The Matka of Statin Intolerance
Many of the so-called side effects of statins are nothing but a nocebo effect.
I was speaking to a colleague, who works in the pharma industry, and has also worked in healthcare service delivery. His brother had calcium in the coronary arteries, which is a good risk predictor for the likelihood of coronary artery disease. A calcium score above 100 generally implies the need to start drugs such as statins, which not only lower the cholesterol levels in the body, but also work on the plaques in the coronary arteries and stabilize them, preventing them from rupturing and causing “heart attacks”.
He mentioned that the new guidelines are very clear that lipid levels are no longer important and statins are no longer needed. It was something he had read in the “Encyclopedia of WhatsApp” and despite being someone who is a little conversant with healthcare issues, had fallen prey to misinformation.
Dr. Vera Bittner [1] in a perspective piece on the new 2019 ACC/AHA Guidelines for the Primary Prevention of Cardiovascular Disease [2], succinctly puts down the matkas of cardiovascular risk. “much of the cardiovascular disease burden and mortality can be traced back to 4 adverse health behaviors (smoking, poor diet, elevated body mass index, and sedentary lifestyle) and 3 major risk factors (hypercholesterolemia, hypertension, and diabetes)”. Most of these are controllable or partly controllable matkas.
Globally, high LDL cholesterol (LDL-C) is the third most important cause of cardiovascular disease (CVD) [3].
In India, in 2019, high LDL-C levels were the sixth commonest cause of estimated deaths (average of 630,000, around 6.7% of all deaths with an average rate of 45% per 100,000) [4].
The lower the LDL-C, the lower is the risk of a cardiac event [image adapted from 5].
Lowering of LDL-C levels can be achieved with food control (sensible eating, diets), exercise, drugs and surgery (bariatric, ileal bypass). Ideally, the LDL-C level should be below 70 mg/dl, especially if there is any level of risk for atherosclerotic cardiovascular disease (ASCVD) (to be calculated using clinical and laboratory parameters) and between 70-100 mg/dl, if the ASCVD risk is low.
If non-drug therapies can keep the LDL-C level below 70 mg/dl and definitely below 100 mg/dl, great…else it becomes necessary to use drugs to control the LDL-C levels. Of the various drugs available, statins have been proven to be the best class of drugs for controlling and lowering LDL-C levels [6]. If the ASCVD risk is high, even with a healthy lifestyle incorporating movement and sensible eating, statins are still recommended to not just control the LDL-C levels, but also to stabilize plaques within the coronary arteries [7].
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