Lifestyle changes may be better for some with high cholesterol, an expert says
By Suzanne Robotti for Next Avenue
Credit: Getty Images
Is your cholesterol high? Has your doctor suggested you might be at risk for heart disease? If so, you have some decisions to make.
You need to know that you can likely improve your health and lower your cholesterol by simple lifestyle changes like exercise and changing your diet. You also will likely have the option of taking a statin.
The fact that people have choices in their health care is very important and something we explore at MedShadow
, an online nonprofit I founded to inform the public about the side effects, risks and benefits of medicine, both prescription and over-the-counter.
Which is why I’m concerned about the USPSTF’s (U.S. Preventative Services Task Force
) impending action to approve a broadening of the group of adults for whom statins are recommended — without including a recommendation to try lifestyle changes to lower cholesterol first. The mission of the USPSTF, as a government agency, is to create guidelines for doctors. Their recommendations strongly influence the care and options that doctors discuss with patients.
The USPSTF is proposing that any healthy adult between the ages of 40 and 75 with no history of cardiovascular disease, but whose 10-year risk of stroke or heart disease is 10 percent or greater, and who has at least one risk factor, take statins.
Although it’s not yet approved, the draft recommendation closely follows the guidelines put out jointly in the fall of 2013 by American College of Cardiologists/American Heart Association. At that time, it was projected
that the guidelines would literally double the number of people on statins, from 25 million to more than 50 million people.
That’s a lot of people to put on a medicine that has been shown in some studies to increase the risk of diabetes and/or cause muscle damage and cognitive impairment but hasn’t proven its effectiveness in this group. Is that really necessary?
In looking at the risks and benefits of statins, we know that they are highly effective in preventing heart attack or stroke in someone who already has cardiac disease. However, in a study published in 2015
of statin drugs given for five years for heart-disease prevention to healthy adults, no lives were saved, but 1 percent developed diabetes and 10 percent suffered muscle damage. The benefits were that 6 percent avoided a nonlethal heart attack, and just over 9 percent avoided a nonlethal stroke. A 2013 study in BMJ
showed a 9 percent increased risk of diabetes when using statins.
That said, the risks might well be different with each type of statin, a good point to discuss if your doctor is recommending this class of drug.
Factors to Consider
It’s possible that some might look at preventing a heart attack or stroke as “better” than getting diabetes. That’s a personal decision best made between the patient and doctor. However, diabetes, a chronic and serious disease that can lead to heart disease, stroke, vision loss, kidney failure, amputation of toes, feet or legs and premature death, should not be considered lightly.
Further, statins have also been linked to liver damage and cognitive impairment, although there is conflicting research on the subject. An article in Monthly Prescribing Reference (MPR) explores the link
between statins and depression and explains why this would make sense.
Since the USTPF’s recommendations are for all adults 40 to 75 and clinical trial results were focused primarily on white males, it is shortsighted to assume that statin use should be recommended across such a wide range of the population. The Patient, Consumer, and Public Health Coalition
, an informal group of nonprofits of which Medshadow is a member, recently sent a joint letter to the USPSTF
about our collective concerns. Those included the lack of women, seniors, racial and ethnic minorities in statin clinical trials.
‘You Have Choices’
Talk to your health care provider about all your options. If you do not have heart disease but do have a risk factor (such as smoking, being overweight or having a family history of heart disease), you have choices. Statins can be a good choice and so can lifestyle changes.
Importantly, consider how your medical choices will affect your entire life — changing your diet and taking a walk every day can have beneficial side effects for every aspect of your life.
Taking statins may appear easy, but comes with a cost.
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