News

11-09-2016

The recent review of randomised controlled trials and observational studies published in the Lancet argued that the risks of statins have been exaggerated by the media and some sections of the medical profession. Statins were demonstrated as a cost-effective public health intervention, preventing 1000 major cardiovascular events like heart attack and stroke, for every 10 000 patients treated for 5 years. All the available evidence was reviewed and published regarding the controversy over the safety and efficiency of statin medication in reducing the risk of major vascular events. The review also provided reassuring evidence that statins do not increase the risk of Alzheimer's Disease or alter cognitive function. Those people who have had previous heart attacks or strokes have a more than 30% chance of another event in the next 5 years if they do not take statins.

So strong was the evidence for the benefit of statins in reducing cardiovascular events, that the editor of the Lancet, Dr Richard Horton compared the criticism of statins as akin to the MMR-autism scandal, where false claims about the safety of the vaccine were incorrectly made on the basis of a now-retracted research paper which led to widespread vaccine refusal.

It is estimated that approximately 200 000 people in the UK stopped taking statins because of media scares, a number estimated to result in 2000 additional cardiovascular events in the next decade.

For every 10 000 people taking a standard doe statin therapy for 5 years, only five would experience muscle weakness a result, but between 500 and 1000 cases of heart attack would have been avoided in the group.

The review did not give an opinion about the use of statins, but highlighted the importance of making an informed decision about any medical issue.

Some Australian experts point out that despite the reassurance of benefit in taking medications such as statins, too much emphasis on statins may result in people neglecting other important interventions such as physical activity and diet and prescribe to younger people irrespective of their personal behaviours, medical history and diet.

The key points about cholesterol are:

  • Cholesterol is a risk factor for cardiovascular disease. Atherosclerosis involves cholesterol accumulation in major arteries, which is derived from LDL cholesterol in blood.  In epidemiological studies, LDL cholesterol is an important risk factor for cardiovascular disease along with hypertension, diabetes, smoking, obesity and exercise lack. Lowering LDL lowers cardiovascular events in proportion to the reduction in LDL cholesterol
  • Criteria for deciding to treat with cholesterol lowering medication is set according to the calculated risk of a major event occurring in the next five years. The following factors are used to calculate risk, age, gender, smoking, diabetes, blood pressure and blood cholesterol levels ( see cvdcheck.org.au ) There is debate as to the long term costs and benefits for those with a risk less than 10%.
  • Statins work by reducing cholesterol synthesis in the liver. This lowers the levels of LDL  cholesterol in the blood.
  • Memory loss is a well-documented, but uncommon side-effect of cholesterol lowering medication. This side-effects usually reversible. Some studies show statins reduce the incidence of dementia. There are many causes of memory disturbance, even for those starting on statin medication, it is advised that you talk to your doctor before ceasing the statin for this problem. Any harmful effects caused by statin therapy can be reversed by stopping therapy, but the effects of heart attacks and strokes can be devastating.
  • Diet can affect LDL cholesterol measures, but lowering saturated fat by 10% of daily intake calories will lower LDL cholesterol by 0.3 mmol, which is difficult to detect as a result in epidemiological studies. Large amounts of dietary cholesterol has marginal effects on LDL cholesterol.
  • Butter, beef fat, palm oil, coconut and full fat milk can all increase LDL cholesterol levels. Unsaturated fats ( olive, canola, safflower and peanut oil) can all lower LDL cholesterol to a small degree. Olive oil and polyunsaturated fats have been associated with lower cardiovascular disease rates
  • Fructose as part of sucrose contributes to excess calorie intake in soft drinks and processed foods. The effects of fructose may be worse if obese, insulin-resistant people thus producing slightly higher postprandial triglyceride levels, increases to visceral and hepatic fat and insulin resistance .

Lancet 2016:online ( Interpretation of the evidence for the efficiency and safety of statin therapy. The Lancet. Published online September 8 2016

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