Studies back up statin recommendations
Ask Dr. Keith Roach M.D
Studies back up statin recommendations
DEAR DR. ROACH: You have made several claims about statins in your column. Could you please clarify the studies or data on which you are basing these statements?
The idea that statins are the first line of heart health seems to be nearly universally accepted among medical practitioners, to the point of being a mantra. However, I have had several direct requests for documentation go unanswered in spite of promises to provide them, by a couple of GPs, a cardiologist, a physician assistant and a nurse practitioner who were trying to convince me that either I or a relative should use statins, or were making statements of their general effectiveness and safety.
As you also seem strongly convinced of their benefits, and publicly promote that opinion, I suspect many of your readers would appreciate a few actual citations that health care professionals are relying on to endorse this drug class. — J.N.
ANSWER: The evidence that statins help people with existing coronary disease is overwhelming. In people without known coronary heart disease, the first study showing benefit for statins was the West of Scotland study, published in 1995 in the New England Journal of Medicine. This study looked at men with high risk for heart disease due to very high total and LDL cholesterol levels, randomized to pravastatin versus placebo. A follow-up paper was published in 2007, confirming a benefit of 30 percent reduction in heart attacks and fatal cardiac events, which in the high-risk group studied translates to about 44 people treated for five years to prevent one event.
A second study, the AFCAPS/TEXCAPS study, published in JAMA in 1998, studied men and women who had normal total but low HDL cholesterol levels, and were randomized to lovastatin versus placebo. This study showed about a 24 percent reduction in coronary events, which in this group meant about 63 people needed to be treated for five years to prevent one event. All study participants were recommended a healthy diet.
The statins have a place in the prevention of heart disease, but they are not right for everybody, and they have the potential for harm. Statin drugs are clearly indicated for anyone with a history of heart attack or stroke, if they can tolerate the drugs, which most people can. For prevention in people who have no history of heart disease, I recommend them only when the benefit clearly outweighs the risk, which is usually in people at high risk from a combination of risk factors, including age, sex, family history, smoking history, blood pressure and others.
Many people can lower their risk for heart disease by managing these risk factors, and good control of these risk factors through lifestyle can have a much bigger reduction in heart disease risk than that afforded by a statin.
Links to the studies can be found on my Facebook page, facebook.com/keithroachmd.
DEAR DR. ROACH: I'm in the steam room five times a week, 30 minutes each time. I get a tremendous sweat. Is this good or bad for eliminating salt from my body? Although I don't put a lot of salt on my food, I love potato chips and salted nuts. — C.J.
ANSWER: Although sweat seems salty, you don't lose a lot of salt in sweat, so I still recommend that you go easy on those chips and salted nuts. Salt raises blood pressure a few points in most people, but a lot more in some. Also, some evidence suggests an increased stroke risk with high salt intake even in a person with normal blood pressure. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
