Statins and Alternatives to Lower Cholesterol

The Journal of the American Medical Association (Sept 27, 2016; 316(12):1289-1297) has an article reviewing 312,175 participants in 49 studies, which shows that the relative risk for suffering a heart attack was exactly the same for those taking statins or any of the following non-statin interventions:

• cholesterol-lowering diet

• bile acid sequestrants

• ileal bypass

• a non-statin drug called ezetimibe

• newer drugs called PCSK9 inhibitors

The report shows that statins and non-statin treatments that lower LDL cholesterol are equally effective for reducing heart attack risk, and that the greater the LDL cholesterol-lowering effect of any treatment, the less chance a person has of suffering a heart attack. However, scientists have not proven that high LDL cholesterol causes heart attacks; it may just be that high LDL cholesterol is associated with increased risk for heart attacks and does not cause them. In previous studies, ezetimide has been shown to lower LDL cholesterol but has not been shown to reduce heart attacks.

An anti-inflammatory diet is as effective as statins in reducing the bad LDL cholesterol. Newer drugs called PCSK9 inhibitors may be more effective in preventing heart attacks than statins.

PCSK9 Inhibitors Last year, the FDA approved the new cholesterol-lowering drug alirocumab (Praluent), a PCSK9 inhibitor, for patients who have had a heart attack or stroke and for those with heterozygous familial hypercholesterolemia, an inherited condition that causes high LDL cholesterol levels. Praluent helps the liver rid the body of the bad LDL cholesterol. The patient takes it by injection once every two weeks. The wholesale cost is about $1200 per month. Statins cost between $500 and $700 a year for name-brand versions and $48 a year for generics. Praluent can cause itching, swelling, pain or bruising from the injection. Patients can also experience cold- and flu-like symptoms.

Should All North Americans be on Statins? Statins can cause muscle pain and raise blood sugar levels. In spite of this, the newest guidelines recommend that people with a 10 percent or greater risk of developing heart disease within 10 years should be placed on statins. Each year in the United States, doctors write more than 200 million prescriptions for statins for more than 32 million North Americans because statins lower blood levels of the bad LDL cholesterol to reduce heart attack rate by up to 40 percent. However, more than half of patients prescribed statins stop them within a year, mostly because of side effects, primarily muscle pain (see Musc;e pain from Statins). Statins are also associated with increased risk for diabetes and kidney disease. A large eight-year retrospective study showed that long-term statin use is associated with a 30-36 percent greater rate of kidney disease (American Journal of Cardiology, December 1, 2015). Two other studies found that statins increase risk for diabetes by nine percent (Lancet, Feb 2010;27;375(9716):735-42) and by 12 percent at higher doses (JAMA, 2011 Jun 22;305(24):2556-64). More at Statin Side Effects

List of Commonly Prescribed Statins atorvastatin (Lipitor) fluvastatin (Lescol, Lescol XL) lovastatin (Mevacor, Altoprev) pravastatin (Pravachol) rosuvastatin (Crestor) simvastatin (Zocor) pitavastatin (Livalo) 

Checked 10/2/18

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