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USCS Statin Effects Study

SHOULD YOU BE ON CHOLESTEROL-LOWERING DRUGS?

This is a decision you must make with your doctor. The following should be taken into account.

Middle aged men with significant risk for heart disease probably benefit more than they are harmed, in terms of survival (The West of Scotland Study). Risk factors include hypertension, smoking, diabetes, premature heart disease in a first degree relative and low HDL. Those who do not have high risk for heart disease experience a lower rate of heart deaths, but not even a trend toward lower overall death rate (The Texcaps/ACAPS study). (The total death rate was infinitesimally higher in the statin group.)

As of this writing, no study has shown statins or any other cholesterol drugs to lower overall mortality in women; and epidemiologically, cholesterol in women does not have the same relation to mortality as in men. Although higher cholesterol is linked to a higher rate of heart attacks per se, it is not linked to overall cardiovascular death or to overall death; indeed, lower cholesterol is linked to a slightly higher risk in some studies. Consistent with this, there is a decided reduction in heart attacks in women with statins, but the death rate overall -- or even cardiovascular death rate - has not been shown to be reduced. It is possible that there are subgroups of women for whom statins confer benefit exceeding risk, but this has never been demonstrated.

No studies have examined the impact of statins in randomized trials in those over age 75. Epidemiological studies show higher cholesterol to be protective, rather than harmful, in this age group, so it cannot be assumed that lowering cholesterol confers benefit exceeding risk. Low cholesterol may be a risk factor for heart arrhythmias, which are the leading cause of death if heart attacks occur; and in the elderly, a heart rhythm abnormality called atrial fibrillation, that may be increased with low cholesterol, is a particularly important risk factor for stroke in the older elderly. It is possible that there are subgroups of those over age 75 for whom statins confer benefit exceeding risk, but this has never been demonstrated. This would most likely be the case in persons at very high risk of death from heart disease, who are at comparatively low risk for other illness and injury.