Visakhapatnam: In recent times, cholesterol-lowering statins have been the subject of intense scrutiny and controversy with several studies coming out with contrary findings regarding their efficacy and safety.
A recent study found that statins can stimulate atherosclerosis and heart failure. But cardiologists and doctors from other specialities recommend taking claims of these resear-chers with a grain of salt. They say that countless large-scale trials in the past achieved a significant reduction of bad cholesterol in patients, decreasing their vulnerability to develop heart disease and stroke. They say side effects manifest in those patients on a very high dose of statins (but doses used in India are pretty low).
However, they agree that statins don’t play a key role in primary prevention of cardiac conditions even though they work well in cardiac patients and people with other co-morbid conditions such as diabetes and hypertension.
Although the body needs cholesterol, too much can lead to plaque buildup on the walls of the arteries.
Apart from stabilising plaque in arteries and preventing them from rupturing, statins inhibit a particular enzyme in the liver and control cholesterol production. Over time, this is expected to decrease cardiovascular disease risk.
Dr D.M.R. Jagan-nadha Raju, an interventional cardiologist from Varma Heart Care Centre, said only a fraction of patients taking higher doses of statins may experience some side effects.
“The raging debate over the cholesterol hypothesis and statins starts from the Western countries, where patients are placed on a relatively higher dose of statins compared to India. In my opinion, statins hold no role in primary cardiac prevention in patients with borderline elevated cholesterol levels. However, they play a role in cardiac care management in cardiac patients as well as patients with family history of cardiac disease or highly elevated levels of cholesterol,” said Dr Raju.
Dr K.P. Hema Malini, assistant professor at Department of Cardiology, King George Hospital/Andhra Medical College, said there was no firm evidence in the ongoing studies against the usage of statins.
“Several studies came out with variable conclusions which cannot be believed. Statins are typically very well tolerated. The benefits of statins are manifold in reducing the risk of heart attacks and strokes,” said Dr Hema Malini.
Dr D.K. Baruah, an eminent interventional cardiologist at the Apollo Hospitals in Visakhapatnam, explain ed saying, “The role of statins in lowering the cholesterol cannot be ignored.”
Healthy lifestyle, not statins: Doctors
Instead of popping a statin drug, doctors recommend adopting a healthy lifestyle and going for frequent cholesterol checkups in borderline elevated cholesterol patients. Doctors say a healthy lifestyle and maintaining a healthy weight can help lower cholesterol and reduce the risk of heart disease and stroke.
Dr D.M.R. Jagannadha Raju, interventional cardiologist at Varma Heart Care Centre, said: “Patients with mildly elevated cholesterol need not be started on statins. Instead, they can go for lifestyle modification to decrease their future disease risk. Certain guidelines need to be followed for dispensing the dosage of statins. Our targeted LDL level in patients with no risk factors is 130, patients with chronic conditions such as diabetes, hypertension, etc., is 100 and patients with stroke and cardiac conditions is 70.”
Genetics and family history also play a role in development of cardiac disease. For some patients, it is tough to control cholesterol levels with a healthy lifestyle alone and they may need therapeutic management.
Dr P. Ramana Rao, an integrated practitioner at Varma’s Multispe-cialty Hospital, said statins have become the new vitamin B-complex tablets.
“There has been a rampant use of statins. All elevated cholesterol patients may not need statins. Those on statins need to undergo frequent cholesterol check to alter their dosages based on cholesterol levels, otherwise, it will eventually boomerang on the patient's health,” Dr. Ramana Rao said.
How statins work
- Statins are a class of drugs prescribed for people with high cholesterol levels. Besides stabilising plaques in arteries, statins work by inhibiting a particular enzyme in the liver and thereby control cholesterol production.
- The study also found that the statins inhibit the synthesis of vitamin K2, which originally protects the arteries from calcification.
- A study found statins’ causative link with coronary artery calcification through the depletion of coenzyme Q10 and ‘heme A’. Statins are said to deplete CoQ10 (coenzyme Q10) enzyme, which is vital for basic cell function and to maintain cardiovascular health in good form.
- Doctors analyse the risk of developing cardiac disease based on age, sex, BMI, cholesterol levels and chronic conditions such as hypertension, diabetes, kidney diseases, etc. before placing patients on statins.
- Muscle pain and weakness, gastrointestinal conditions, etc., are the primarily reported side effects with the use of statins. Apart from the common side effects, increased risk of developing diabetes, mental fogginess and muscle damage were reported in some studies.
