July 13, 2012

If you are over age 60, "stay away from statins at all costs"!!

That's one of the many provocative, seemingly well-documented recommendations in Armon Neel and Bill Hogan's intriguing new book, Are Your Prescriptions Killing You?

Statins, prescribed to combat high cholesterol, are the best-selling class of drugs in the United States, and Lipitor (atorvastatin) is the best-selling prescription drug in history. I've been using Lipitor since age 60, and it's one of the priciest drugs I take. Currently a 30-day supply costs about $200, or $2,400 a year. That means -- to date -- my insurers and I have shelled out about $52,800 to Pfizer... unnecessarily, if Neel is right!

And this guy is not a quack.

Armon B. Neal, Jr. -- Credentials
Armon Neel, Jr., PharmD, CGP, is a board-certified geriatric pharmacist who has been counseling older patients and their caregivers on the safe, effective use of medications for more than 40 years. His work has been featured in AARP Bulletin, Prevention, and Reader’s Digest.

In 2010, the American Society of Consultant Pharmacists gave Neel its annual achievement award. The organization then announced it was renaming the award for him! Neel serves as a resource on drug therapy management for seniors through his website, MedicationXpert.com, and is AARP.org’s “Ask the Pharmacist” columnist. At age 73, he also maintains an active private consulting practice.

The Case Against Statins for the Elderly
Neel has concluded that statins are "among the most ineffective and dangerous drugs on the market, largely because the doctors who prescribe them haven't done their homework, relying instead on information supplied by the manufacturers of statins and the studies they've underwritten."

Not one to pull his punches, he says:
I stop these drugs on all the older patients I see because they are invariably at the root of nearly all their problems.
You can have high cholesterol without having coronary artery disease -- what we use to call "hardening of the arteries." Neel points to the significance of HDL, the so-called "good cholesterol":
If your HDL is above 45, then high LDL is not that important to treat. 
Here's the report I got from my internist after my annual check-up this spring:
Your total cholesterol was 161. The HDL, the desirable component, was splendid at 68. The less desirable LDL was 81. These are certainly very nice numbers, indeed.  Please stay on the same dose of Atorvastatin (Lipitor), 20 mg every day.
Hmmm. My HDL sure is well above 45!  Due to Lipitor or not?  That is the question.

If you don't have hardening of the arteries by the time you're 70 or 80, you most likely never will, Neel says. And if you do have this problem, it's too late for statins to do any good.

In a recent study by the Cochrane Collaboration, data from 14 randomized control trials involving 34,272 patients was reviewed, and researchers found no "strong evidence" that statins reduce death from coronary heart disease among patients who had no prior history of it. They concluded:
We recommend that caution should be taken in prescribing statins for primary prevention among people with low cardiovascular risk."
Statins Can Cause Problems
According to Neel, the most common unwanted side effect of statins involves muscles. "When I see an older patient who complains about muscle pain, fatigue, and weakness, I know from experience that a statin drug is the most likely culprit."

Neel claims that statins also cause serious cognitive problems. He cites a study based on patient surveys published in the journal Pharmacotherapy in 2009. That study found that 75 percent of the subjects "experienced cognitive ADRs [adverse drug reactions] determined to be probably or definitely related to statin therapy."

However:  I checked  for the latest reports on this by searching "statins and cognitive problems" at NIH's PubMed site and found these two recent studies:
  • A review of previous research conducted at the University of Waterloo in Canada -- reported this past April -- concluded: "Despite several reports of statin-associated cognitive impairment, this adverse effect remains a rare occurrence among the totality of the literature. If statin-associated cognitive impairment is suspected, a trial discontinuation can reveal a temporal relationship. Switching from lipophilic to hydrophilic statins may resolve cognitive impairment. The vascular benefits and putative cognitive benefits outweigh the risk of cognitive impairment associated with statin use; therefore, the current evidence does not support changing practice with respect to statin use, given this adverse effect."  http://www.ncbi.nlm.nih.gov/pubmed/22474137
  • Another April report, this one from McGill University in Montreal, Canada, dealt with an experiment using the statin simvastatin (brand name Zocor) in tests on mice, concluding "simvastatin and, possibly, other brain penetrant statins bear high therapeutic promise in early AD and in patients with vascular diseases who are at risk of developing AD." http://www.ncbi.nlm.nih.gov/pubmed/22492027 
I know from earlier research that there are contradictory reports on the relationship between statins and cognitive issues.

Neel makes these additional observations on the possible side effects of statins:
  1. Statins may increase your risk of developing diabetes.
  2. If you've had a hemorrhagic stroke, taking statins may increase your risk of having another one.
  3. Statins can interfere with your ability to metabolize other drugs.
The Older You Are, the More Dangerous Statins May Be
Indiscriminately prescribing statins to people over age 80 (like me!) is ill-advised, according to a study by Danish researchers published in the journal Age and Aging in 2010. These researchers concluded: "There is not sufficient data to recommend anything regarding initiation or continuation of lipid-lowering treatment for the population aged 80+ with known cardiovascular disease (CVD), and it is even possible that statins may increase all-cause mortality in this group of elderly individuals without CVD."

That did it. I'm stopping the Lipitor (generic). I'll get my cholesterol rechecked in six months or so.

Alternatives to Statin Treatment 
Basically, Neel views statins as drugs of last resort, especially because non-drug approaches can often control lipid levels.

For starters, Neel gives this standard advice: stop smoking and lose weight. Another old stand-by -- exercise -- is particularly important, he says. He advises avoiding foods high in saturated fats. Lycopene, the powerful anti-oxidant that gives ripe tomatoes their bright red color, may be especially helpful. A team of Australian researchers, Neel says, reported in 2011 that eating as little as two ounces of tomato paste a day could be an effective alternative to statins.

For older patients, Neel believes a combination of supplements is effective in controlling lipids. He recommends 1,000 micrograms of vitamin B-12, injected into muscle -- each week for four weeks, then going monthly, along with a daily regimen of folic acid (1mg), vitamin B-6 (200mg), and fish oil (3,000mg). 

Neel recommends the injection route for B-12 because the elderly often have problems with digestive absorption. But the Wikipedia write-up on B-12 suggests injection may no longer be needed with modern high potency oral supplements of 0.5 to 1mg. Neel and others have recommended that if B-12 pills are used, they should be taken sublingually, a suggestion -- according to Wikipedia -- that has not been proven necessary or helpful.

I'll post more later about the pain pills and blood pressure meds that also are questioned in Neel's Are Your Prescriptions Killing You?


James said...

Thanks, John.
 Good that you are takining time to reconsider use of statins. I have avoided Lipitor and other cholesterol busting drugs for decades. Prefer to minimize consumption of cheese, butter, cream, and of course, red meat to keep my cholesterol count down. I eat oatmeal, oatmeal bread, and, yes, oatmeal cookies.
 Makes for a bland diet as I am allergic to shellfish also. Whatever.

Hank said...

Hmmm, me too!  I ordered the book to see what else he has to say. I went from 10mg to 20 mg about a year ago.

Terry said...

In the UK we are far less likely to treat things with prescriptions than it seems is the case in the USA. Whether that means we live longer, I have no idea!

Roll on Obamacare!

Jason said...

Thanks, John.  I fall in this category!

Mark said...

John -
Thanks for the confirmation.   I am "running 62" and have a cholesterol reading around 240.   Everything else checks out OK and no signs of heart disease.   My physician has insisted that I "stay away from statins!"  I have elected not to do anything other than increase activity level and further refine my already-healthy diet.   Most friends my age or a bit older are on Lipitor and deathly afraid of discontinuing.  

Sandypanzella said...

When taking b12 make sure it it is methyCobalamin...the other is useless!

John Martin said...

Fascinating stuff.  I'm one of those (un)lucky individuals with horrendous lipid numbers -- even though I'm slender, even though I've exercised regularly and vigorously for decades, even when my diet became positively Spartan, and even with super-uncomfortable mega-doses of niacin -- until I started taking Lipitor, at which point my numbers quickly aligned with what they should be for someone with my body and lifestyle.  I guess one moral of the story is: Regardless of statistical evidence, each of us is an individual, not a statistic, and ... "your mileage may vary".

Jimpat said...

John's comments are similar to mine. I've had cvd for some time, lost 30 lbs, have taken lipitor, had an aortic valve transplant, some  heart rate irregularity and...I am having muscle problems, loss of energy, etc.  But I;m 85 and still functioning fairly well.  Afraid to stop taking lipitor. Unless the muscle problems become totally disabling, I think I'll stay with it at this juncture.

Faith said...

Dr. of Internal medicine near me lowers cholesterol with use of supplements vitamins.  Recommended Artichoke Extract to my husband.  Get blood monitored every 3 mths as if on medicine.  Dad on statin since came out.  Had Parkinson's, TypeII diabetes, prostate cancer - all can be caused by statins.  So many other supplemnts can help lower cholesterol.  Google 'lower cholesterol naturally' etc.

gleeson1929 said...

Thanks, Faith. I've marked my calendar to remind myself to get a 3-month check on my cholesterol readings w/o statins.

gleeson1929 said...

Thanks, John. I couldn't agree more on our mileage varying. Lots of new studies on both cancer and Parkinson's about personalizing treatment based on individual genetics, recognizing what I keep saying -- I have two diseases -- Parkinson's disease and John's disease. Same with my cancer and most other issues. BTW, staying in the DC swamp this August I keep thinking about last year when we started out 3 weeks in the Pacific NW with you in SF. What a difference! -- John

gleeson1929 said...

Thanks, Sandy. I'll check it out. -- John

gleeson1929 said...

Sounds much like my diet. BTW, as a non-cook, I've fallen in love with the new blender I bought. I just thrown lots of fruit or vegetables in it, push a button, and I have the centerpiece of a meal! -- John

gleeson1929 said...

I saw a recent report that if you've been on statins for a long time, it's advisable to stick with it unless you've made some major changes like losing a lot of weight. Which is why I'll have my cholesterol checked in 3 months to see what it looks like after stopping the Lipitor -- John

gleeson1929 said...

You Brits do a lot of things right. Like keeping your election campaigns to a month or two as I recall rather than our interminable and hugely expensive and irritating campaigns! -- John

Nads said...

The trouble is, nobody has actually proven that high cholesterol causes heart disease. Only that there is an association, a totally different thing!