Statins: The Rest of the Story
There is a rise in the religion of “antistatinism.” Another way to put it: There is a “War on Statins.” Just like there was a war on early treatment of a serious viral illness with safe repurposed medication. I prefer to share a positive fact based message.
But I must fight back to promote optimal outcomes and maximize quality and quantity of life. If antistatinism is your religion, no need to read further. You won’t be convinced by data or admit you're being fooled. I can’t coach someone who already knows everything.
But many are struggling with the threat of disability or death vs the propaganda designed to lure you to drive your money to their “solution” and their profit.
I'm frustrated almost daily by patients when, in addition to prescribing healthier lifestyle and correction of deficiencies, I explain the benefits and reversible risks and prescribe statins while monitoring for their benefit and harm. They are stable or improving on very well tolerated low dose rosuvastatin but stop this life saving treatment in spite of demonstrated life threatening atherosclerosis with measurable personal improvement in inflammation, arterial age, plaque healing and inflammatory markers because of "something I've read."
I don’t blame the patients. We are susceptible to “fear porn” propaganda. I blame the opportunistic writers who are pushing people toward far more costly and more profitable PCSK9 inhibitors, expensive and less effective nutraceuticals, stents, surgery, cardiac/stroke rehab, dialysis, memory care centers and funeral expenses in their pursuit of likes, followers, and speaking fees based more on charisma and charm than interest in you personally!
Every one of these messengers has a business plan counting on growth!
Everything must be read with a filter of "what is offered as an alternative and what is the financial conflict of interest?" And "what does the author know or care about my individual circumstances, results and needs?"
I get it, but let’s put facts before feelings on this issue. Are statins mis/over prescribed? For sure. Is it driven by profit motive? It’s hard to blame this when almost all statins are cheap generics. Mostly, the driver is the guidelines that employed providers must follow and check the box under financial incentives and penalties to adhere. Reducing arterial disease progression or achieving remission doesn’t support a multibillion dollar procedural intervention and rehabilitation business model projecting and depending on growth. This is why I’m suspicious of any interventional cardiologist who disputes efforts to achieve remission, including statins to reduce inflammation. I’d prefer to hear more about the useless and potentially harmful stents placed over the years in asymptomatic individuals provoked by the “oculostenotic reflex” and provider revenue incentives.
Statin fear drives demand for more profitable pharma options like PCSK9 inhibitors (more than $500/month vs $5/month for generic rosuvastatin on GoodRx) and nutraceutical alternatives.
Statins are the most proven pharmaceutical treatment (in addition to a healthy diet and exercise) for remission of arterial disease and the reduction of heart attack and stroke for those with arterial injury/disease/plaque.
Evidence strongly supports that statins prevent death and disability from heart attack and stroke in patients with arterial disease. That evidence guides us to recommend statins at lower but still effective and well tolerated doses for those with atherosclerosis, which we identify and measure using carotid ultrasound and coronary calcium scoring. We monitor inflammation levels with ultrasound (intima media thickness measurement) and blood tests: C reactive protein, LpPLA2, microalbumin/creatinine ratio and myeloperoxidase. We consistently see improvement in these measures on statins and deterioration when stopped. I recently documented an 18 year improvement in arterial age in less than 5 months in a 66 year old clean living man while on rosuvastatin 5 mg 3 times weekly in addition to his continued healthy lifestyle. It is common for patients to admit to stopping their statin when confronted with mysterious adverse results on these measures after maintaining they were adherent prior to seeing the numbers. The numbers don’t lie!
You should be far more afraid of untreated inflamed plaque killing or disabling you than concerns about reversible annoying symptoms from an inexpensive generic medication that offers reliable protection. There is little controversy about statin benefit after an event (heart attack, stroke, bypass surgery or stent). When we find plaque (ultrasound or coronary calcium score) we consider those findings as essentially a near miss, an event that, fortunately, did not cause damage. Next time plaque develops, you might not be so lucky.
The foundation of health is nutrition/lifestyle/toxin avoidance. Think of this as the “belt” that keeps our pants from falling down. Statins are like “suspenders” that cover our lapses in optimal lifestyle choices. Safety programs, like airlines and the space program, are built on redundancy and backup plans. Belts AND Suspenders provided by the Department of Redundancy Department. 🙂
Where does the negative information about statins come from?
The biggest problem with statins is higher than needed doses of the wrong statin prescribed for the wrong reason. This is particularly true of the least effective but most effectively marketed statins (e.g. atorvastatin) for the lowering of LDL to target cholesterol levels based on general guidelines. The focus should be on reduced inflammation as measured by LpPLA2, myeloperoxidase and intima media thickness/arterial age by ultrasound in the individual.
At the CureCenter, I don’t prescribe statins if the arteries are healthy, no matter how “bad” the cholesterol is. I prescribe lower doses of rosuvastatin (has shown the strongest evidence of reduction in cardiovascular events while not crossing the blood brain barrier or promoting diabetes) based on documented atherosclerotic arterial plaque or inflammation, identification and monitoring of LpPLA2, myeloperoxidase and carotid intima media thickness/arterial age.
Event risk reduction begins in hours, but not for the reason most think. Statins lower LDL cholesterol levels, but their most potent benefit is reduced inflammation in the artery wall. I have seen this repeatedly by monitoring LpPLA2 and carotid intima media thickness trends.
Statin adherence consistently yields improvement. I can tell when they have been stopped by unfavorable trends in LpPLA2 and CIMT. In other words, they stabilize/heal plaque and improve the health and age of diseased arteries! There is evidence they reduced COVID deaths, probably due to suppression of baseline inflammation and mitigating the inflammatory effect of spike protein. Is it possible they protect my from vaccine injury as well?
When encountering negative propaganda about statins, ask the following questions:
Is the alternative offered a more expensive and profitable proprietary supplement or pharmaceutical? Statins should cost less than $10/month and are usually covered by insurance. Supplements will cost 2-4 times that amount and not covered by insurance. Ezetimibe is less effective at reducing inflammation. PCSK9 cost more than $500/month. To get coverage, it helps if you are “statin intolerant” which can be promoted by the “nocebo” effect. They cannot claim superior results except with extreme familial hyperlipidemia. But that would make them “orphan drugs. Pharma prefers blockbuster profits.
Does the reduction or elimination of heart attack, stroke, bypass surgery, stents, and rehab for heart attack and stroke undermine their business plan and revenue from treating late stage disease with stents, surgery, rehab, dialysis, memory care centers and funeral expenses?
Is the goal reduction of cholesterol or prevention of heart attack, stroke, premature death, surgery, stents or rehab by suppressing inflammation due to oxidative stress?
Is the advisor using the optimal measurement tools that show improvement in arterial health/age as we do at The CureCenter with Carotid Intima Media Thickness ultrasound or blood markers of arterial inflammation? Or are they solely focused on LDL cholesterol?
Is the advisor like a child with a hammer pounding on everything that looks like a nail? Are they using all the tools and options available from a program in pursuit of optimal quality of life and longevity?
How does the CureCenter prescribe and measure the benefits of statin use?
When prescribing statins, the only reason we monitor lipid levels is that we are expected to do so AND as a way to verify that the medication is being taken. We measure benefit by demonstrating a reduction in measures of inflammation and arterial wall thickness using CIMT.
In some cases, we will pay less attention to elevated cholesterol levels if we know that arteries are healthy based on healthy carotid ultrasound and coronary calcium score.
In other cases, if we know that arteries are sick in spite of normal cholesterol levels, we generally prescribe statins unless we know of prior intolerance based on personal experience. Arteries improve with statins in spite of "normal" cholesterol because statins reduce inflammation. We generally use lower doses of statins (fewer side effects) because we are treating for artery health improvement, not the lowest possible LDL cholesterol levels.
Has Dr. Backs had his own personal experience with statin use?
Dr. Backs personally takes a daily statin called rosuvastatin. When he stopped it for a time (to see if his muscles ached from hard workouts or the drug), his arterial age increased by 10 years while he experienced the same sore muscles. This is all while he continued to exercise and live the “cleanest” lifestyle possible. When the statin was resumed, the arterial age returned to lower levels.
Do statins have any side effects?
Statins can provoke dose dependent side effects in a minority of users most commonly muscle aching. The vast majority of individuals can take them safely with benefit with no adverse results. Untreated sleep apnea and low vitamin D levels increase the likelihood of muscle aches. Correction of these issues reduces these side effects and has other benefits. Coenzyme Q may be helpful, but reducing the dose of the statin or changing to a better tolerated option is the best first step for someone whose arteries are a threat.
A small minority of users have reported cognitive harm in relation to statins. This is less likely with rosuvastatin, our preference, because it does not cross the blood brain barrier like Lipitor/atorvastatin, the most successfully marketed statin.
Reduction in arterial disease-related dementia is far greater than the incidence of reversible cognitive compromise from statins. If you experience cognitive changes after starting a statin, they will reverse when the drug is stopped if due to the statin. Don’t get stuck on this worry. Dementia and Alzheimer’s are a far greater risk with arterial disease and insulin resistance driven chronic inflammation. Therefore, addressing this risk is far more important than fearing a temporary side effect.
Increased diabetes risk and insulin resistance have also been a concern. In many cases, patients are not counseled to or fail to reduce sweets and starches in their diets, thinking they are protected by the statin prescription. In fact, the focus on salt, fat and cholesterol leads to increased inflammatory addicting sugar intake. Therefore, it is no wonder that they progress from insulin resistance to prediabetes to Type 2 Diabetes, the progression caused by the western processed glycemic diet. Reduced Sweets, Starches and Snacks in the diet can offset fears about increased risk of diabetes or insulin resistance. Our patients are constantly coached and monitored for evidence of progression to prediabetes or Type 2 Diabetes.
Without personally trying a drug, predicting how you will tolerate it is impossible! The experience of a friend or family member, while provoking understandable concern and fear, will not predict your experience with statins or any other drug. Fears of statin intolerance tend to be self-fulfilling. This is known as the “nocebo” effect.
Intolerance of one statin doesn’t necessarily predict intolerance of all statins. Some side effects disappear with lower doses that will still have benefit measurable by blood and ultrasound measurements of inflammation.
At the CureCenter, we monitor reaction to any medication we recommend, both good and bad. Our bottom line: If you have atherosclerosis, you will generally benefit from a statin (if you can tolerate it) to reverse arterial inflammation, heal plaque and prevent life altering events: heart attack, stroke, and dementia.
If you are still skeptical, we offer alternatives like Bergamot BPF or niacin. None of these have the same degree of net favorable track record of statins, and side effects are not zero. They offer benefits that vary by individual.
Open minded willingness to consider risks AND benefits of any treatment leads to the best outcomes. But if your mind is made up, and you decline to take a statin, I won’t “have a stroke” over it.
I hope and pray the same is true for my patients