Thoughts on Statins

Lipitor, a statin, is the best-selling drug of all time, generating $1.9 billion in 2019 for its maker Pfizer (down from its high of $12.8 billion in 2006).¹ What is heartening is that the numbers seem to be decreasing, however that may be reflective of the availability of cheaper generic alternatives. When it first became available, I was in training, and remember the giddiness of the pharmacy residents, discussing how they believed that Lipitor should be added to the water supply, like fluoride.  

Statins may improve your cholesterol numbers, however they do nothing to alter the eating patterns which necessitated the statin in the first place. They interact with quite a few medications, so one has to be uber careful when prescribing, if a statin is part of the equation. They are mitochondrial (powerhouse of the cell) toxins.² This is a problem, particularly as we are realizing that more and more diseases – such as cancer – have a metabolic (rather than genetic) cause. They may stimulate arteriosclerosis and exacerbate heart failure.³ They are known to cause transaminitis (elevation of liver enzymes) and myositis (muscle inflammation and damage).⁴ One can show signs of muscle damage even if bloodwork is normal and they have no symptoms whatsoever.⁵ Statins have also been found to increase the risk of developing diabetes.⁶ 

 Patients over-estimate the ability of statins to prevent heart attacks 20-fold⁷ (as do their physicians, to which I can personally attest!). Approximately 500 people would have to take a statin for 1 year to prevent one initial heart attack.⁸ One would have to take a statin for 6 years for a 3% reduction in absolute risk of a second heart attack.⁹ The chance of even a high-risk patient of benefitting from them is less than 5% over a period of 5 years.¹⁰ 

 A very large 2010 meta-analysis involving 65,229 patients was published in the Archives of Internal Medicine and found that – contrary to popular belief – statins had no impact at all for reducing all-cause mortality.¹¹  In contrast, switching to a whole plant-based diet offers an absolute risk reduction for heart attack of 60% in <4 years.¹² A healthy, plant-based diet may prevent further cardiac episodes in 99.4% of patients,¹³ and has only good side-effects! Ergo, it is much safer and more effective to change the diet than to take a statin.  

So the next time your doctor recommends a medication, it is a fair to ask a question like: “Has this been shown to reverse X disease or decrease deaths?” or other questions along that line. I like to think that it is patients asking questions that will prompt changes in physician behavior, as so far the data has not been able to. After what has gone on in medicine for the past 3 years, we need to question everything. 

References 

1. https://www.statista.com/statistics/254341/pfizers-worldwide-viagra-revenues-since-2003/. Accessed 8/17/23. 
2. Okuyama H, Langsjoen PH, Hamazaki T, Ogushi Y, Hama R, Kobayashi T, Uchino H. Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. Expert Rev Clin Pharmacol. 2015 Mar;8(2):189-99. doi: 10.1586/17512433.2015.1011125. Epub 2015 Feb 6. Erratum in: Expert Rev Clin Pharmacol. 2015;8(4):503-5.  
3. Ibid. 
4. Liu A, Wu Q, Guo J, Ares I, Rodríguez JL, Martínez-Larrañaga MR, Yuan Z, Anadón A, Wang X, Martínez MA. Statins: Adverse reactions, oxidative stress and metabolic interactions. Pharmacol Ther. 2019 Mar;195:54-84. doi: 10.1016/j.pharmthera.2018.10.004. Epub 2018 Oct 12.  
5. Draeger A, Monastyrskaya K, Mohaupt M, Hoppeler H, Savolainen H, Allemann C, Babiychuk EB. Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia. J Pathol. 2006 Sep;210(1):94-102. 
6. Jefferson, E. FDA announces safety changes in labeling for some cholesterol-lowering drugs. US Food and Drug Administration website. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm293623.htm. February 28, 2012. Accessed February 14, 2015. 
7. Lytsy P, Westerling R. Patient expectations on lipid-lowering drugs. Patient Educ Couns. 2007; 67(1-2):143-50. 
8. Garcia-Gil M, Comas-Cufí M, Blanch J, Martí R, Ponjoan A, Alves-Cabratosa L, Petersen I, Marrugat J, Elosua R, Grau M, Ramos R. Effectiveness of Statins as Primary Prevention in People With Different Cardiovascular Risk: A Population-Based Cohort Study. Clin Pharmacol Ther. 2018 Oct;104(4):719-732.. Epub 2018 Feb 2.  
9. Trewby PN, Reddy AV, Trewby CS, Ashton VJ, Brennan G, Inglis J. Are preventive drugs preventive enough? A study of patients’ expectation of benefit from preventive drugs. Clin Med. 2002;2(6):527-33. 
10. Ibid. 
11. Ray KK, Seshasai SR, Erqou S, Sever P, Jukema JW, Ford I, Sattar N. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med. 2010 Jun 28;170(12):1024-31. 
12. Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Practice. 2014;63(7):356-364b.
13. Ibid.