The Misguided War on Cholesterol? (Or What You Don’t Know About Statins)

“Everyone knows that high cholesterol can lead to heart attacks. After all, doctors and big drug companies have been warning you about it for years. But are they really telling you everything?” I know, sensational stuff here. This is the opening line from a promotional email from a retired MD and author now making public claims that we’ve all been misled by the widespread promotion of statin drugs for reducing risk of heart attack. And he’s not the only one.

Honestly, I wouldn’t have put any credence in it if I hadn’t received multiple emails from a respectedSide_effects reader whom I happen to know personally, who tells me that “statins wrecked my upper arms and shoulders in a matter of weeks.”

We wrote briefly about statins in our book, but in all honesty, I still don’t know that much about them. Looking into it, I’ve found there is open recognition that statins can cause serious muscle damage, although most of the literature paints this as exceedingly rare.

Still, my good friend Reader X may have a more momentous point:

“There seems to be significant debate about whether high ‘bad’ cholesterol is in fact a causal factor in heart disease. As someone put it, the bigger the fire, the more fireman you will see at the scene. That doesn’t mean fireman cause fires. If cholesterol isn’t a causal factor, then putting people on statins in the first place could be a big waste of time,” he writes.

In fact, this discussion has apparently been going on for quite a long time. No matter what the critics say, the NIH still claims that “High blood cholesterol is one of the major risk factors for heart disease.”

I guess it’s important to recognize, however, that high cholesterol is only ONE of many causes of heart attack and stroke. Other causes include the risk factors that make up so-called “metabolic syndrome“:

* abdominal obesity,

* elevated triglycerides,

* low high-density lipoprotein cholesterol (i.e., HDL, or “good” cholesterol),

* elevated blood pressure, and

* elevated glucose levels.

Right, so if we’re extremely overweight and inactive, have large amounts of fat in our blood, high blood pressure, and/or high A1c, we’re pretty much Heart Disease Waiting to Happen. It’s certainly important to address these factors as much as it is to worry about “bad” cholesterol (LDL) levels.

What worries me more is the assertion that statins may not be as safe as they seem. I know many doctors brush this off as malarky, but has anyone had similiar experiences to my friend? From looking around at message boards and the like, it appears the negative side effects of statins may be much more common than the authorities would have us believe.

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9 Responses

  1. kendra
    kendra May 7, 2007 at 9:04 am | | Reply

    A timely post…I’m expecting to get yelled at again about my LDL cholesterol from my endo. My LDL has hovered around 100 for years (since my teens) and I am just now, with a new doc, getting heavy pressure to start on statins…since of course if you’re diabetic you are extra special and have to have the lowest LDL that is humanly possible. I’m a little peeved/freaked out by the pill pushing but don’t know if my feelings are justified.

  2. Bernard Farrell
    Bernard Farrell May 7, 2007 at 9:14 am | | Reply

    Amy

    Thanks for opening this discussion. I’ve been on a statin for some time, because my cholesterol was JUST over the (newly-reduced) limit for someone with Type 1 diabetes. It was around 202. I went on the statin and some months later it was about 135! Now this was great, but in my mind it was too much. So I’ve cut the statin dose (10mg) into 5mg every other day. Last I checked my level was still around 150 (don’t remember the units). That seems plenty low enough.

    I happened to bump into a rep for the drug company at my doctors office last year. I asked her if anyone was doing a study on the efficacy of an every-other-day dose. Surprisingly, that’s not being worked on at present.

    I’m not suggesting my approach for everyone, I’m merely questioning whether we need to get the levels as low as people think.

    I’ll keep an eye on where this goes. Thanks again.

  3. ralph berry
    ralph berry May 7, 2007 at 11:26 am | | Reply

    This is perfect. I am a 56 years of type one and my endo has been encouraging me to take statin which I do not. Funny but true point is my Dad, long deseased had a wonderful friend of his, who was one of the leading cadiologist in the country, a long time ago and they use to sit around Sunday afternoons sharing a bottle of whiskey and argue about cholesterol till the dogs came home.

  4. George
    George May 7, 2007 at 5:17 pm | | Reply

    Being in Canada we use a different scale than is used in the US. My current reading is 2.16 and I have to get it under 2 according to my endo. Ideally, they want us to have the same cholesterol count that newborns have. By the way, if your LDL is above 4 you are courting disaster.

  5. David Mendosa
    David Mendosa May 8, 2007 at 9:20 am | | Reply

    Dear Amy,

    Thank you for sharing your concerns about the statins. My former doctor put me on at least four of the six statin drugs.

    Each one caused some of the most severe muscle pains in one of my legs that I ever experienced. I found out later doctors are very familiar with it and call it rhabdomyolysis.

    If I had not stopped taking each statin immediately, it could have caused permanent muscle damage. Even kidney damage, as Medline Plus says, “Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle fiber contents into the circulation. Some of these are toxic to the kidney and frequently result in kidney damage.”

    Everyone who takes or considers taking a statin should read the most informative web page from Dr. Duane Graveline. He is no flake. He is a former USAF flight surgeon, a former NASA astronaut, and retired family doctor. His web page on the statins is http://www.spacedoc.net/muscle_pain_statins.htm

    He writes there that the “muscle inflammation…has progressively mushroomed to a 20% incidence rate.”

    My new doctor is, of course, also a believer in the statins. He is such a believer that even after he saw my new and much better cholesterol levels as a result of my taking Byetta and especially losing a lot of weight, that he wanted to me go on one of them again!

    I was incredulous and promptly refused! After all, he and I had just seen my cholestrol numbers — and every one of them are normal!!!

    My total cholesterol is 155 (should be below 200), my LDL is 93 (should be below 100), my VLDL is 22 (should be below 150), and my HDL is 40 (should be at least that). My triglycerides are 109 (should be below 150).

    What stupidity! Or influence of the drug companies.

    Thank you, Amy, for bringing your concerns about the statins to those of us with diabetes.

    Your friend,

    David

  6. Anne
    Anne May 8, 2007 at 12:20 pm | | Reply

    I don’t take statins, personally, and I’m not sure how compelling the evidence is that a diabetic must have LDL <100, but I guess I try to shoot for that goal anyway..

    I swear I don’t own stock in Quaker Oats but if you are trying to lower your LDL and raise your HDL, you may want to try eating oatmeal daily (in addition to regular exercise etc etc, of course). My cholesterol profile improved significantly after a year of regular oatmeal eating, and I have a good friend who observed the same effect (and he doesn’t exercise nearly as much as I do). I know that’s only a sample of 2, and that for some people, diet modifications + exercise are simply not effective enough. But it’s easy to try and with some cut-up fruit + skim or low fat milk, makes a delicious and healthy breakfast.

    I figure that if I keep the rest of me (aside from my wimpy pancreas) as healthy as possible, I have the best shot for a long, healthy life. And whether high cholesterol is a symptom of something or a cause, I guess lowering it through a better diet couldn’t hurt…

  7. Ouch
    Ouch May 8, 2007 at 5:55 pm | | Reply

    I’m the friend with the sore arms and shoulders. It’s been worse than sore, though. Imagine your upper arms and shoulders have been transformed from good muscle fiber into tissue paper, and every time you reach, stretch or exert yourself, that tissue paper tears – with all the pain that a muscle tear has. Because that’s what’s happening – muscle is tearing, real damage is being done.

    I started taking statins in January this year, due to a slightly elevated “bad” cholesterol level. Within a couple of weeks, I was getting terrible pain from arm muscles tearing. Unfortunately I didn’t put the two things together and kept taking statins until the end of February. Since then, my arms and shoulders have gradually been recovering, but I’m still in almost constant pain or discomfort, and my upper arm strength is greatly diminished from what it was in December. I can’t sleep on my sides at night as it hurts my shoulders too much, and putting on my backpack every morning results in acute shooting pains. Scratching my back is completely beyond me.

    For me, and anyone with this severe a reaction, statins are obviously A Bad Thing. This kind of reaction if you keep taking the pills can be quite literally crippling – a few google searches will uncover any number of horror stories about atrophied muscles never regaining their former strength.

    But it’s clear these reactions are mercifully rare – millions of people are on statins, and there aren’t *that* many horror stories to be found (even including the equally alarming memory / brain damage stories).

    The general concern I believe should be more widely raised is that these are serious drugs, with serious effects. They’re not a miracle drug with no downsides you should prescribe whenever possible – is there such a thing? But they’re dispensed by doctors all too easily, for the rest of your life, and certainly in my case there was little discussion of serious side effects or that I should consider the risks in the context of the perceived benefits of reducing cholesterol. Like others, I did feel pushed to take them. Fortunately my endo has agreed I should not take statins again as I still have a CPK level 50% higher than normal (it’s the test which determines if muscle damage has occurred), but my PCP got the same results and left me a voicemail telling me the results looked fine and to start on with the Lipitor!

    My own grandfather took statins for 25 years following a major heart attack when I was 10 years old, so maybe I have statins to thank for knowing him for as long as I did. My father has recently been prescribed statins to deal with his combination of hypertension and high cholesterol, maybe he too will gain a longer life as a result, so I shouldn’t be too churlish I guess. But I’m 40 years old, 6’ 1” and 190 lbs, have low blood pressure, play tennis three times a week, ski, hike and bike, with type 1.5 diabetes (lower risk than type 2) and cholesterol only slightly above the target range. Bearing that in mind, and knowing the risks of prolonged use of statins, would you have prescribed them to me? Or told me to keep taking them despite the muscle pains? Neither would I.

  8. KJ
    KJ May 9, 2007 at 6:42 am | | Reply

    I was put on Lipitor last summer and, within 3 days, I began to feel weak all over and my muscles began to hurt. I called my doc and he said to stop taking the drug. I can never be on another statin.

    Now, the trick is trying a whole array of non-pharmaceutical approaches to lowering my LDL, which has always been higher than it should be. However, my triglycerides are normal and my HDL has gone up and is “normal” under some parameters and not quite normal under others.

    I agree with those who say the serious side effects of statins are given short shrift by the medical community (and certainly by the drug companies). Statins are considered miracle drugs by many of these folks. And, I suppose, they may be – for some people. But for other people, statins will not only destroy their muscles, they will also destroy the quality of their life as they know it.

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