Statins for all men of a certain age?

In My Humble Opinion
1

Yes, I know you are not my doctors, and apologies for yet another thread about statins/cholesterol. But I just got back from my annual checkup, and am casting a wide net for information/opinions.

First the stats:
Age 61.5
Total chol 236
HDL 66
LDL 158
Non HDL 170
height 6’3
wt 205#
bp 122/80
Mom and dad both had HTN, both died in mid 70s, and dad had a stroke in his 60s.

What my doctor basically told me was that, given my age, bp, and chol levels, the AHA cholesterol risk calculator recommends that I take statins. Crestor or Lipitor. I believe my % was 8% or so, above the recommended 7.5%. I asked if I could adjust it through diet, and he said not really, because my age was the main factor. IIRC, he said 1 out of 2 men die of heart-related causes. So if they give every man statins, 1 will benefit, and the other will experience no harm. Other than possible side effects presumably. I tend to feel a little creaky - muscle/joint aches from past abuse/surgeries. So the idea of increased body aches doesn’t really thrill me. But not a bg deal.

On the one hand, I’m not opposed to taking statins, but I have no desire to take meds that aren’t really needed. My doctor’s advice just struck me as so different from what I had heard for so long - of people trying to manipulate their diets to avoid taking statins. I exercise pretty regularly and eat a pretty good diet - little meat and lots of veggies/whole grains, but I could cut down on cheese/ice cream. In a reverse way, my doctor’s advice sounds like “Eat whatever you want, just take meds.” Which seems to me like an unhealthy attitude too many Americans have.

He said I could take a calcium scan, just to see if it was too high, which could further convince me to take statins, but my impression was that he thought “the experts” advised me to take status in any event.

Messing around with the risk calculator, it looks like by the time I am 62, even if I get my total chol down to 200, my % will still be 7.9% - above the 7.5% target. I’m not sure I’m capable of/interested in the drastic dietary/lifestyle changes it would take to get well below 200. My total chol has always been somewhat high, but my HDL consistently high. I suspect there is a considerable genetic component.

So, am I overthinking this? Should I just take the meds? Or look for a 2d opinion (or different PCP)?

2

Many medical decisions nowadays are based on statistics. After my coronary artery stent was placed, the cardiologist started me on a statin. I asked why, as my numbers were excellent and always had been so. He told me that statistically, following stent with statins for one year led to better survival regardless of lab numbers.

I took my statin for a year, but had leg cramps that made me jump out of bed three nights out of seven. It was awful. On my one year anniversary of my stent I stopped taking the statin and my leg cramps decreased 99%.

3

Or specialist.

4

IANAD, but my total cholesterol was 237 at age 30, and my PCP, who also happened to be a cardiologist, had me try various things before putting me on a statin. With a strict diet and exercise, I could get it down 10 or 15 points, and I did a little better when he put me on Niacin which caused severe flushing (YMMV).

In my case, the cholesterol is created mainly by my body, not the foods I eat. It’s hereditary in my family (thanks, mom!). There are other non-prescription supplements besides Niacin (B3), but I’m not sure any are as good as statins at lowering it.

Finally, he decided to put me on a statin, and my cholesterol immediately dropped to 165 and has remained there ever since. I can eat anything I want, but I don’t eat many fried and fatty foods to keep my weight under control. There are some known side effects of statins, but I never had any. If I were you, I would try the statin and see what the impact is on you.

5

Same here. Went from well over 200 to well under (around 160). Only change is the statin. Lose dose they say. No side effects that I’ve noticed. Started around age 58. Two years ago

6

I was like the OP and questioned if the statin was “really” needed. To verify, at least according to screenings, I asked my doctor if I could try 6 months without it, adjusting my diet, to see if I could manage things. The answer is a big, fat no. All my levels went in the wrong direction after 6 months without the statin. 6 months after going back on it, everything is back in the acceptable ranges (except HDL). I am taking a low-dose (20mg) generic and have not experienced any side effects, and the cost is almost nothing, so I will just keep on taking it.

I think there is discussion to be had around outcomes of statin use - does it really lead to longer lives for men, with less cardiac events? I am not sure the jury is in on that one, but statins do appear to lower risk factors, especially when the issue is hereditary, as in my case. As for ALL men of a certain age taking statins, I am not really sure, but again it depends on individual risk factors.

7

I have no particular knowledge on the topic and am not a doctor. Here is the Wikipedia page for Statins:

I notice that two of the statins, in the list, are naturally occurring in food (oyster mushrooms and red yeast rice). Another two are produced naturally, through fermentation, by bacteria.

If you’re worried about dying in the next 365 days then I’d say, “Do what the doctor is telling you to do.” If you feel like you’ve still got a few decades then you might try a compromise where you switch up your diet to include a lot of red yeast rice and oyster mushrooms for ~6 months and then go in for a new test, to see if it moved the needle.

This might sound like doing not what the Doctor said but it’s the best shot you’ve got for the “diet” option so, if it fails, there can’t be any hesitation afterwards for going with what the doctor said. (Or, if it succeeds then, hey! Science!)

Golden Chanterelle actually have more statins than Oyster Mushrooms: Fruiting bodies of selected edible mushrooms as a potential source of lovastatin | SpringerLink

8

I’m not criticizing you, but this sorta typifies the attitude I see/hear so often - especially from diabetics who treat insulin as a magic bullet and ignore diet/exercise. I encounter so many people who never exercise, are grossly obese, eat like shit, many smoke and drink - but the doctors keep prescribing additional meds.

Even today just hours after the visit, I found myself saying to my wife, “Let’s get some ice cream.” I can very easily fall into lazy/addictive behavior. It takes some (not incredible) effort for me to eat reasonably well and exercise somewhat. I really don’t NEED encouragement to drop my efforts in reliance on a “magic pill.”

I’ll take the meds if it really is advised. But his approach just kinda turned me off.

9

I have a reasonably healthy diet, lots of fruits and vegetables, and I exercise regularly, walking/hiking on average 10 miles a day. I was doing most of that even before I started taking the statins, so I’m not suggesting they are a magic pill, and you can ignore doing healthy things, just that trying to lower my cholesterol using diet and exercise alone didn’t work. For some people, diet and exercise can drop it down well into the below 200 range. Whether it makes any difference in the long run, is anyone’s guess, but I don’t think it hurts to lower your cholesterol no matter how you choose to do it. I don’t think they should be routinely prescribed to all men of a certain age.

10

What do you expect the doctor to do, deny you medicines that might save your life? Doctors can’t force their patients to have a healthy life style. I think you’re pointing at the wrong target here. Each individual bears the responsibility for their own actions. The fact that those actions now lead to pills and delayed penalties, instead of immediate penalties and death, is supposed to be a benefit of modern civilization and science.

11

I know you did not mean anything with this for this discussion, but just so we are all on the same page, in a lot of cases, taking a statin is not a failing in life. I, too exercise regularly and am not overweight. I do not smoke and only drink alcohol occasionally. I eat animal protein sparingly. I am the one who controls what I put in my mouth - but still, I do not have total control over my diet, since my SAH wife does most of the shopping and cooking (and gets mad if I get all choosy with her cooking). Even if I did have total control over my diet, I would still have borderline high cholesterol marks due to my genes.

And I think that is the take-away for the OP - diet and exercise may not be enough to improve your numbers, and it’s OK if you want to try to improve them without a statin, but if you subscribe to the risk factors associated with high-cholesterol, it’s no shame to try out a low-dose statin to see if it helps things and assess side-effects. You can always stop taking it, if it does not work for you.

A pharmacist friend of mine said the longer you can go in life without the pharmaceuticals, the better-off you’ll be as you get older. But, at some point the drugs start to do more good than harm, so don’t AVOID them, if they are warranted.

12

This. Statins greatly improve outcomes for many conditions which cause morbidity and mortality, period. Including folks who did their best with diet, exercise but were doomed by genetics and other circumstances to high chances of debility and death at young ages.

We really need to get away from this ‘blame the victim’ mentality in medicine and society in general. It does not help. Bad health outcomes due to bad diets and lifestyles are far, far more of a societal problem as a whole than an individual’s failure of will. Giving appropriate individual care and advice for the situation results in better outcomes, and is more likely to change individual behavior for the better.

As for the question in the OP: I don’t think statins are right for everyone, but they sure are one of the most effective interventions for extending life and health that we have.

13

oops! Never mind . . .

14

My Doc finally got around for prescribing one, due to an odd spike in my normally low Chol stats.

15

Thanks for the responses.

So, when I hear so many of my contemporaries say they want to avoid going on statins, is that for fear of side effects, ignorance, something else?

I don’t quite understand what you mean by that. I readily admit that it does not generate a good feeling in me, when I enter/leave the hospital, an OVERWHELMING percentage of folk entering/leaving are grossly obese, many of them smoking. But I guess the Hospital for Generally Healthy People likely wouldn’t be a great business model! :wink:

16

Probably a bit of all of those.

There are, in fact, some bad (but fairly rare) side effects from statins, including muscle damage, liver damage, and risk of developing diabetes.

I would not be surprised if part of the issue, particularly for guys, is that “I have to take meds now” is an acknowledgement of aging, and no longer being invulnerable.

My endocrinologist (whom I see because I’m diabetic) put me on a statin soon after my diabetes diagnosis. His reasoning was that the numbers showed that, unless one couldn’t tolerate the statin (see the rare side effects above), the benefits were significant.

17

It works for Kaiser Permanente - probably because they also provide the insurance.

18

This is a primary care issue, primary prevention of heart disease. The PCP is the expert and the right place to be.

The OP’s PCP is following the guidelines formulated by expert review of the evidence and by the consensus of those experts. Sure you can find some provider who goes against the guideline if you search for one.

@Dinsdale - No major harm in trying diet and exercise first but even dropping to LDL of 120 from the current158 would still land you in range to recommend a statin in addition to the diet and exercise plan.

For me it was many years back. I was marathon training, was thin enough that coupled with my thinning hair people were asking my receptionist if I had cancer, and my LDL was still 160 plus with HDL maybe 40. Lipitor and both have been 60 to 70 ever since. Misplaced pride had me wanting to avoid it up to then.

DO the healthy diet and exercise for many reasons but yes you are overthinking. The statin is a no brainer.

19

Based on your numbers I would think the statins are a good option. I started taking statins three years ago at about your age after my cardiologist reviewed my lipid numbers (which were better than yours are now) and strongly recommended it. He also ran the numbers through a risk algorithm and said I was just a little higher than I should be. I don’t have the numbers handy but my total chol dropped from just over 200 to around 140. I am 5’10" and weigh 165-170, and am very active physically. My BP is similar to yours.

Exercise helps a lot with controlling cholesterol but genetics plays a huge role. I do not know what the science says today about the role of diet, but most of the cholesterol in your system is made by you. Saturated fats, especially trans fats, can stimulate the production of cholesterol in your body, although I think there is less emphasis now on dietary cholesterol.

Also, I don’t know of any downside to statins. I have not experienced any side effects whatsoever. And there are significant side effects to having a heart attack.

20

Thanks again, all.