February 11, 2009
Statins Cut Death Risk In High Cholesterol Group

Statins cut death risk.

Varda Shalev, M.D., and colleagues at Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv, Israel, analyzed data from 229,918 adults (average age 57.6) enrolled in a health maintenance organization who began taking statins between 1998 and 2006. This included 136,052 individuals without heart disease (primary prevention group), who were followed for an average of four years, and 93,866 already diagnosed with heart disease (secondary prevention group), with an average five years of follow-up. Researchers checked pharmacy records to calculate the proportion of days that each individual took statins.

During the study, 4,259 patients in the primary prevention group and 8,906 in the secondary prevention group died. In both groups, continuity of taking statins—defined as taking statins for at least 90 percent of the follow-up period—conferred at least a 45 percent reduction in the risk of death compared with patients who took statins less than 10 percent of the time. The risk reduction was stronger among patients with high levels of LDL cholesterol at the beginning of the study and among patients whose initial treatment was with high-efficacy statins.

"In conclusion, this study showed that the continuation of statin treatment provided an ongoing reduction in all-cause mortality [death] for up to 9.5 years among patients with and without a history of coronary heart disease," they continue. "The observed benefits from statins were greater than expected from randomized clinical trials, emphasizing the importance of promoting statin therapy and increasing its continuation over time for both primary and secondary prevention."

If you have high cholesterol do something to lower it. Take statins if you can't be bothered to radically change your diet. Or take statins and radically change your diet. Or at least change your diet. On the other hand, if you have a death wish I don't have any arguments to offer for why to take statins. But maybe if you changed your diet for the better you might feel better and less inclined to die.

Eat the Mediterranean Diet enhanced with the Ape or Portfolio Diet. The Portfolio Diet rivals statins in cholesterol lowering ability. But popping a pill requires less effort.

Update: Keep in mind that for a minority of statin users the side effects are severe and even damaging (e.g. myopathy - muscle damage). Try diet first. If you are willing to change your diet you can cut your cholesterol and also cut your risks of many diseases besides cardiovascular diseases. For example, the Mediterranean Diet will cut your risks of cancer. Also, as I point out in the comments, genetic tests that will identify those who will suffer side effects are probably on the way. The research on genetic variants responsible for statin side effects looks promising.

Share |      Randall Parker, 2009 February 11 11:20 PM  Aging Drugs


Comments
Tom Bri said at February 12, 2009 5:53 AM:

I just spent the morning looking into this. Satins do decrease all cause mortality. But, cholesterol lowering does not seem to be the cause. In fact, for older people higher cholesterol is protective.

Google 'cholesterol all cause mortality' and check the links to published studies.

Inflammation and stress seem to be the bad guys here, not cholesterol.

Jake said at February 12, 2009 7:32 AM:

Statins raise people's Vitamin D levels. That maybe its only benefit amoung non-CHDers. I would like to see a study of statin use by people with optimum Vitamin D levels. I suspect that statin disadvantages would increase mortality among people who have nothing to gain by more Vitamin D.

bbartlog said at February 13, 2009 1:30 PM:

There are other issues with the frankly weird way they put together this study. We might ask ourselves a couple of questions:

- why, instead of a regular control group that doesn't use statins, did they decide to compare different levels of statin use in a population where everyone uses at least some statins?
- why, if statins are being prescribed for heart disease, did they trumpet the all-cause mortality differential instead of the difference in heart disease deaths for the different cohorts (assuming it exists)?

I don't have access to anything more than the abstract, but here's some speculation. If you take statins but then stop, you have a greatly increased risk of dementia (source) (on the other hand, as long as you continue to take them your risk of dementia is slightly reduced). This is probably due to depletion of glial progenitor cells. There may be other risks associated with stopping statins but they seem more immediate in nature and the study would probably not have detected them.

So all of the patients in the low-statin-use group would have been those who started and then stopped statins - a group with twice the risk of clinical dementia as those would continued taking them. And even those who didn't manifest clinical dementia might have been affected in other ways that ultimately manifested themselves as increased mortality. This is why I think the use of all-cause mortality rather than mortality from heart disease is suspicious.
Anyway, I'll be interested to see the full paper. We'd also want to see how they dealt with some other confounding variables - for example, someone who stops statins may be less compliant with meds *in general*, or less devoted to trying to maintain good health. But the failure to have a *true* control group that never used statins in the first place makes this study really rather useless in determining the value of starting statin therapy, as opposed to the value of continuing it.

Dave The Engineer said at February 15, 2009 4:59 AM:

This does not tell me anything. "During the study, 4,259 patients in the primary prevention group and 8,906 in the secondary prevention group died." Died of what? And for these deaths what was the mortality rate for each cause of death and how does that compare to the norm for each of those causes? It may be that statins cause a higher incidence of death from causes other then heart disease. Next, statins have a history of being hard to tolerate for some people. Consequently the people who continue to use statins are the more robust of the patients therefore the study may be a study of "those who can tolerate statins live longer then those who don't". Also people who have a tendency to quit their medication, for whatever reason, probably have other bad habits that shorten their life. How did the study normalize for that? I'm not a medical statistician, not even a (whatever)statistician but if I can see flaws in this study it can't be worth much.

DWPittelli said at February 15, 2009 5:11 AM:

bbartlog,

Good point about the choice of "control." I would add that people who are prescribed a drug but fail to take it more than 10% of the time are -- especially if the drug is to prevent a serious risk of death -- liable to be careless of their health and irresponsible in other ways.

Alan said at February 15, 2009 5:33 AM:

In my case, statins are more likely to cause death, not prevent it. Satins caused me to suffer severe muscle pain and loss of memory.

My heart attack in 2005 was caused by a blood clot which I've traced to a loss of the enzyme Plasmin in my bloodstream. This is mainly age related. I am taking Nattokinase to replace it.

Dr. B said at February 15, 2009 6:11 AM:

As someone who has worked in medical stats for over a decade I have to say that the quality of the comments on this thread is quite a bit higher than the quality of this particular study.

Chuck Pelto said at February 15, 2009 7:31 AM:

TO: All
RE: Statins & the Quality of Life

My GP put me on a statin, Lipitor, because of a 200+ cholesterol level.

Six months later:

• I was having trouble remembering names of common household items.
• I could no longer write computer code.
• I began speaking like Yoda: "If Yoda in Force so strong, how come Yoda, in proper order, words cannot put?"

I stopped taking the drug. And it took me a year and a half to recover to the point that I could write computer code again.

I've talked to a number of men of my age (or greater) group who are taking statins and they ALL report similar changes in their cognition.

There are advantages and disadvantages to every course of action you take. BUT....

....if statins destroy my mind, I'd rather be dead.

Regards,

Chuck(le)
[Caveat EMPTOR!]

goy said at February 15, 2009 8:22 AM:

Chuck(le),

I had problems with these drugs as well.

And I'm afraid I'll need more specifics on this study before I'll believe its conclusion, since to date, no study comparing cholesterol level and heart disease has shown any statistically significant causal relationship. I called my cardiologist on this very point just two days ago, and he was forced to admit that this was in fact true. "Still," he went on... and began reciting all the standard Big Pharma propaganda. Who funded the study, and what additional controls were applied that make this conclusion anything more than an exercise in post hoc fallacy?

One of the recent statin studies that showed "excellent" ability to reduce cholesterol also showed exactly no correlation between use of the drug and reduction in heart disease. The conclusion - conveniently not mentioned in any of the media fanfare broadcasting this result - is that no relationship was found between serum cholesterol reduction and any reduction in the incidence of heart disease. Cholesterol is to heart disease as man-made CO2 is to "global warming", IMHO. Check the profit levels Big Pharma makes on these drugs. They'd make an oil baron blush. And they're increasingly being prescribed for off-label use. Just what we need. Not. All part of a huge problem that is bankrupting us.

In my case, the reactions were all physical, not neurological/mental. I spent almost ten years trusting doctors' advice as they experimented with each of the available statin drugs in turn - Pravachol, Mevachor, Lipitor, etc. None of these reduced my cholesterol level - which was well over 400 in my youth despite an extremely lean diet - by even 10%. I did better on a diet of oat bran and megadoses of Niacin. What these drugs DID do was make me intolerant to sunlight and/or ambient temperatures in excess of about 85 degrees. I had constant dizziness and nausea. And finally, years taking these drugs changed my liver function to the point where I landed in the hospital requiring gall bladder surgery. I've stopped taking them since. My level has come down on its own in the ensuing years through intelligent diet and exercise (now around 300).

While somewhat off-topic, the most recent chapter in this saga involves trusting my GP's advice to start taking a diuretic. 9 months later I was experiencing irregular heartbeat / premature ventricular contractions due to a potassium deficiency he never mentioned, and never bothered to run any baseline bloodwork to monitor. I had to find the info on Teh Internetz. A subsequent self-referral to my cardiologist revealed the cause and he advised against taking the drug. I give him credit for not simply recommending another drug to counter the side-effects of the first, which is standard operating procedure for most physicians today.

I'm through taking pharmaceuticals. I'm through trusting doctors whose offices are wallpapered with Big Pharma propaganda. And I'm through trusting "studies" like this one without detailed information on who funded it and how the data was analyzed.

g

Randall Parker said at February 15, 2009 8:53 AM:

Chuck Pelto, Alan,

I always push better diet in any post I write about statins because some people such as you suffer pretty severe side effects.

Statins will deliver a much better cost/benefit once genetic and other testing allow identification of those who will suffer the most severe side effects.

For example, a variant in a gene called SLC01B1 might explain 60% of myopathy (muscle) problems with statins. A genetic test for it should be rushed to market.

Genetic variants in ABCA1 and APOE reduce responsiveness to statins.

Curt said at February 15, 2009 12:16 PM:

Count me among those who have strong doubts about the relevance of this study. DWPittelli made the key point that I was intending to make -- that if the control group was people who had been told to take these drugs to "save their lives", but couldn't be bothered, is the real difference the drug levels, or more general behavioral patterns?

Frankly, this study reminds me of those I have heard since I was a kid in the 60s -- that kids who eat a good breakfast do better in school. Is it because of the breakfast, or the underlying behavioral patterns in the family?

TallDave said at February 15, 2009 5:06 PM:

Statins should be a last resort. Niacin and diet can achieve similar results without the risks.

Herodotus said at February 16, 2009 10:47 AM:

As one who has familial hypercholesteralemia -- discovered when I was a youth in the 1940s, long before cholesterol became a household word -- I began taking statins as soon as they were introduced in the late 1980s, and though they didn't reduce my elevated cholesterol much, I continued to take them until about five or six years ago. Then I began to experience peripheral neuropathy in my toes. My doctor said there was no connection. But shortly afterward a study was published in a journal devoted to neurology which found that long term users of statins have a 20 times greater incidence of neuropathy than non-users, a finding that astonished my doctor who took me off statins immediately. My neuropathy has diminished significantly if not completely. Statins are useful but be very wary about its side effects.

Helen said at March 2, 2009 1:31 AM:

My husband also did the statin merry go round. He started on Lipitor, which caused stomach and leg pain, and adverse liver function test findings. He was then switched to Crestor. Honestly, it nearly killed him. He was doubled over in severe pain, for several hours a day. He ended up having a full CT/MRI scan of his abdomen as the doc suspected cancer. It came back ok. The cardiologist and 2 GPs refused to entertain the idea that the problem was Crestor. He then was sent for a colonoscopy. It also came back ok. In the meantime, he stopped the Crestor. Within a week the pain eased, and within a further two weeks it was gone. We live in Australia, but I managed to find the Canadian prescribing information which contained a more thorough list of potential side effects. It had pancreatitis as a side effect, and the GP now (finally) thinks this was my husband's problem, caused by Crestor. We also read recently that the World Health Organisation has called for investigations into statin use and the disproportionately high incidence of ALS. I would rather drop dead of a heart attack than die slowly of motor neurone disease. There ARE alternatives for managing heart disease-niacin and a good diet are the places to start.

rendev said at August 13, 2009 8:23 AM:

Hi

According to a study in the University of Michigan, announced Statins may reduce the risk of dementia and loss of memory.
But some people advice not to use statins in preventing dementia due to the side effects of drug.
The information posted is interesting!
Thanks!

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