, lower dietary cholesterol, and increase soluble fiber and plant sterols in your diet. can lower LDL cholesterol. On the other hand, exercise and weight loss can improve triglycerides and increase HDL cholesterol, the good cholesterol. But overall, the effects are relatively modest, usually around a 10 to 20 percent change, whereas statins can lower LDL cholesterol by more than 50 percent in many cases.

pedro kenworth

So if you put me on a statin, I can go ahead and eat my grilled chicken and cheeseburgers all the time.

Dr. Ian Neeland

No, I really wouldn't put it that way. You know, nutrition has many components. And while statins help lower cholesterol, a poor diet that's high in saturated fat, high in sodium or salt, and low in potassium and essential nutrients can have negative effects on your health far beyond cholesterol. First, high levels of sugar are stored in the body as fat. So even if you don't eat a high-fat diet, you're bound to gain weight if you drink sugary drinks, such as: B. Non-diet soft drinks, sugary drinks. Things high in fat, cholesterol, and sodium cause blood pressure to rise and triglycerides to rise. And triglycerides, I mentioned that briefly, but it's another lipid-related risk factor that many people overlook. So we know that even if you could lower your LDL cholesterol to a low level with a statin, there are many other lipoproteins in the blood that contribute to heart disease that aren't necessarily lowered by a statin, and diet plays a big role. . very important role in this. So you're not out of the woods when you eat cheeseburgers and fried chicken.

matt jepson

So conventional wisdom has always told us that what we eat affects our health, and it does. But what I heard from you is that genetics also play a role. And when it comes to high cholesterol, could you break it down for us?

Dr. Ian Neeland

Yes of course. You know, genetics play a role in your cholesterol set point. In other words, the amount of cholesterol your liver makes and reabsorbs from your bloodstream is largely determined by your genetics. However, statins and other lipid-lowering drugs can change the way the liver handles cholesterol and reduce bad cholesterol to very low levels. Well, there are some genetic diseases that are linked to very high cholesterol levels, such as: B. Familial hyperlipidemia or HF, which can cause the premature development of heart disease, heart attacks and death. And these diseases, which are genetic diseases, can be hereditary and can be very dangerous.

matt jepson

Doctor, you have the last word here. What would you like to say to anyone who is undecided about statins? What is your reasoning?

Dr. Ian Neeland

So I would say, you know, talk to your doctor, see a preventive cardiologist if you're concerned. We can answer all your questions. We can help you understand the risks and benefits of taking drugs like statins and other drugs to prevent heart disease and stroke. And it's really important to have the right information and feel confident about what it means to take a statin. It is also important to understand what are the myths and what are the truths. And the only way to really do that is to talk to someone who has experience in these areas and really find out what you need to know. And as always, it's important to check your numbers. So many people don't know they have high cholesterol until they are checked by their doctor, which can be until someone is in their 40s or 50s. Therefore, it is very important that you check your numbers and know what your numbers are and what your goals are. And I think this will help you a lot to identify areas where you need to improve. And when you have a good preventive cardiologist to work with you, you're guaranteed to reduce your risk of heart disease as much as possible and live a longer, healthier life.

matt jepson

Thank you for joining us, Dr. Ian Neeland, Director of Cardiovascular Prevention at University Hospitals. And remember, you can find and subscribe to this podcast on Apple Podcasts, Google Podcasts, Stitcher, and anywhere else you get your podcasts. Look up Universitätskliniken or Healthy@UH depending on where you are listening.

pedro kenworth

For more health news, advice from medical experts and Healthy@UH podcasts, visit UHHospitals.org/blog.