# To statin, or not to statin **URL:** \ **Category:** Factual Questions\ **Created:** [August 8, 2008, 11:59pm UTC](https://boards.straightdope.com/t/to-statin-or-not-to-statin/459355 "2008-08-08T23:59:08Z")\ **Posts on this page:** 6\ **Page:** 1
**Author:** ![volleyballer](https://avatars.discourse-cdn.com/v4/letter/v/22d042/32.png) [@volleyballer](https://boards.straightdope.com/u/volleyballer)\ **Post date:** [August 8, 2008, 11:59pm UTC](https://boards.straightdope.com/t/to-statin-or-not-to-statin/459355/1 "2008-08-08T23:59:08Z")
ok, not including quacks, New Age crystal worshippers, Eckhart Tolle & David Icke devotees - What’s the undiluted, purely _medical_ latest proof for use of statins to prevent heart attacks? Just today, the FDA issued a warning about 1 in particular and all in general. It’s well-known that they cause muscle aches & pains, and the warning is about a rare but real & fatal muscle complication. Is it really proven that lowering cholesterol will prevent heart attacks, or at least clear arteries (like, 50% blocked now, down to 30% 2 years later)? Or has the medical establishment simply stuck its head in the sand, figuring that the benefits outweigh the risks no matter what, better to try something rather than nothing? Is there any other alternative to statins, such as Red yeast rice extract, which in the U.S. anyway is emasculated, since it ain’t allowed to contain lovastatin? What I’m looking for is treatments and/or substances _proven_ to prevent heart problems or clear arteries years down the road, backed up by controlled clinical studies, not anecdotal stories. Any medical pros out there care to settle this controversy? ---
**Author:** ![Szlater](https://avatars.discourse-cdn.com/v4/letter/s/90ced4/32.png) [@Szlater](https://boards.straightdope.com/u/Szlater)\ **Post date:** [August 9, 2008, 1:15am UTC](https://boards.straightdope.com/t/to-statin-or-not-to-statin/459355/2 "2008-08-09T01:15:29Z")
[QUOTE=volleyballer] Is it really proven that lowering cholesterol will prevent heart attacks, or at least clear arteries (like, 50% blocked now, down to 30% 2 years later)? Or has the medical establishment simply stuck its head in the sand, figuring that the benefits outweigh the risks no matter what, better to try something rather than nothing? [/QUOTE] IANAD… The Cochrane Collaboration is conducting/has conducted a review into statins and their use in the prevention of cardiovascular disease. It lists the following in [the abstract](http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004816/frame.html): > [@Cochrane Review abstract](#): > > Several systematic reviews of the effects of statins have been published since the early statin trials were reported (Bartlett 2003; Blauw 1997; Briel 2004; Cheung 2004; Katerndahl 1999; LaRosa 1994; LaRosa 1999; Law 2003; Pignone 2000; Thavendiranathan2006; Wilt 2004). In particular, an individual patient data review and meta-analysis of 90,056 participants in 14 large RCTs including the very large Heart Protection Study (HPSCG 2003), followed up for 5 years, concluded that statins were beneficial in reducing the risk of cardiovascular events in people at risk, and showed consistency of treatment benefits across a wide range of patient subgroups (Baigent 2005). More recently a comprehensive review concluded that the use of statins, compared to placebo, was associated with a reduction in all cause mortality, as well as other cardiovascular clinical outcomes, in both primary and secondary prevention (Ward 2007). This review also looked at evidence for differences in treatment in between men and women, in the elderly and in those with diabetes. They found limited evidence but none that suggested there was any difference in effect in women compared to men or in the those over 65 compared to those under 65, or in those with or without diabetes. A systematic review of lipid lowering drugs to prevent cardiovascular complications in people with diabetes is currently underway (Manning 2000). The Cochrane Collaboration is a pretty reliable source for EBM. [The National Institute for Clinical Excellence (UK)](http://www.nice.org.uk/nicemedia/pdf/TA094publicinfo.pdf) recommends the use of statins in all patients with or at risk of (\>20%) cardiovascular disease. > [@volleyballer](#): > > Is there any other alternative to statins, such as Red yeast rice extract, which in the U.S. anyway is emasculated, since it ain’t allowed to contain lovastatin? There would be all sorts of issues with dosing based on uncontrolled “remedies”. One day you may get 10% of the recommended dose, and another 200%. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [August 9, 2008, 2:57am UTC](https://boards.straightdope.com/t/to-statin-or-not-to-statin/459355/3 "2008-08-09T02:57:18Z")
Thanks for including the Cochrane link and abstract. There are (at least) two things worth emphasizing. Note the phrase ‘at risk’ in the quoted text in your post: “statins were beneficial in reducing the risk of cardiovascular events in people at risk”. In other words, not _everybody_ benefits from them or needs to take them. Only people at risk (eg. strong family history, diabetics, high blood pressure, etc.) The other point that I’ll make is that although statins _are_ effective in preventing heart attacks, etc., a lot of people must be treated with them for, say, one heart attack to be prevented. For example, in middle-aged men with high cholesterol but who have never had a heart attack, most of the studies get results along the lines of 50 to 100 men need to be treated with a statin for 5 years to prevent one heart attack. Phrased differently, if you treat 100 men with high cholesterol with a statin for five years, 99 out of the 100 will experience no benefit and will have taken the drug for almost 2000 days for ‘no reason’. So, I’d emphasize that a) statins aren’t for everyone and b) they are far, far from a magic bullet. In fact, despite their good ability to lower cholesterol, they really don’t have much of an impact in preventing first heart attacks. For men with known heart disease, the number of men needing to take a statin to prevent a recurrence is much lower than the above. That’s more like on the order of 10 to 15 men having to be treated for 5 years to prevent a recurrence of a heart attack. ---
**Author:** ![volleyballer](https://avatars.discourse-cdn.com/v4/letter/v/22d042/32.png) [@volleyballer](https://boards.straightdope.com/u/volleyballer)\ **Post date:** [August 10, 2008, 10:23pm UTC](https://boards.straightdope.com/t/to-statin-or-not-to-statin/459355/4 "2008-08-10T22:23:13Z")
[QUOTE=KarlGauss] Thanks for including the Cochrane link and abstract. There are (at least) two things worth emphasizing. Note the phrase ‘at risk’ in the quoted text in your post: “statins were beneficial in reducing the risk of cardiovascular events in people at risk”. In other words, not _everybody_ benefits from them or needs to take them. Only people at risk (eg. strong family history, diabetics, high blood pressure, etc.) The other point that I’ll make is that although statins _are_ effective in preventing heart attacks, etc., a lot of people must be treated with them for, say, one heart attack to be prevented. For example, in middle-aged men with high cholesterol but who have never had a heart attack, most of the studies get results along the lines of 50 to 100 men need to be treated with a statin for 5 years to prevent one heart attack. Phrased differently, if you treat 100 men with high cholesterol with a statin for five years, 99 out of the 100 will experience no benefit and will have taken the drug for almost 2000 days for ‘no reason’. So, I’d emphasize that a) statins aren’t for everyone and b) they are far, far from a magic bullet. In fact, despite their good ability to lower cholesterol, they really don’t have much of an impact in preventing first heart attacks. For men with known heart disease, the number of men needing to take a statin to prevent a recurrence is much lower than the above. That’s more like on the order of 10 to 15 men having to be treated for 5 years to prevent a recurrence of a heart attack. [/QUOTE] Good answers & cites so far. Is there a specific statin recommended for someone who: a) has coronary artery disease, but already low ldl (~ 50) b) has had an m.i. c) is active, exercise everyday d) needs to raise hdl and e) has tried some before, with unbearable muscle pain, tightness in chest? ---
**Author:** ![3waygeek](https://avatars.discourse-cdn.com/v4/letter/3/e95f7d/32.png) [@3waygeek](https://boards.straightdope.com/u/3waygeek)\ **Post date:** [August 10, 2008, 10:57pm UTC](https://boards.straightdope.com/t/to-statin-or-not-to-statin/459355/5 "2008-08-10T22:57:09Z")
**volleyballer** , I have most of the conditions you cite, except I haven’t had a heart attack yet. I’ve been on Zocor since my angioplasty in March. Even without the Zocor, my cholesterol wasn’t high, but my triglycerides are a bit high, so they put me on the lowest standard dose of Zocor in an attempt to lower my triglycerides. It hasn’t worked so far, so my cardiologist just added niacin to my extensive list of meds – niacin is supposed to change the hdl/ldl balance for the better. I only started it a week ago, so it’s a bit early to tell if it’ll work. I don’t have much chest pain, but when I do (usually once or twice a month), I’ll take a nitroglycerin tablet and it goes right away. I also take Imdur daily – it’s a nitrate that expands blood vessels, which helps prevent the chest pain. Of course that means I can’t take Viagra or Cialis, which might be an issue if: [list=a] [li]I had ED, or[/li][li]If I actually had sex[/li][/list] ---
**Author:** ![robcaro](https://avatars.discourse-cdn.com/v4/letter/r/df705f/32.png) [@robcaro](https://boards.straightdope.com/u/robcaro)\ **Post date:** [August 10, 2008, 11:07pm UTC](https://boards.straightdope.com/t/to-statin-or-not-to-statin/459355/6 "2008-08-10T23:07:33Z")
I was taking Lovastatin for my high cholesterol, but I began to have leg muscle pain and weakness, so the doctor took me off that about a year ago. My cholesterol has not been high since quitting the medicine, but my leg muscles have never regained strength and are now quite soft. Some pain still exists too.