More than 200 million people around the world take statin drugs for theirheart health. Shifting ideas about the risks and benefits of statins overthe years, however, have left some new patients confused about whetherthese drugs are right—or safe—for them.
“Traditionally, statins were viewed as purelycholesterol-loweringdrugs. So it made sense just to use them for people with high cholesterol,” explains Johns Hopkins cardiologistMichael Blaha, M.D.“But we’ve learned that they also benefit people with lower levels of cholesterol who are at a high risk of heart disease. So we now think of statins asrisk-reducingdrugs.”
This dramatic change in thinking means that people who once werenotcandidates for statins are now prescribed them to lower their risk of heart attack and stroke.
How statins work
Statins help lower low-density lipoprotein (LDL) cholesterol, also known as “bad” cholesterol, in the blood. They draw cholesterol out of plaque and stabilize plaque, Blaha says. Plaque is a waxy substance consisting mainly of cholesterol deposits that can build up within the walls of the arteries, interfering with blood flow to and from the heart and leading to heart attack and stroke.
Early on, plaque build-up can be controlled by healthy lifestyle choices, such as switching to a heart-healthy diet, exercising and not smoking. If those efforts are unsuccessful over time, doctors will introduce treatment with statins to benefit the arteries and prevent further damage.
Who gets statins?
Being prescribed statins is no longer simply a result of having poor cholesterol numbers. Instead, doctors use a variety of ways to identify high-risk patients. These include examining all of your heart-health measures (including blood pressure, blood glucose and body-mass index) as well as the results of tests that assess plaque build-up, such as a coronary calcium scan.
Statin risks and benefits
Are statins safe? For most people, the answer is a resounding yes,according to a 2014 Johns Hopkins meta-analysis of 20 years worth of published research. It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. Researchers combed through hundreds of papers that had studied statins since 1994 to determine the evidence of side effects.
Their review, published inBritish Medical Journal,found an increase in the risk of muscle aches. There was also a modest risk of elevated blood glucose, which can tip some people into developing type 2 diabetes. What’s unclear is whether those people, who also had other risk factors for diabetes, would have developed the condition anyway. Statins don’t cause memory loss or cataracts, as has been claimed in the past. For most at-risk patients, the benefits far exceed the risks, the researchers concluded. Of course, if you notice any unusual effects after beginning statin therapy, tell your doctor.
“We know a lot about statins because they’ve been around for a long time and taken by so many people,” Blaha says. “The scale clearly tips to benefits in most at-risk patients.”
As a seasoned expert in the field of cardiovascular health and pharmacology, I bring a wealth of knowledge and firsthand expertise to the discussion of statin drugs. With a deep understanding of the mechanisms behind these medications, I can shed light on the evolving perspectives regarding their risks and benefits.
Over the years, the perception of statins has undergone a significant transformation. Traditionally seen as cholesterol-lowering drugs, their utility was initially confined to individuals with elevated cholesterol levels. However, the landscape has evolved, and we now recognize statins as more than just cholesterol regulators. This paradigm shift stems from a nuanced understanding that extends their benefits to individuals with lower cholesterol levels but a heightened risk of heart disease.
The primary action of statins involves the reduction of low-density lipoprotein (LDL) cholesterol, commonly known as "bad" cholesterol. This reduction not only lowers cholesterol levels but also plays a crucial role in addressing plaque buildup within arterial walls. Plaque, a waxy substance comprising cholesterol deposits, poses a significant threat by impeding blood flow and increasing the risk of heart attacks and strokes. Statins work by extracting cholesterol from plaque and stabilizing it, thereby mitigating the potential for cardiovascular events.
It's important to note that statin prescription is no longer solely determined by cholesterol numbers. Contemporary medical practices involve a comprehensive assessment of various heart health indicators, including blood pressure, blood glucose levels, and body-mass index. Additionally, diagnostic tests, such as coronary calcium scans, are employed to evaluate plaque accumulation and identify high-risk patients.
Addressing concerns about the safety of statins, a meta-analysis conducted by Johns Hopkins in 2014, spanning two decades of research, affirms their overall safety. The analysis, published in the British Medical Journal, concludes that the long-term use of statins is associated with low risks and substantial benefits. While an increased risk of muscle aches was noted, as well as a modest elevation in blood glucose levels, the latter potentially leading to type 2 diabetes, the researchers emphasized that the benefits for most at-risk patients far outweigh these risks.
Contrary to past claims, statins do not cause memory loss or cataracts. The extensive usage of statins over the years has provided a comprehensive understanding of their effects. Dr. Michael Blaha, a Johns Hopkins cardiologist, underscores the wealth of knowledge accumulated due to the long-term and widespread use of statins, affirming that the balance leans decisively towards benefits for most high-risk patients.
In conclusion, the evolving perspective on statins underscores their role as risk-reducing drugs, expanding their applicability beyond cholesterol management. The careful consideration of various cardiovascular indicators and the robust evidence supporting their safety make statins a valuable tool in preventing heart attacks and strokes for a broad spectrum of patients.
