HYPOCRATIC OATH.......... FIRST DO NO HARM.........
Why Women Should Stop Their Cholesterol Lowering Medication
If you are a post-menopausal women with high cholesterol, your doctor will almost certainly recommend cholesterol lowering medication or statins. And it just might kill you. A new study in the Archives of Internal Medicine found that statins increase the risk of getting diabetes by 71 percent in post-menopausal women.
Since diabetes is a major cause of heart disease, this study calls into question current recommendations and guidelines from most professional medical associations and physicians. The recommendation for women to take statins to prevent heart attacks (called primary prevention) may do more harm than good.
This current study adds to an increasing body of literature questioning the benefits of statins, while highlighting their potential risks.
New Study Shows 48 Percent Risk of Diabetes in Women Who Take Statins
This study examined the data from the large government sponsored study called the Women’s Health Initiative, the same study that disabused us of the idea that Premarin prevented heart attacks in postmenopausal women.
In fact, based on this randomized controlled trial, estrogen replacement therapy, once considered the gold standard of medical care for the prevention of heart disease, was relegated to the trash bin of history joining medicine’s many other fallen heroes including DES, Thalidomide, Vioxx, Avandia, and more.
In this new study researchers reviewed the effect of statin prescriptions in a group of 153,840 women without diabetes and with an average age of 63.2 years. About 7 percent of women reported taking statin medication between 1993 and 1996. Today there are many, many more women taking statin medications, thus many more are at risk from harm from statins.
During the 3-year period of the study, 10,242 new cases were reported – a whopping 71 percent increase in risk from women who didn’t take statins. This association stayed strong at a 48 percent increased risk of getting diabetes, even after taking into account age, race/ethnicity, and weight or body mass index. These increases in disease risk were consistent for all statins on the market.
This effect also occurred in those with and without heart disease. Surprisingly disease risk was worse in thin women. Minority women were also disproportionately affected. The risk of diabetes was 49 percent for white women, 57 percent for Hispanic women, and 78 percent for Asian women.
But in a typical “my mind’s made up, don’t confuse me with the facts” statement by the medical establishment, the researchers said we should not change our guidelines for statin use for the primary prevention of heart disease.
In a large meta-analysis published in the Lancet last year, scientists found that statins increased the risk of diabetes by 9 percent. If current guidelines were followed for those who should take statins, and people actually took them (thank God only 50 percent of prescriptions are ever filled by patients), there would be 3 million more diabetics in America. Oops.
Other studies have recently called into question the belief that high cholesterol levels increase your risk of heart disease as you get older. For those over 85 it turns out having high cholesterol will protect you from dying from a heart attack, and, in fact, from death from any cause.
Low Cholesterol May Kill You
A recent study showed that in healthy older persons, high cholesterol levels were associated with lower non-cardiovascular-related mortality. This is extremely concerning because millions of prescriptions are written every day to lower cholesterol in the older population, yet no association has been found between higher cholesterol and heart disease deaths for those aged 55 to 84; and for those over 85, the association seems to be inverse — higher cholesterol predicts lower risk of death from heart disease.
The pharmaceutical industry, medical associations, and academic researchers whose budgets are provided by grants from the pharmaceutical industry continue to preach the wonders of statins, but studies like these should have us look good and hard at our current practices. Are we doing more harm than good?
Cardiologists recommend putting statins in the water and giving them out at fast food restaurants and having them available over the counter. They believe in driving cholesterol as low as possible. Statin prescriptions are handed out with religious fervor, but do they work to prevent heart attacks and death if you haven’t had a heart attack already?
Bottom line: NO! If you want to learn why this is true, read on.
Statins Don’t Work to Prevent First Heart Attacks
Recently, the Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death. In addition, many other studies support this and point out the frequent and significant side effects that come with taking these drugs. (i) If scientists found that drinking two glasses of water in the morning prevented heart attacks, even if the evidence was weak, we would jump on board. Big up side, no down side.
But this is not the case with statins. These drugs frequently cause muscle damage, muscle cramps, muscle weakness, muscle aches, exercise intolerance (ii) (even in the absence of pain and elevated CPK – a muscle enzyme), sexual dysfunction, liver and nerve damage and other problems in 10-15 percent of patients who take them. (iii) They can also cause significant cellular, muscle, and nerve injury as well as cell death in the ABSENCE of symptoms. (iv)
There is no lack of research calling into question the benefits of statins. Unfortunately, that research doesn’t get the benefit of billions of dollars of marketing and advertising that statins do. One big trial was touted as proving statins work to prevent heart attacks, but the devil is in the details.
It was the JUPITER (v) trial that showed that lowering LDL (or bad cholesterol) without a reduction in inflammation (measured by C-reactive protein) didn’t prevent heart attacks or death. (vi) Statins happen to reduce inflammation so the study has been touted as proof of the effectiveness of these medications.
Mind you it wasn’t lowering the cholesterol that helped (which is the intended purpose of statins), but the fact that they lower inflammation. What is ignored by people who use this study to “prove” that statins work is the fact that there are so many better ways to lower inflammation than taking these drugs.
Yet other studies have shown no proven benefit for statins in healthy women (vii) with high cholesterol or in anyone over 69 years old. (viii) Some studies even show that aggressive lowering of cholesterol can cause MORE heart disease. The ENHANCE trial showed that aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone, but led to more arterial plaque and no fewer heart attacks. (ix)
Other research calls into question our focus on LDL or the bad cholesterol. We focus on it because we have good drugs to lower it, but it may not be the real problem. The real problem is low HDL that is caused by insulin resistance (diabesity).
In fact studies show that if you lower the bad (LDL) cholesterol in people with low HDL (good cholesterol) that is a marker of diabesity – the continuum of obesity, prediabetes and diabetes – there’s no benefit. (x)
Most people simply ignore the fact that 50-75 percent of people who have heart attacks have normal cholesterol. (xi) The Honolulu Heart Study showed older patients with lower cholesterol have higher risks of death than those with higher cholesterol. (xii)
Some patients with multiple risk factors, or who have had previous heart attacks do benefit, but when you look closely the results are underwhelming. It’s all in how you spin the numbers. For high-risk males (those who are overweight and have high blood pressure, diabetes, and/or a family history of heart attacks) and are younger than 69 there is some evidence of benefit, but one hundred men would need to be treated to prevent just one heart attack.
That means that 99/100 men who take the drug receive no benefit. Drug ads say the risk is reduced by 33 percent. Sounds good, but that just means the risk of getting a heart attack goes down from 3 percent to 2 percent.
Despite the extensive data showing that statins are a questionable therapy at best, they are still the number one selling drug in the US. What isn’t so well known is that 75 percent of statin prescriptions are written for people who will receive no proven benefit. The cost of these prescriptions? Over $20 billion a year.
Yet somehow the 2004 National Cholesterol Education Program guidelines expanded the previous guidelines to recommend that even more people without heart disease take statins (from 13 million to 40 million) (xiii) What are we thinking?
Why would respected scientists go against the overwhelming research that statins don’t prevent heart disease in people who haven’t already had a heart attack?
You can find the answer if you follow the money. Eight of the nine experts on the panel who developed these guidelines had financial ties to the drug industry. Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak.
What Should Women Do?
It is time to push the sacred cow of statins overboard.
But first let me say this. If you have had a heart attack, or have heart disease, the evidence shows they do in fact help protect against a second heart attack, so keep taking them. However, you should be aware that most prescriptions for statins are given to healthy people whose cholesterol is a little high. For these folks the risk clearly outweighs the benefit.
The editorial that accompanies the recent study on women taking cholesterol-lowering medication that I opened this article with was quite clear. Dr. Kirsten Johansen from the University of California, San Francisco said that the increased risk of diabetes in women without heart disease has “important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality.”
In plain English, she said that we shouldn’t be using statin drugs for women without heart disease because:
Remember what you put at the end of your fork is more powerful than anything you will ever find at the bottom of a pill bottle.
My new book The Blood Sugar Solution, which comes out at the end of February, gives exact details on what you should put at the end of your fork to prevent and reverse diabesity. It provides a comprehensive solution to the health problems facing our nation today.
Now I’d like to hear from you …
What do you think of statins?
Have you taken statins? What has your experience been?
Why do you think the medical establishment prescribes drugs that research shows don’t work?
Please leave your thoughts by adding a comment below – but remember, we can’t offer personal medical advice online, so be sure to limit your comments to those about taking back our health!
To your good health,
Mark Hyman, MD
References:
Since diabetes is a major cause of heart disease, this study calls into question current recommendations and guidelines from most professional medical associations and physicians. The recommendation for women to take statins to prevent heart attacks (called primary prevention) may do more harm than good.
Statins have been proven to prevent second heart attacks, but not first heart attacks.Take it if you already have had one, but beware if your doctor recommends it for you if have never had a heart attack.
This current study adds to an increasing body of literature questioning the benefits of statins, while highlighting their potential risks.
New Study Shows 48 Percent Risk of Diabetes in Women Who Take Statins
This study examined the data from the large government sponsored study called the Women’s Health Initiative, the same study that disabused us of the idea that Premarin prevented heart attacks in postmenopausal women.
In fact, based on this randomized controlled trial, estrogen replacement therapy, once considered the gold standard of medical care for the prevention of heart disease, was relegated to the trash bin of history joining medicine’s many other fallen heroes including DES, Thalidomide, Vioxx, Avandia, and more.
In this new study researchers reviewed the effect of statin prescriptions in a group of 153,840 women without diabetes and with an average age of 63.2 years. About 7 percent of women reported taking statin medication between 1993 and 1996. Today there are many, many more women taking statin medications, thus many more are at risk from harm from statins.
During the 3-year period of the study, 10,242 new cases were reported – a whopping 71 percent increase in risk from women who didn’t take statins. This association stayed strong at a 48 percent increased risk of getting diabetes, even after taking into account age, race/ethnicity, and weight or body mass index. These increases in disease risk were consistent for all statins on the market.
This effect also occurred in those with and without heart disease. Surprisingly disease risk was worse in thin women. Minority women were also disproportionately affected. The risk of diabetes was 49 percent for white women, 57 percent for Hispanic women, and 78 percent for Asian women.
But in a typical “my mind’s made up, don’t confuse me with the facts” statement by the medical establishment, the researchers said we should not change our guidelines for statin use for the primary prevention of heart disease.
In a large meta-analysis published in the Lancet last year, scientists found that statins increased the risk of diabetes by 9 percent. If current guidelines were followed for those who should take statins, and people actually took them (thank God only 50 percent of prescriptions are ever filled by patients), there would be 3 million more diabetics in America. Oops.
Other studies have recently called into question the belief that high cholesterol levels increase your risk of heart disease as you get older. For those over 85 it turns out having high cholesterol will protect you from dying from a heart attack, and, in fact, from death from any cause.
Low Cholesterol May Kill You
A recent study showed that in healthy older persons, high cholesterol levels were associated with lower non-cardiovascular-related mortality. This is extremely concerning because millions of prescriptions are written every day to lower cholesterol in the older population, yet no association has been found between higher cholesterol and heart disease deaths for those aged 55 to 84; and for those over 85, the association seems to be inverse — higher cholesterol predicts lower risk of death from heart disease.
The pharmaceutical industry, medical associations, and academic researchers whose budgets are provided by grants from the pharmaceutical industry continue to preach the wonders of statins, but studies like these should have us look good and hard at our current practices. Are we doing more harm than good?
Cardiologists recommend putting statins in the water and giving them out at fast food restaurants and having them available over the counter. They believe in driving cholesterol as low as possible. Statin prescriptions are handed out with religious fervor, but do they work to prevent heart attacks and death if you haven’t had a heart attack already?
Bottom line: NO! If you want to learn why this is true, read on.
Statins Don’t Work to Prevent First Heart Attacks
Recently, the Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death. In addition, many other studies support this and point out the frequent and significant side effects that come with taking these drugs. (i) If scientists found that drinking two glasses of water in the morning prevented heart attacks, even if the evidence was weak, we would jump on board. Big up side, no down side.
But this is not the case with statins. These drugs frequently cause muscle damage, muscle cramps, muscle weakness, muscle aches, exercise intolerance (ii) (even in the absence of pain and elevated CPK – a muscle enzyme), sexual dysfunction, liver and nerve damage and other problems in 10-15 percent of patients who take them. (iii) They can also cause significant cellular, muscle, and nerve injury as well as cell death in the ABSENCE of symptoms. (iv)
There is no lack of research calling into question the benefits of statins. Unfortunately, that research doesn’t get the benefit of billions of dollars of marketing and advertising that statins do. One big trial was touted as proving statins work to prevent heart attacks, but the devil is in the details.
It was the JUPITER (v) trial that showed that lowering LDL (or bad cholesterol) without a reduction in inflammation (measured by C-reactive protein) didn’t prevent heart attacks or death. (vi) Statins happen to reduce inflammation so the study has been touted as proof of the effectiveness of these medications.
Mind you it wasn’t lowering the cholesterol that helped (which is the intended purpose of statins), but the fact that they lower inflammation. What is ignored by people who use this study to “prove” that statins work is the fact that there are so many better ways to lower inflammation than taking these drugs.
Yet other studies have shown no proven benefit for statins in healthy women (vii) with high cholesterol or in anyone over 69 years old. (viii) Some studies even show that aggressive lowering of cholesterol can cause MORE heart disease. The ENHANCE trial showed that aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone, but led to more arterial plaque and no fewer heart attacks. (ix)
Other research calls into question our focus on LDL or the bad cholesterol. We focus on it because we have good drugs to lower it, but it may not be the real problem. The real problem is low HDL that is caused by insulin resistance (diabesity).
In fact studies show that if you lower the bad (LDL) cholesterol in people with low HDL (good cholesterol) that is a marker of diabesity – the continuum of obesity, prediabetes and diabetes – there’s no benefit. (x)
Most people simply ignore the fact that 50-75 percent of people who have heart attacks have normal cholesterol. (xi) The Honolulu Heart Study showed older patients with lower cholesterol have higher risks of death than those with higher cholesterol. (xii)
Some patients with multiple risk factors, or who have had previous heart attacks do benefit, but when you look closely the results are underwhelming. It’s all in how you spin the numbers. For high-risk males (those who are overweight and have high blood pressure, diabetes, and/or a family history of heart attacks) and are younger than 69 there is some evidence of benefit, but one hundred men would need to be treated to prevent just one heart attack.
That means that 99/100 men who take the drug receive no benefit. Drug ads say the risk is reduced by 33 percent. Sounds good, but that just means the risk of getting a heart attack goes down from 3 percent to 2 percent.
Despite the extensive data showing that statins are a questionable therapy at best, they are still the number one selling drug in the US. What isn’t so well known is that 75 percent of statin prescriptions are written for people who will receive no proven benefit. The cost of these prescriptions? Over $20 billion a year.
Yet somehow the 2004 National Cholesterol Education Program guidelines expanded the previous guidelines to recommend that even more people without heart disease take statins (from 13 million to 40 million) (xiii) What are we thinking?
Why would respected scientists go against the overwhelming research that statins don’t prevent heart disease in people who haven’t already had a heart attack?
You can find the answer if you follow the money. Eight of the nine experts on the panel who developed these guidelines had financial ties to the drug industry. Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak.
What Should Women Do?
It is time to push the sacred cow of statins overboard.
But first let me say this. If you have had a heart attack, or have heart disease, the evidence shows they do in fact help protect against a second heart attack, so keep taking them. However, you should be aware that most prescriptions for statins are given to healthy people whose cholesterol is a little high. For these folks the risk clearly outweighs the benefit.
The editorial that accompanies the recent study on women taking cholesterol-lowering medication that I opened this article with was quite clear. Dr. Kirsten Johansen from the University of California, San Francisco said that the increased risk of diabetes in women without heart disease has “important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality.”
In plain English, she said that we shouldn’t be using statin drugs for women without heart disease because:
- The evidence shows they don’t work to prevent heart attacks if you never had one.
- They significantly increase the risk of diabetes.
Remember what you put at the end of your fork is more powerful than anything you will ever find at the bottom of a pill bottle.
My new book The Blood Sugar Solution, which comes out at the end of February, gives exact details on what you should put at the end of your fork to prevent and reverse diabesity. It provides a comprehensive solution to the health problems facing our nation today.
Now I’d like to hear from you …
What do you think of statins?
Have you taken statins? What has your experience been?
Why do you think the medical establishment prescribes drugs that research shows don’t work?
Please leave your thoughts by adding a comment below – but remember, we can’t offer personal medical advice online, so be sure to limit your comments to those about taking back our health!
To your good health,
Mark Hyman, MD
References:
(i) Abramson J, Wright JM. Are lipid-lowering guidelines evidence-based? Lancet. 2007 Jan 20;369(9557):168-9
(ii) Sirvent P, Mercier J, Lacampagne A. New insights into mechanisms of statin-associated myotoxicity. Curr Opin Pharmacol. 2008 Jun;8(3):333-8.
ABOUT DR. HYMAN
- ********
Statin Drugs and Diabetes
Because of the close correlation between diabetes and risk for Alzheimer’s and dementia, you really want to be focusing on keeping your blood sugar under control. A new study has found that exposure to statins may put you at greater risk for diabetes, thereby increasing your chances of experiencing dementia or Alzheimer’s.
Read Next
Statins Linked to Raised Risk of Type 2 Diabetes
Large Finnish study found a nearly 50 percent increase in people taking cholesterol-lowering drugs
By Dennis Thompson
HealthDay Reporter
WEDNESDAY, March 4, 2015 (HealthDay News) -- Cholesterol-lowering statin drugs may significantly increase a person's risk of developing type 2 diabetes, a new study from Finland suggests.
Researchers found that statins were associated with an almost 50 percent higher risk of developing type 2 diabetes, even after adjusting for other factors.
Statins appear to increase the risk of type 2 diabetes in several ways, the researchers said. One is that the drugs can increase a person's insulin resistance, and the other is that the cholesterol-lowering drugs seem to impair the ability of the pancreas to secrete insulin, according to the report.
Continue Reading Below
Commenting on the study, Dr. Ronald Goldberg, director of the Lipid Disorder Clinic and associate director of the Diabetes Research Institute at the University of Miami, said the researchers "show evidence that statins increased insulin resistance, and that the people who developed diabetes appeared to have less ability to respond to the insulin resistance by making more insulin."The study authors noted, however, that their research only found an association between statin use and diabetes risk. And since the study was limited to white men, it's not clear if the findings would apply to women or other racial groups.
More than 29 million people in the United States have diabetes, according to the American Diabetes Association (ADA). Type 2 diabetes occurs when the body becomes resistant to insulin, a hormone needed to process the sugars found in foods. To compensate, the body produces more insulin. Excess weight and a sedentary lifestyle are two important risk factors for type 2 diabetes, according to the ADA.
Prior studies have indicated that statins may increase a person's risk of diabetes, the authors said in background information in the study. However, these earlier studies were focused mainly on statins' role in preventing heart disease, not on their potential diabetes risk.
In this new study, University of Eastern Finland researchers tracked the effects of statin treatment in almost 9,000 men without diabetes over the course of six years. The men were between 45 and 73 years old. One in four of the men was taking a statin at the beginning of the study.
Pagination
Business 61,232 12 Stocks to Buy NowTop Cardiologist Argues We Should Dial Back On Statins Because Of Diabetes Risk
Eric Topol, a well-known cardiologist and professor of genomics at Scripps Research Institute, has broken ranks with many other heart doctors tonight with a New York Times Op-Ed in which he says many patients might want to reconsider their use of statins such as Lipitor, Crestor, and Zocor in light of the risk that these drugs might cause diabetes.
Eric Topol by Getty Images via @daylife Click New York Times Article..- *************************
Nearly All With Type 2 Diabetes Need Statins
April 19, 2004 -- There are new guidelines on statin use. Experts now say no matter how low the cholesterol count, nearly all people with diabetes should take these cholesterol-lowering drugs.That advice now is part of the official practice guidelines of the American College of Physicians, a major doctors' group. The guidelines -- and a review of all clinical trials of statins in patients with diabetes -- appear in the April 20, 2004 issue of the ACP's Annals of Internal Medicine. Vincenza Snow, MD, the ACP's senior medical associate for science policy, is lead author of the new recommendations."As we were doing the review, we were very interested to see that for preventing first-time and recurring heart disease in type 2 diabetes, there is a very significant benefit to statins," Snow tells WebMD. "And this benefit does not end at normal or even low cholesterol levels. That the statins seem to have some other protective property beyond cholesterol lowering."
Statins Advised for Nearly All With Type 2 Diabetes
The old guidelines recommend statins for patients with type 2 diabetes if their bad LDL cholesterol level is over 100 and if they have at least one risk factor for heart disease. Available statins include Crestor, Lescol, Lipitor, Pravachol, and Zocor.The new guidelines say anyone with type 2 diabetes and one heart disease risk factor should be taking one of the drugs. These risk factors are:- More than 55 years of age
- High blood pressure
- High LDL "bad" cholesterol (over 100)
- Smoking
- Physical inactivity
- Obesity
- Existing heart disease
This includes all but a few younger patients with type 2 diabetes, says Sandeep Vijan, MD, researcher of the review of statin/diabetes studies. Vijan is an investigator at the Ann Arbor VA Health Services and Research Center and assistant professor of internal medicine at the University of Michigan, Ann Arbor."If you look at the numbers, between 50% and 75% of people with type 2 diabetes have high blood pressure, and most are over 55," Vijan tells WebMD. "And maybe 20% smoke and 45% to 60% have coronary artery disease. So by the time you add all those things up, you are talking about almost everybody with type 2 diabetes."Once people with diabetes start taking statin drugs, the new guidelines say, they should keep taking it -- no matter how low their cholesterol goes.Pagination- WHAT A CROCK OF CRAP..........Heart Disease Heart Disease Drugs
Do Statins Cause Diabetes? YES
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Should You Have Your CRP Measured?
Measuring CRP Can Be Important to Your Cardiac Health
Dana Neely/Taxi/Getty Images
Measuring C-reactive protein (CRP) levels can be useful in assessing the risk of coronary artery disease (CAD) in some individuals. CRP is a protein that is released into the bloodstream during periods of inflammation. Since inflammation is now known to play a major part in the development of atherosclerosis (the process that forms plaques in the arteries), it makes sense that CRP levels might be elevated during periods of active plaque formation and that high levels of CRP would correlate with cardiovascular events.Studies have now shown that elevated CRP is associated with an increased risk for cardiovascular events, such as heart attack and stroke. Whether CRP actually causes the increased risk or is just a marker for risk is still debated, though the preponderance of evidence suggests it is not a direct cause. Still, it is now known that treating people who have high CRP levels with statins can reduce their risk. This fact alone makes measuring CRP potentially worthwhile in some people.How Is CRP Measured?
CRP is measured using a high sensitivity test (called the hs-CRP blood test). In general, the higher the hs-CRP level, the higher the risk. Levels of hs-CRP below 1 are considered low; levels of 1 - 3 are considered moderately elevated; levels greater than 3 are considered high. Levels greater than 10 are usually only seen with active, obvious inflammatory processes, such as severe infection, major trauma, or chronic inflammatory diseases - these ultra-high levels cannot be used to interpret cardiac risk.Treat Your Afib
Deciding on atrial fibrillation treatment is most often a compromise for those with the heart condition. Make sure to find out which approach is best for you.Deciding whether measuring CRP should be part of the routine screening process has been difficult for two reasons. First, interpreting the significance of an elevated CRP level is often not straightforward, and can lead to more confusion rather than less.Second, until recently it was unclear whether treatment should be changed in anybody based on the results of CRP values.When Is It Useful To Measure CRP?
Elevated levels of CRP are most often associated with the presence of several other risk factors for cardiovascular disease such as smoking, obesity, sedentary lifestyle, increased cholesterol, hypertension and metabolic syndrome. So higher levels of CRP are usually seen in patients with the greatest number of additional risk factors. In these cases, finding a high CRP level merely confirms what already is quite apparent - the patient has a high risk of cardiac disease, and needs aggressive risk factor modification (most likely including statins) whatever their CRP levels.On the other hand, an elevated CRP level in a person with only one or two other risk factors does add potentially important information. For these people, a high CRP level seems to indicate that their risk is higher than it otherwise appears. It means that a little bit of hypertension, or a little bit of extra weight, is indeed associated with possible inflammation in the blood vessels and that the risk of cardiovascular events may be elevated.So, at the very least, having an elevated CRP level should make you and your doctor much more serious about risk reduction. Furthermore, data from the recent JUPITER study tells us that giving statins to apparently healthy patients who have high CRP levels can substantially and significantly reduce their risk of cardiovascular disease.The bottom line
CRP levels certainly do not need to be measured in everybody. Before ever considering a CRP measurement, you and your doctor should assess your baseline risk of cardiac disease, based on the more obvious risk factors. This assessment will tell you whether you are in a high, intermediate, or low risk category.If you are already in a high-risk category, measuring CRP will not be very helpful. You're reasonably likely to have a heart attack or stroke unless you aggressively reduce your risk, no matter what your CRP level may be. But if you or your doctor are hesitant to use statins, and are unsure of the benefit they may provide you, then measuring your CRP levels may give you one more reason to consider these risk-reducing drugs.It is more reasonable to measure a CRP level if you are in the moderate risk category. An elevated CRP level here should send up the red flags that your risk is probably higher than you think. Also, if your cholesterol levels are normal or only a little elevated, then knowing that your CRP is high would give you and your doctor a clear-cut reason to consider therapy with statins.With today's state of knowledge, the value of measuring CRP levels in people in the low-risk category is far less clear. If the CRP is elevated and you have no other risk factors, the use of statins could be considered but is very controversial. Most doctors agree that there is very little reason to measure CRP levels in people who are in the low-risk category.If you do have your CRP measured and it comes back high, you may want to read this article: What To Do When Your CRP Is Elevated.You may have read reports in the press that statin drugs have been linked to the development of type 2 diabetes. Do statin drugs really make diabetes more likely? And if they do, is the increased risk anything to worry about?
These questions seem particularly important in view of the fact that, recently, FDA-approved indications for using statin drugs have been greatly expanded. Statins are now recommended not only in people with elevated cholesterol levels whether or not they have known heart disease, but also in certain people who don't even have an elevation in cholesterol levels.
This broadened usage of statin drugs is based on clinical trials showing that, when used in the right people, statins can produce a significant reduction in heart attacks, strokes, and the need for coronary artery revascularization procedures (i.e., stents or bypass surgery).One potentially disturbing signal that has been seen in some of these clinical trials, however, is the finding that patients randomized to statin drugs may have had a higher risk of developing type 2 diabetes. This finding was first noted in the well-known JUPITER trial, the landmark trial that led the FDA to approve the statin drug Crestor for patients with elevated CRP levels.
Studies Looking Specifically At Statins and Diabetes
Three published studies have now specifically addressed the question of whether statins lead to an increase in diabetes. The first, published in the Journal of the American Medical Association in June, 2011, was a meta-analysis of 33,000 patients enrolled in five major clinical trials using statins.
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This meta-analysis concluded that the use of high-dose statins was associated with one additional case of type II diabetes for every 498 patients treated; whereas one major cardiovascular event (such as heart attacks and strokes) was prevented for every 155 patients treated. The authors concluded that, while statins do indeed appear to increase the risk of type 2 diabetes, when they are used in people with a high risk for cardiovascular disease, the benefit of statins appears to substantially outweigh the risk.The second study, published in 2012 in the Archives of Internal Medicine, analyzed data from 153,840 postmenopausal women between 50 and 80 years of age who were enrolled in the Womens Health Initiative study. In this observational study, women taking statins had a 48% increased risk of diabetes compared to women not taking statins.
The METSIM study, conducted in Finland, was published in March, 2015 in Diabetologia. This study enrolled 8749 non-diabetic men between 45 and 73 years of age. During a 6-year follow-up, the risk of developing type 2 diabetes was 46% higher in the 2412 men who used statin drugs.
What Can We Conclude From This Information?
There is now enough evidence from enough clinical trials to conclude that statins, at least at high-dose, are associated with a significantly increased risk of developing type 2 diabetes - as high as 46-48% higher than in similar people not taking statins. (Note that this is the relative percentage, and not the absolute percentage. In plain terms, this means that for every 2 people not taking statins who develop diabetes, roughly 3 people taking statins will develop diabetes.)
Despite the risk of diabetes, however, in people who are at high risk for heart attacks and strokes, the use of statins significantly reduces the overall risk of having serious cardiovascular events .
So experts agree that in high-risk people - especially those who already have known cardiovascular disease - the use of statins remains an extremely important part of reducing subsequent risk.
There is more controversy, however, in using high-dose statins in people who do not yet have cardiovascular disease, but are moderate risk of developing it. It is likely that prospective clinical trials will need to be done in such individuals to really define the optimal role of statins.
Recommendations
If you have coronary artery disease or have had a stroke, or if your cardiac risk factors place you in a high-risk category, your doctor will want you to take a statin.
This is because - even with an increase in the risk of diabetes - a statin drug will significantly reduce your overall risk of death or of having another serious cardiovascular event.If you are at moderate risk for cardiovascular disease, a statin still may turn out to be a good idea - but only after you carefully discuss with your doctor the relative risks and benefits of statin therapy, as well as possible alternative method of reducing your risk. For instance, if you are able to engage in an aggressive program of lifestyle changes, you might very well move yourself into a low-risk category without the use of statins.
Sources:
Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy. JAMA 2011; 305:2556-2564.
Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med 2012; DOI: 10.1001/archinternmed.2011.625.
Cederberg H, Stancakovia A, Uyaluri N, et al. Increased risk of diabetes with statin treatment is associated with impaired insulin sensitivity and insulin secretion: a 6 year follow-up study of the METSIM cohort. Diabetologia, 2015. DOI 10.1007/s00125-015-3528-5.
Statins: Are these cholesterol-lowering drugs right for you?
Find out whether your risk factors for heart disease make you a good candidate for statin therapy.By Mayo Clinic StaffStatins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Statins may also help your body reabsorb cholesterol that has built up in plaques on your artery walls, preventing further blockage in your blood vessels and heart attacks.
Statins include medications such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor). Lower-cost generic versions of many statin medications are available.
Already shown to be effective in lowering cholesterol, statins may have other potential benefits. But doctors are far from knowing everything about statins. Are they right for everybody with high cholesterol? What kinds of side effects may occur? Can statins help prevent other diseases?
Should you be on a statin?
Whether you need to be on a statin depends on your cholesterol level, along with your other risk factors for cardiovascular disease.
Most people should try to keep their total cholesterol level below 200 milligrams per deciliter (mg/dL) (6.22 millimoles per liter, or mmol/L). Low-density lipoprotein cholesterol (LDL, or "bad" cholesterol) should be below 100 mg/dL (3.37 mmol/L).
But the numbers alone won't tell you or your doctor the whole story. High cholesterol is only one of a number of risk factors for heart attack and stroke.
The most important factor to consider is a person's long-term risk of experiencing a heart attack or stroke. If the risk is very low, there is probably no need for statins, unless the LDL is above 190 mg/dL (4.9 mmol/L). If the risk is very high — for example, someone who has had a heart attack in the past — the person may benefit from statins, even if his or her cholesterol is not elevated.
Risk assessment tools
Your doctor may suggest using an online tool to better understand your long-term risks of developing heart disease.
The American College of Cardiology and the American Heart Association have recently developed an online tool to predict a person's chances of having a heart attack in the next 10 years. For people under the age of 50, the Framingham cardiovascular disease risk calculator might be a better option because it provides a 30-year risk prediction.
In addition to your cholesterol numbers, these risk calculators also ask about your age, race, sex, blood pressure and whether you have diabetes or smoke cigarettes.
New cholesterol guidelines
New guidelines from the American College of Cardiology and American Heart Association focus on four main groups of people who may be helped by statins:
- People who already have cardiovascular disease. This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, mini-strokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or replace coronary arteries.
- People who have very high LDL (bad) cholesterol. This group includes adults who have LDL cholesterol levels of 190 mg/dL (4.9 mmol/L) or higher.
- People who have diabetes. This group includes adults who have diabetes and an LDL between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of vascular disease.
- People who have a higher 10-year risk of heart attack. This group includes people who have an LDL above 100 mg/dL (1.8 mmol/L) and whose 10-year risk of a heart attack is 7.5 percent or higher.
Lifestyle is still key for preventing heart disease
Lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not. To reduce your risk:
- Quit smoking and avoid secondhand smoke
- Eat a healthy diet that's low in saturated fat, trans fat, refined carbohydrates and salt, and rich in fruits, vegetables, fish, and whole grains.
- Be physically active, sit less and exercise regularly
- Maintain a healthy waist girth: less than 40 inches in men and less than 35 inches in women
If you're following the recommended lifestyle behaviors but your cholesterol — particularly your LDL (bad) cholesterol — remains high, statins might be an option for you. Risk factors for heart disease and stroke are:
- Smoking
- High cholesterol
- High blood pressure
- Diabetes
- Being overweight or obese
- Family history of heart disease, especially if it was before the age of 55 in male relatives or before 65 in female relatives
- Not exercising
- Poor stress and anger management
- Older age
- Narrowing of the arteries in your neck, arms or legs (peripheral artery disease)
- Because CRP levels can fluctuate over time, most experts now recommend measuring 2 CRP levels a few weeks apart and averaging the two values.
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