Like any drug treatment (and even natural treatments) there are risks, but there are also benefits. Naturally our human brains tend to focus more on the negative - we are wired this way - but you can't look at one side without consideration for the other. The class of medication called statins which include the commonly known Lipitor/atorvastatin, or Crestor/rosuvastatin are one of the most prescribed classes of medications. I see patients all the time on these medication. We know those who benefit the most are those who have had a heart attack or who are at high risk for one. The benefits of statins go beyond total cholesterol and LDL reduction - they support the health of the artery lining (endothelium), support nitric oxide important for the relaxation of the arteries, act as an antioxidant and help to reduce inflammation. Not bad eh?
For those who have no known cardiovascular disease and are at a low risk for a heart attack, I like to use a more natural approach to reducing cholesterol where possible however, sometimes the best approach is a cholesterol lowering drug. Part of my role in working with patients is discussing all treatment options and advocating for the best approach for them. Not all cholesterol lowering medications or statins are the same and may pose different risk profiles. Sometimes it’s necessary to look at each person’s unique risk profile and chose an approach that will have the most benefit with the least amount of harm. What’s more is that if you need to be on a drug, we can create a strategy to reduce your risk of side effects. Two tests that help in assessing a patient’s potential for statin-related side-effects are vitamin D and insulin.
Vitamin D
Low serum vitamin levels have been associated with statin related muscle pain, and as a result, low adherence. Low serum vitamin D itself can contribute to muscle pain and so the addition of a stain medication such as atorvastatin (Lipitor) or rosuvastatin (Crestor) may increase the susceptibility of those already at risk, particularly if your serum vitamin D level is under 75nmol/L.[1]
Insulin
It is known that those who use statins are at an increased risk for new-onset diabetes than non-statin users, and seems to have a bigger impact the higher the dose and the longer duration of use. It is an even bigger concern for those who have any of the risk factors for diabetes (metabolic syndrome, obesity, impaired fasting glucose, HbA1C >6 percent).[2] [3] This does not mean that statins should be avoided. Rather an assessment of individualized risk should be done prior to making an informed decision about the use of statin, which statin to use and how to prevent future diabetes risk. It is known that elevated insulin is an early indication of metabolic dysfunction and diabetes risk and can precede changes in fasting glucose and HbA1C by years.
Any treatment plan, whether it includes pharmaceuticals or natural alternatives to drug therapy should be done with consideration of a patient’s unique risk factors. My approach when creating any heart health plan with patients involves not just targeting a few numbers in a lipid panel but involves a look at your totality of risk factors in order to achieve the best outcome for you.
[1] Michalska-Kasiczak, M. et al. Analysis of vitamin D levels in patients with and without statin-associated myalgia — A systematic review and meta-analysis of 7 studies with 2420 patients. International Journal of Cardiology. 2015. 178: 111-116.
[2] Jung Ko, M et al. Time‐ and Dose‐Dependent Association of Statin Use With Risk of Clinically Relevant New‐Onset Diabetes Mellitus in Primary Prevention: A Nationwide Observational Cohort Study. Journal of the American Heart Association. 2019. Vol 8 (8).
[3] Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380(9841):565-571.
Disclaimer: The information presented on this site does not constitute medical advice and does not replace the advice from your doctor. Always consult a qualified health care professional when changing or beginning a new health plan.
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