A study from Ireland shows that many people at low risk for heart attacks who take statin drugs gain little benefit, and may be wasting healthcare resources (BMJ, Oct 16, 2019;367:l5674.) The European guidelines for cardiovascular disease prevention would put 61 percent of adults on cholesterol-lowering drugs, to prevent one heart attack in 400 people taking them. This does not mean that statins do not prevent heart attacks, because the literature overwhelmingly shows that they do. It means that a lot of people are taking statins when they may not benefit from taking them.

Even though statins can cause muscle pain and raise blood sugar levels, the guidelines recommend that people with a 10 per cent risk of developing heart disease within 10 years be placed on statins. Each year in the United States, doctors write more than 200 million prescriptions for statins for more than 32 million patients because statins lower blood levels of LDL cholesterol to reduce the 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 such as muscle pain.

Lifestyle Changes May Be More Effective Than Statins
Having high cholesterol increases risk for a heart attack, but a review of 49 studies of 312,175 participants showed that the reduced risk for suffering a heart attack is the same for statins as it is for dietary changes (J of the Am Med Assoc, Sept 27, 2016; 316(12):1289-1297).

High blood sugar levels may be a far greater risk factor than high LDL cholesterol for suffering a heart attack. That means that insulin resistance caused by excess fat in the liver may be the major risk factor for a heart attack in North America (Diabetes Care, 2009 Feb; 32(2), 361-366) and that an anti-inflammatory lifestyle may be the most effective way to help prevent heart attacks (Clin Med Insights Cardiol, 2014;8(Suppl 3):61-65).

Tests to Predict your Risk for a Heart Attack
If you have these risk factors for heart attacks, you should change your lifestyle immediately and may even need statins:
• High blood pressure >120/80 (at bedtime)
• LDL cholesterol >100 (fasting)
• HBA1C >5.7 (diabetes)
• CRP >1 (inflammation)
• Abdominal obesity
• Small hips compared to waistline (a risk factor for diabetes)
• Resting heart rate >70 (weak or damaged heart muscle)
• Lp(a) >125 (genetic clotting disease)
• Triglycerides >150 (usually from eating too much sugar)
• HDL “good” cholesterol <40 (also usually from eating too much sugar)
• Homocysteine >10 (vitamin deficiency or genetic)
• Small LDL particle size (diabetes)
• High coronary artery calcium score. Half of the people who are identified as being at high risk for heart attacks, but have never had a heart attack, may not be at high risk if their coronary artery calcium score is normal (J Am Coll Cardiol, 2015;66(15):1657-1668). A special X-ray called a computed tomography (CT) scan to find the buildup of calcium on the walls of the arteries leading to the heart tells you the size of plaques on the walls of your arteries and the likelihood for them to break off and cause a heart attack..

My Recommendations
Statin drugs do help to lower cholesterol and prevent heart attacks. Statins have been shown to help prevent a second heart attack even in patients who suffer their first heart attack over age 80 (J of the Am Geriatrics Soc, Oct 25, 2019). If your LDL cholesterol is above 100 or you have other factors that increase risk for a heart attack, most guidelines recommend that you take statin drugs to help protect you from suffering a heart attack.

However, statin drugs come at a price. They can raise blood sugar levels, damage your muscles to make them hurt, and interfere with your ability to exercise. If you are a competitive athlete, they can interfere with your ability to compete at your best. Many studies show that strict lifestyle changes can be as effective as statins in lowering high blood levels of the bad LDL cholesterol and reducing your risk for a heart attack:
• avoid being overweight
• try to exercise every day
• avoid smoking
• avoid or restrict alcohol
• follow an anti-inflammatory diet (eat lots of fruits, vegetables and nuts; avoid or limit sugar-added foods, all sugared drinks including fruit juices, red meat, processed meats and fried foods)
• keep blood levels of hydroxy Vitamin D above 20 nmol/L