Maybe you do and maybe you don’t!

As a primary care physician I often get asked the question of whether a patient really needs to be on statin therapy and if so, do they actually need the highest dose. Recently, a friend told me he stopped his maximum dose statin because he read an article that said statins were bad. He offered to send me the article and thought after I read it, I too would believe statins are bad.

The article was actually not a bad read and even quoted well respected medical journals, like the New England Journal of Medicine. Albeit, the article made causation between statins and certain medical complications that clearly could not be made based on the data collected. Interestingly, the article never said statins were bad, but I can see how a person (like my friend) not versed in interpreting medical studies and their analysis could be confused. In addition, he had a preconceived notion about statin therapy and felt that this article confirmed his beliefs.

By no means am I saying that everyone needs to be on statin therapy. As a matter of fact, I have many patients with technically elevated cholesterol levels that I do not put on a statin. The decision to prescribe statin therapy should be a conversation between the patient and his/her physician and should include a discussion regarding the patient’s risk of a heart attack or stroke.
For example, if you have had a stroke or heart attack in the past, smoke cigarettes, have high blood pressure and diabetes, you need to be on a statin. If you have high cholesterol, but otherwise are healthy and have no other medical conditions, you may not need to be on a statin.

The next question after determining that someone needs a statin is the dose to prescribe. The dose of statin needed to lower one’s cholesterol levels depends on what their baseline numbers are and what risk factors for stroke and heart attack they have. Again, this decision should be made by the physician and patient together.

There are certainly side effects of statin therapy, including the most commonly reported, leg cramps. Other potential side effects include diarrhea, nausea, liver impairment among others. Developing these potential side effects should not be the sole reason a patient refuses statin therapy. You are probably more likely to get in a car accident than experience any of these side effects. However, if you are someone that has experienced any of these or other adverse effects, you should speak to your doctor before deciding to discontinue the medication. Sometimes changing the dose or switching to a different statin or other medication alleviates the unwanted side effects.

The bottom line really is that statins are not bad, but prescribing statin therapy unnecessarily or at doses not indicated, is bad. If you have concerns about your statin therapy talk to your doctor. If you are not comfortable discussing important health issues with your physician, it is time to find a new one.