Are statins worth the risk?

The US Food and Drug Administration nod recently to a new cholesterol-lowering drug Repatha has reignited the debate over statins. There is a growing body of research that suggests that statin use has side-effects that outweigh the benefit they bring in the fight against cholesterol, and therefore, against heart disease.
While those with a history of heart disease do benefit from statins, their use as a preventive is under question.An editorial published earlier this month in the Prescriber medical journal cited industry-sponsored studies which found that only 0.5% of those surveyed avoided a heart attack or stroke by taking statins for five years. Dr Deepak Natarajan, a senior cardiologist in Delhi, cautions that pharma companies often manipulate scientific studies to exaggerate the benefits of statins.
Many are now loath to blindly accept a prescription for statins. Shivraj Pershad, 41, was prescribed statins last year but decided instead to rely on lifestyle changes to bring down his LDL (low-density lipoprotein or bad cholesterol). He gave up smoking, hit the gym and started counting calories. “Now my levels have stabilized,” says Pershad, a communication consultant based in Delhi.
Amit Kishore too started on a course of statins a few months ago, but discontinued it because “of their side-effects”. The 38-year-old executive with an MNC in Hyderabad is now following a low-fat, high-fibre diet and plans to start gymming soon.
Statins, which have to be taken life-long, have side-effects like muscle pain, memory loss, liver damage and increases susceptibility to diabetes. Earlier, it was believed that long-term use of statins increased diabetes risk by 22%. But in March this year, medical journal Diabetologia reported that the risk could be as high as 46%. Though Repatha too has side-effects, it is touted to be a safer alternative to bring LDL levels down.
The statin debate has a special relevance for India because ischemic heart disease (IHD), is the number one killer (among non-communicable diseases) in India, according to a Global Burden of Disease report. High cholesterol is a factor in IHD and doctors often prescribe statins for the primary prevention of cardiac disease. Given the controversy that statins find themselves in, it is perhaps a blessing that India has a low capacity for statins, both because of a growing awareness about their side-effects as well as their cost in a price-sensitive economy (statins cost around Rs 250 for a monthly course). A Harvard Medical School study headed by Dr N K Choudhry found that statin prescription for coronary artery disease in India between February 2006 and January 2010 saw an increase of 0.80 prescriptions per month. The US reported a growth from 18% to 26% in the same period, according to the Centers for Disease Control and Prevention.
However, Dr Uday B Khanolkar, senior consultant cardiologist at Narayana Health City, Bengaluru, points out that most drugs have side-effects and these have to be weighed against the benefits. “Right now statins are the best treatment for high cholesterol despite 7.5-12% of users experiencing side-effects, which are reversible,” he says. While newer statins have lesser side effects, the jury is still out on the drugs.
Alternative ways to lower cholesterol
GO NUTS Research shows eating nuts daily – in particular almonds and walnuts – can reduce bad cholesterol. A Mediterranean-style diet rich in olive oil, fruit, veg, fish can slash heart attack risk by a third
SHIFT YOUR SPARE TYRE Shedding your pot belly can slash cholesterol by as much as 10%
GET ENOUGH SLEEP A recent study found that people who got around eight hours shut-eye per night had lower cholesterol than those sleeping for six or less
KEEP MOVING Regular exercise lowers harmful cholesterol by as much as 5%. Aim for 40 minutes, five days a week
Source: Daily Mirror