What Are Statins?
Statins are a particular class of drugs that doctors typically prescribe to treat patients who have high cholesterol levels, which can be a contributing factor to heart attack and stroke. Patients whose cholesterol level exceeds the normal range which is anyone with a level 5 mmol/l or above may be put on statin therapy. Statins are used to lower the enzyme HMG-CoA reductase which is the enzyme that controls how much cholesterol your liver produces. It is important to note that once a patient has been put on statin therapy it is typically permanent, even when the cholesterol level is reduced to the normal range the patient will continue on statin therapy to maintain stable cholesterol levels.
Who Will Benefit From Statin Drugs?
Statins are being routinely prescribed by primary care physicians for millions of people each year to prevent heart disease, which studies have clearly proven the value of in preventing heart attack and stroke by lowering cholesterol. However, in recent years primary care doctors have begun prescribing statins for their very elderly patients who have no history of heart or vascular disease. The rate of people 79 and older with no heart disease history who are on statin therapy as a preventive measure to stave off heart attack and stroke has quadrupled since 1999 up to 2012. This statistic is raising some concerns among cardiologists and endocrinologists who specialize in treating people with heart or vascular disease and diabetes.
While there have been numerous studies conducted on various age groups which showed conclusively that statins are beneficial in preventing a second heart attack or preventing a first one in people with high cholesterol and a family history of heart disease, there is practically no clinical evidence of the value of statin therapy for people 79 years of age and older because drug companies have not funded the studies for people over 75. Therefore only a handful of studies on this age group have been conducted and it is unclear if the risks associated with statin use are greater or of any real value in this population. Yet, doctors are prescribing statins to people 79 and older more than any other population in the United States today.
What Are the Possible Side Effects of Statins?
Known side effects from statin use that may occur include onset of Type 2 diabetes, memory loss or impairment, confusion, and muscle pain. As a preventive medicine philosophy there are no clear guidelines for the use of statins in the very elderly verses the risks of side effects from statin use.
Great consideration must be given to treating the very elderly with statins as the side effects of diabetes Type 2 can have serious complications such as diabetic coma, serious injury from falling, or death in patients who do not control their blood sugar levels and muscle pain so severe that it can cause the patient to fall can lead to serious or life threatening injuries. Memory loss or confusion can also lead to situations that may put the patient’s life in danger.
Are There Guidelines or Statin Use?
Guidelines which were published in 2013 by the American Heart Association and the American College of Cardiology prepared a risk calculator to help doctors determine whether a patient would benefit from statin therapy as a preventive measure for people with no history of heart disease, but having high cholesterol. The guidelines risk calculator only included people up to age 75, due to insufficient clinical trial data on people over 75.
Therefore, doctors were left in the position of making that determination on their own. Dr. Robert Eckel, an endocrinologist and professor of medicine at the University of Colorado Denver and one of the drafters of the guidelines said, “It’s a gray zone, evidence based medicine only goes so far, doctors can instead use judgment and talk with patients about their preferences to compensate for lack of data.”
But cardiologists from Johns Hopkins and the Mayo Clinic had a different outlook on the problem. Referring to past studies and the guidelines risk calculator, some researchers have said the risk calculator that was designed to help doctors apply the guidelines “overestimates risk” and that “overreliance on such algorithms can lead to unnecessary treatment with statins.” They also stated that further updates to heart disease prevention guidelines were necessary. And Dr. Michael Johansen, a co-author of a recent statins study suggested that doctors need to be more cautious when prescribing statins for the very elderly until there is further hard data or in the absence of it.
