Statins, cholesterol, side effects… is there an alternative?

Cholesterol and heart disease have become synonymous; having a high cholesterol being associated with a high risk of heart disease. While arguments rage on regarding this cause and effect relationship what is known is that heart disease is a multi-factorial issue. In other words, a mixture of age, sex (being male or female that is!), being a smoker, having high blood pressure, being diabetic, not exercising much along with having an elevated cholesterol are all in the mixing bowel when it comes to heart disease. Cook this over a gentle heat of an ill-determined collection of individual genetic traits and the growing knowledge of environment and emotional stress influences and it becomes very evident that just altering the cholesterol level may be easily measurable and important but it is by far just one modifiable risk factor. Despite this, the cholesterol business is booming. Special spreads to help lower cholesterol are appearing and retired cricketers are spouting the heart protective virtues of wholegrain breakfast cereals… Along side this onslaught we now have a range of powerful drugs that floor cholesterol levels within a very short space of time; the infamous ‘statins’.

I find it interesting that back in 2000 the Journal of the American Heart Association stated that “Statins are well tolerated and have an excellent safety record “, and by 2010 the UK medical journal Heart was commenting that “…studies have found that patients starting statins are at increased risk of adverse effects, including liver dysfunction, myopathy, acute renal failure and cataracts.”

Today, statins are one of the commonest prescribed drug which prompted a large scale investigation of the available information by a team from Cambridge University, followed by their publication in the highly respected journal Archives of Internal Medicine. After the careful analysis of 11 key clinical trials involving 65,229 participants their conclusions rocked the statin world; “ …analysis did not find evidence for the benefit of statin therapy.” So…, confusion all round!

If we look at heart disease as an end point then its not surprising that simply shifting one factor is not the answer. Statin therapy or other cholesterol lowering approaches may be important in individuals at high risk, such as those with diabetes or previous heart attacks, but slapping all those with a low risk or simply a mild elevation in total cholesterol may need some rethinking when all the potential list of side effects are taken into account. With their tendency to cause side effects another problem arises when lowering cholesterol is needed but the user simply can’t tolerate any of the statins prescribed. Reliable estimates show that as many as 40% of those who receive a prescription for a statin are thought to take it for less than 1 year. Possible reasons include the  adverse effects, poor explanations of their benefits by their doctor, and patients’ reluctance to take prescription or long-term medications. This may help explain the growth in the use of Red Yeast Rice (RYR) powder as a food supplement which, in the USA, rose by 80% from 2005 to 2008. RYR has been shown to reduce cholesterol levels and in a recent study demonstrated the ability to reduce cholesterol levels in those previously affected statin related side effects, such as muscular pains, to the point where they had to stop statin therapy! RYR powder in capsules may be the way forward for those needing to trim their levels. Often just 2 capsules (1200mg) daily is all that’s needed!

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