March 20, 2013

Cholesterol and Statins and Me: an Update

The benefit of statins for the elderly has been especially controversial of late. For years, I've been taking 20mg of Lipitor -- the most popular statin -- every day (night, actually). Fortunately, a generic is finally available, but it's still a pricey drug.

When I'd receive the letter from my internist with results from my annual physical, he'd report on my "very good" or "excellent" cholesterol numbers. He'd then urge me to continue the Lipitor routine, and I'd keep it going. But recently, I've seen reports questioning the use of statins generally, especially for seniors with no evidence of heart disease.

Last July, I reported on a book Are Your Prescriptions Killing You? by geriatric pharmacist Armon B. Neal, who warned "if you are over age 60, stay away from statins at all costs." I began researching the issue and have amassed a thick file of reports.

Based on that research, I decided to discontinue Lipitor and see what happened. I'll share the results of a cholesterol test I took last week. But first . . .

New Concerns about Statins' Side Effects
A year ago, the FDA required major statin producers to add a warning to the labels about the potential risk of diabetes and memory loss. A 2010 study in the British medical journal Lancet reported that statins could raise diabetes risk by nine percent. The memory loss issue came to the FDA's attention primarily through anecdotal reports, not a formal study.

Of concern -- though not mentioned by the FDA -- are the risks statins pose for muscle damage. Patients have complained that statins made their knees and shoulders hurt, and physical therapists report that statins have put patients into rehab. The ongoing study at the University of California, San Diego, carries this warning:
Muscle symptoms are common with statin drugs. “Myopathy," involving actual damage to muscle tissue, can be very serious. For this reason, if you develop new muscle pain, weakness, or tenderness on the drugs you should inform your doctor immediately.
Flying under the  radar for now are other complaints from statin users about sexual dysfunction, peripheral neuropathy, depression, and irritability.

Questions about Risk/Benefit of Statins in General
Virtually all the studies supporting the benefits of statins on lowering cholesterol were based on trials involving middle-aged men, not seniors (or women). Even these studies are being questioned. A 2008 editorial in the British Medical Journal took a look at a major five-year statin study involving middle-aged men in western Scotland that reported a 32% reduction in cardiovascular mortality for those who took statins. But, the editorial notes, "converting the 32% relative risk reduction into an actual reduction gives a derisory 0.7% reduction in cardiovascular mortality." It concludes:
This is the "treatment paradox": That an individual patient, despite many years of investment in taking statins, gets virtually nil health benefits.
In a similar analysis of other studies, Dr. Malcolm Kendrick, author of The Great Cholesterol Con, concluded:
In short, if a fifty-year-old man asked you how much longer he could expect to live if he took a statin for thirty years, you can inform him "just over two weeks . . . max."
Lots More Doubt about Statins for the Elderly
Many doctors and researchers would argue that a good case can be made for continuing to prescribe statins for high cholesterol, particularly if patients already have diabetes or show signs of heart disease. But the rationale for treating elderly people with statins is much less clear, because the association between cholesterol and coronary heart disease diminishes with age.

In fact, for the oldest old people (those like me over 80), low cholesterol is associated with increased mortality. Though not generally known by the public, that link has been recognized in the medical literature for about two decades (

My Experiments with Stopping Lipitor
After reading Neal's book (see above), I went on a four-month Lipitor holiday. Then I went back to my internist to get my cholesterol checked.  As I reported last November,  the new numbers were not good. Here's the November numbers compared to the numbers from my annual checkup in May:
My total cholesterol number, which had been 161 in the spring now was 289. AND my "bad cholesterol" had more than doubled, from 81 to 196. Interestingly, my good cholesterol was virtually unchanged, dropping barely from the 68 to 67.
I decided to go back to the old routine: 20mg of Lipitor at bedtime. Continuing the statin research, I found the reports (above) and others with similar conclusions. And so . . . being a confirmed neophiliac (addicted to novelty) and in line with my "less is more" mantra for 2013, I again stopped taking  Lipitor a month ago.

Last week, I got my cholesterol checked at my local CVS's "one-minute clinic." The new numbers :
  • Total cholesterol -- 214 (Normal/desirable is under 200)
  • HDL (the good guy) -- 64 (Normal/desirable over 60)
  • LDL (the bad guy) -- 140 (Normal/desirable under 129)
  • TC/ HDL ratio -- 3.4 (Normal/desirable under 5)
These new numbers were worse than my stats last May, but not as bad as they were in November after my four-month Lipitor recess. But the CVS report also had a new and interesting number:
  • My Framingham Coronary Heart Disease Risk is 10% (the risk of dying of CHD in the next 10 years).
I went back to my research folder on statins and found this recommendation from the British National Institute of Clinical Effectiveness: 
  • Statins should be taken by people who have a 20% or greater risk of developing cardiovascular disease within 10 years.
So I'll continue the Lipitor holiday, at least until I talk with my internist at my annual checkup this spring.   Who knows? Maybe my short-term memory -- terrible during my Lipitor years -- will start to improve.

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