Statins remain controversial for the primary prevention of heart disease. A review this week in the BMJ concludes that the benefit from a statin is small for low-risk patients (BMJ, Oct. 16, 2019). The scientists were looking specifically at primary prevention–that is, the use of a statin to prevent a heart attack in people who don’t already have heart disease.
Would You Get Benefit from a Statin?
Another analysis in The New England Journal of Medicine, however, states that the benefits outweigh the risks (New England Journal of Medicine, Oct. 17, 2019). The authors point to the importance of “lifestyle management,” utilizing the approaches we endorse at The People’s Pharmacy. These include a healthy weight, a diet low in simple sugars and refined carbs, and time spent in physical activity every day. (Not on the list: eating lots of vegetables, getting enough sleep or regular meditation, although these also contribute to overall health and reduce the risk of heart disease.)
The reviewers recommend that a prescription should be based on a mutual decision between patients and their doctors and the possibility of benefit from a statin. In addition, such a decision must take the patient’s overall likelihood of heart disease into account. Statins can cause serious muscle injury (rhabdomyolysis) or liver damage, although these complications are rare. The authors downplay the risks of diabetes and muscle pain, which have caused trouble for many readers. They also consider other means of lowering cholesterol with the goal of reducing heart disease risk.
A Different Reason to Take a Statin:
A study in Cancer Medicine describes an unexpected new benefit from a statin (Cancer Medicine, Oct.8, 2019). The authors found that men taking statins for at least 11 months were significantly less likely to develop prostate cancer. Men got more protection from cancer with higher Gleason scores, a marker for more advanced pathology.
Men concerned about prostate cancer should welcome this news. It is not the only signal of a prostate benefit from a statin (BJU International, Sep. 3, 2019). In a recent trial, men taking statins along with dutasteride had small but significant drops in prostate size. When men weigh statin benefits against risks, this might help tip the balance.