Cardiologists and most internists have so many people on statins that they have already formed their own opinions about the drug's safety.
What doctors really need to consider is whether many of their patients need to be on a statin at all.
There is no question that today statins are being prescribed to far too many patients, often simply on the basis of a person’s total cholesterol number. Remember this: Total cholesterol and/or LDL cholesterol are poor predictors of heart disease and heart attack. Studies show that total cholesterol levels among people who’ve had heart attacks are almost the same as those of people who haven’t and that roughly half of heart attacks occur in people without high cholesterol. There is no one size ts all when it comes to prescribing statins. Doctors need to individualize treatment decisions to the patient. It is not uncommon to find individuals with very high cholesterol levels who don’t have any coronary plaque and who do not need to be treated with a statin. Conversely, there are individuals who are thin and fit and lead a healthy lifestyle and yet have a genetic propensity for plaque accumulation. Such patients absolutely need a statin.
What Patients Need to Consider About Statins
Rather than worrying about side effects, the main thing individuals need to consider when it comes to taking a statin is whether it’s been necessarily prescribed.
There is no question that almost all people who have had a heart attack should be on a statin. Those who do not have established heart disease, but who have a family history of heart disease or any conventional cardiac risk factors should ask for a Calcium Score.
A CT heart scan for a Calcium Score helps clarify risk.
A Calcium Score is the measure of the amount of calcium nestled in the walls of your coronary arteries (the arteries that feed your heart muscle). This number reflects the total amount of atherosclerotic plaque that has built up and it’s an indicator of how all of your risk factors interact with each other to cause heart disease.
The higher your Calcium Score for your age, the greater your risk of a heart attack or stroke, and the greater the likelihood that you’ll need a statin. Conversely, if you have a Calcium Score of 0, even with high cholesterol, you probably don’t need to be on a statin and should discuss this with your doctor.
Today many preventive cardiologists are recommending that all asymptomatic men over age 45 and most postmenopausal women over age 55 have a heart scan to determine their Calcium Score. What this screening test has found is that many patients considered to be low risk by conventional risk factors are actually harboring plaque and are in fact at high risk.
If you are already appropriately taking a statin and have been experiencing side effects, it may simply be that you need to take a break from the medication, need a dosage adjustment, or need a different statin. Don’t stop taking your statin medication, however, without talking with your doctor. Alternative treatment plans that can help you lower your cholesterol without side effects are available.
Arthur Agatston, MD, is a cardiologist and Medical Director of Wellness and Prevention for Baptist Health South Florida and clinical professor of medicine at Florida International University Herbert Wertheim College of Medicine.
A pioneer in cardiac prevention, Dr. Agatston worked work with Warren Janowitz, MD, on development of the Agatston Score (also called the calcium score), a method of screening for coronary calcium as an indicator of atherosclerosis. Agatston is well known as the author of the best-selling book The South Beach Diet. He maintains a cardiology practice and research foundation in Miami Beach.
Many thanks to Dr. Arthur Agatston
PHOTO CREDIT: Andrew Duany
