Many late-middle age adults and seniors are being prescribed the class of drugs called statins. These are supposed to be cholesterol-lowering drugs.
But even if one’s cholesterol levels are within normal range, there is now convincing data that taking statins regularly can benefit our relatively senior adults, regardless of whether they have heart disease or not, and regardless of their cholesterol levels.
In a recent panel discussion I was invited to join, I stressed this recommendation of routinely giving appropriate doses of tried-and-tested statins to everyone with documented atherosclerosis or narrowing of the arteries in the heart, brain and legs.
A colleague argued that we should also consider the possible side effects of statins in the long term. This includes elevation of liver enzymes and muscle pains.
Well, it’s true that these side effects might occur in a very small percentage of cases. However, compare this to the number of people who will benefit from statins—in terms of reduced risk of heart attack, stroke, sudden cardiac death and all-cause death—and any doubting Thomas would be convinced that the benefits of statins far outweigh their potential risk of side effects.
Why do people with normal cholesterol levels benefit from a supposedly cholesterol-lowering drug?
Statins are apparently versatile drugs which confer benefits beyond cholesterol lowering. Foremost of these benefits is its ability to improve the integrity of the lining of the arteries, called the endothelium.
Endothelial function is important to maintain the optimal functioning of the arteries all over the body. So long as endothelial function is maintained, the process of atherosclerosis, which progressively clogs the arteries, is kept at bay.
Atherosclerosis is actually a very insidious type of swelling or inflammation of the arteries. Substances called inflammatory cytokines are released, which can trigger a heart attack or stroke. Statins significantly reduce this risk.
However, for strokes, only the type caused by clogging of the arteries (ischemic stroke) is prevented.
Statins don’t decrease the risk of hemorrhagic stroke, usually caused by high blood pressure (BP). This type is more effectively prevented by making sure that one’s BP is less than 140/90 mm Hg.
In high-risk patients, it should preferably be less than 130/80 mm Hg. In these patients, giving medicines for the high BP plus statins is also highly recommended.
About five years ago, there were isolated reports that some patients taking statins experienced deterioration of brain function (cognitive decline). The reported side effects included memory deterioration, occasional confusion and disorientation.
Hence, since 2012, the Food and Drug Administration has required statins manufacturers to include a black box warning in their product information leaflets disclosing such possible side effects.
These signs and symptoms were reported to be mild and transient, usually disappearing after discontinuation of the statin.
Since the incidence was quite low, almost rare in proportion to the big number of people taking statins, doctors were advised that they should continue prescribing statins if there are really indications for its use.
Three weeks ago, the results of a landmark trial which evaluated whether the risk of mental deterioration was really statin-related or not were presented during the American Heart Association scientific sessions.
Subjects enrolled in the study, 70 years old and older, were given a moderate dose of a statin for an average of 5.6 years. They were compared to a control group, who were not placed on statins.
There was no red-flag signal that would indicate that statin-induced cognitive decline is a significant side effect of long-term statin use.
That is reassuring for the millions of patients, particularly elderly patients, who are regularly taking this drug, but are also concerned about its long-term side effects.
So, for the big majority of males (55 years or older), and females (60 years and older), you may benefit from taking statins even if your cholesterol levels are normal, and even if you have no coronary heart disease. It can significantly cut your risk of a heart attack, stroke and of dying prematurely from these causes.