Statins – in a class by themselves

By Robert M. Stark, MD

In my work as a clinical cardiologist, I’ve been accustomed to getting the occasional medical question at the parties I attend. Almost without exception, these questions have centered on the person’s cholesterol concerns: “What can I eat?”  “What shouldn’t I eat?”  “Is my cholesterol level really all that important?”

Recently, all of this seems to have changed. Either people have simply lost interest or something truly dramatic has happened.

The dramatic change turns out to be the availability of a new class of drugs, the statins, which has all but revolutionized the field of heart disease prevention. The statins lower cholesterol so effectively that they have rapidly become the number one class of drugs prescribed in the U.S. today.

Taken as a once-a-day pill, a statin will stop the liver from producing cholesterol while, at the same time, causing the body’s cells to increase their metabolism (breakdown) of cholesterol. The net result is a significant fall in serum cholesterol, often by as much as 50 to 100 points. This decrease is sometimes possible even without the familiar, stringent dietary restrictions (fat, eggs, cheese, butter, red meat, etc.)

The statins have already had a measurable impact on the incidence of coronary heart disease both nationally and locally. Area cardiologists have noticed a significant decline in heart attack admissions since the statins were introduced. Published studies have documented decreases of up to 37 percent in heart attacks among patients who were given statin therapy.

These clinical studies are of real relevance to us, because heart attack remains the No. 1 cause of death for area residents. One out of three women die from coronary heart disease. Twice as many die from heart disease than from breast cancer and all other causes combined. For men in this area, one out of two will die of coronary disease. But these statistics are likely to improve as statins are prescribed more widely.

What are the potential downsides of statin therapy? Because they make cholesterol lowering so deceptively simple, statins risk undermining our time-honored advice concerning weight loss, exercise and a low-fat, low-cholesterol diet. These drugs should be reserved for when diet and lifestyle measures have fallen short in achieving cholesterol-lowering goals.

Statins are also known to have a low but measurable incidence of side effects. Liver inflammation can develop in approximately 1 percent of patients taking statins. This is detectable by a blood test and is reversible once the statin drug is discontinued. Muscle aches or inflammation can also develop in 1 percent to 2 percent of patients. There is an accurate blood test for this problem, too.

There are six brands of statin drugs available by prescription. They are Mevacor, Pravchol, Lipitor, Zocor, Crestor and Livalo. Each is effective in lowering cholesterol, but all need to be monitored periodically by a physician.

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Beware of the “natural” or herbal statins that have recently become available as dietary supplements.  These are all derived from rice that has been fermented with a red yeast mold.  This mold produces small amounts of lovastatin, a cholesterol-lowering statin.  Also produced, however, are numerous other organic by-products.  Some of these by-products are potentially toxic.  There’s a good parallel here with the antibiotic penicillin, which is also derived from the yeast that grows on moldy bread.  Certainly, few patients would want to take a bread mold extract instead of purified penicillin, which is available in clean tablet form.

Although this might make for a lively conversation at a future cocktail party.


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