By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
In 2011, the U.S. Food and Drug Administration ordered the manufacturers of statins, the widely prescribed cholesterol-lowering drugs, to include a warning on medication labels about the potential for raising blood sugar levels. The action took place after multiple published meta-analyses showed an increased risk of diabetes from taking statins.
The Sinatra Spin on Statins
I have long been turned off by the obsessive promotion of statins for population-wide cholesterol lowering, a questionable and dangerous standard of practice in Western medicine. Statins do have other relevant uses, namely as powerful anti-inflammatory and blood thinning agents, and it is for those effects that I have recommended the drugs to middle-aged men with cardiovascular disease and low HDL. The benefits, in their case, outweigh the side effects. But I’m now tweaking my recommendation to middle-aged men with cardiovascular disease and low HDL and who do not have diabetes or pre-diabetes.
Past studies have shown a trend towards progression of coronary artery calcification with use of statins. In a 2012 study, published online at the Diabetes Care journal, researchers at several Veterans Affairs medical centers found that more frequent use of statins was associated with accelerated coronary artery calcification among diabetics with advanced atherosclerosis. To me, this was breaking news.
When I was in active practice, I used to routinely order calcification scans for patients because arterial calcification is a big deal. A buildup of calcium indicates excessive oxidative stress, irritation, and inflammation in the arterial wall that leads to plaque, and represents a significant risk factor for coronary artery disease (CAD). In fact, a recent comparison published in the Journal of the American Medical Association, concluded that coronary artery calcium topped several other risk factors, including family history and C-reactive protein (an inflammatory indicator), as a predictor of heart attacks, angina, and stroke among more than six thousand individuals without diabetes who were considered at intermediate risk.
The new Veterans study involved nearly 200 diabetics with a mean age of 61 who already had significant arterial disease. Their calcification progress was monitored by scans over an average of 4 ½ years.
I’ve seen reports that statins may slow down calcification in the aortic valves, but that doesn’t seem to be the case for arterial calcification, and for diabetics, just the opposite, according to this and other studies. In previous studies, statins have also been implicated in the calcification of blood vessel tissue and mesenchymal cells, fundamental connective tissue cells that develop into bone, cartilage, and circulatory system tissue.
What all this tells me is that the presence of diabetes and pre-diabetes should be a red flag for prescribing a statin and doctors need to take these new revelations into consideration. They really need to look at every patient as an individual and not prescribe statins as a one-size-fits-all remedy in the name of cholesterol lowering. I’ve seen too much dismissal of statin side effects on the part of the medical establishment and that’s disturbing. As an example, a recent editorial in Lancet stated that the risk of statins, in the absence of diabetes risk factors “is negligible.” What utter nonsense, indicative of gross bias or ignorance of the facts. Statins cause CoQ10 depletion, which seriously impacts cellular energy. People may develop muscle pain, fatigue, and even temporary amnesia, as a result.
A recent study by Greek researchers published in the International Journal of Cardiology reminds doctors that statin-associated muscle pain is an “underestimated risk.” Five to 10 percent of patients are affected, they say, which is probably also an underestimation given that side effects are typically under-reported or dismissed by doctors.
Another recent study adds cataracts into the side effect list. Researchers at a university optometry clinic in Canada have found that statin use generates a risk of cataracts similar to that associated with diabetes. Their conclusion was based on a statistical analysis of nearly six thousand patients. The researchers said that the findings don’t prove that statins directly cause cataracts, but suggested “that such a link is biologically plausible.” They cited studies in animals showing a clear link between long-term, high-dose statins and cataracts.
Caveat emptor! What more can I say? Because of overuse, statins have become a real medical quagmire.
- Saremi A, et al. Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT). Diabetex Care, 2012; published online before print.
- Watts GF, et al. Balancing the cardiometabolic benefits and risks of statins. Lancet, 2012; 380: 541-543.
© 2013 HeartMD Institute. All rights reserved.