Living Well We're no strangers to controversy, but by far one of our most controversial topics is on statins...
Last week, I detailed the basics on statins and explained why you should only take them if you've tried other lifestyle changes first.
After the issue, I started hearing from two types of readers:
The one who praises me for taking on "Big Pharma" and the other who tells me how much they love their statins and accuse me of harming people who have high cholesterol.
Here's the thing...
In our line of business, we often look at cost-benefit analysis. We want to know if the benefits are worth the price you pay.
But how do you quantify things like a diagnosis of diabetes? Or losing your memory?
These are real considerations when you start on statin medications. Last week, I covered what statins are and why you should only take them if you've tried other lifestyle interventions first.
If you are considering a statin, you need to weigh the costs and benefits... And those costs include some side effects.
Statin Side Effects
- Muscle pain and weakness. According to the Mayo Clinic, about 30% of folks report muscle pain from statins. It's one of the top reasons folks regularly quit their medications.
- Possible liver damage. These drugs are essentially shutting down an important function of your liver. As such, they can cause damage to it over time. About 50% of doctors won't prescribe statins if your liver levels are elevated more than 1.5 times the upper limit of normal. That's why you should always ask to get your liver function tested if your doctor recommends statins.
- Increase in blood sugar. Statin users have a huge risk of getting type two diabetes after starting the drug. Since many of the same risks apply to both heart disease and diabetes, getting to the root of the problem with lifestyle factors is crucial.
- Memory loss. Several studies point to a connection between statins and memory loss. The FDA even updated its safety information sheet about statins to reflect this side effect.
And something else your doctor likely won't tell you... The vast majority of people who start a statin prescription will quit within the first year because of the side effects.
What's more, there's no evidence statins reduce your risk of heart problems once you're past the age of 75. The U.S. Preventive Services Task Force (USPSTF) – our guide for evidence-based testing recommendations – doesn't recommend statins for folks over 75.
And as we wrote last year, a 2017 study showed that folks over 75 who took a type of statin called Pravastatin had a higher risk of premature death.
What's more, a study published earlier this year from the Lancet failed to show that statins prevent heart disease-related deaths in folks 75 and older with a history of heart disease.
After weighing these concerns, you should have a reasonable conversation with your doctor.
Statins are one of the most over-prescribed drugs on the market. If your doctor recommends you start taking them (or if you're already taking them), we've come up with a list of questions to help guide your conversation...
- What are my cholesterol numbers? Make sure you've been tested more than once, preferably with a two-week break in between. You also want to make sure you aren't stressed at the time of the test, as that can throw off your readings.
- What is my inflammation score? Request a C-reactive protein (CRP) test to check for inflammation. There are a few other inflammation tests available, so be sure to get one that your insurance will cover.
- What is my cardiovascular (CV) risk score? Any score under 10% generally can be reduced efficiently with nothing more than lifestyle changes.
- Can I try lifestyle interventions first? If so, what are my goals for those?
- Can I try a non-statin drug instead? Other drugs are available to treat cholesterol and related issues, like PCSK9 inhibitors and bile-acid sequestrants. There are also more natural treatments, like red yeast rice (which has a similar active compound to the one found in statins). However, we urge caution in choosing any supplement due to the lack of regulation. The amount of active ingredients may differ wildly from the claim on the bottle. We'll cover more on red yeast rice and the best brands out there in a future report.
These alternatives may not work for you specifically or could interfere with other drugs, but always ask about your options.
- What are the side effects and how can I manage them? A good physician should have a plan in place to make sure you're monitored for things like liver problems on every follow-up visit.
- How do I get off statins after I've used them for years? This is a hard question. Most doctors will balk at trying to take you off of these supposedly "safe" pills. If they won't work with you to monitor your side effects or try lifestyle changes first, get yourself a new doctor. You want an advocate for your health, not a pill-pushing bully.
That said, we never recommend quitting a prescription on your own.
I've said it for years and I'll say it again... The best person to take care of you is you. Be your own health advocate. Know your numbers and have a serious conversation with your doctor about your risk factors, your 10-year risk for heart attack calculation, and your concerns about statins.
We want to empower you to take charge of your own health. If there are more topics you'd like to learn about, let us know here: [email protected].
What We're Reading...
- A major recall on statins.
- Something different: Measuring changes in the economy based on... dog leashes?
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
September 24, 2019