Statin drugs can benefit almost everyone

To Your Health with Dr. Robin Dale

To Your Health with Dr. Robin Dale

“What should I do about my cholesterol? I’m so confused. One doctor says I don’t need it, another says I do. I see stuff on TV and the internet about bad side effects. I even heard Lipitor causes diabetes. What in the world am I supposed to believe, doctor?” my patient asks.
That’s a great question and one that many doctors may not wish to take the time to explain. Starting in December, 2013, a major shakeup in the way we treat cholesterol occurred based on evidence-based medicine. With the release of the ATP4 guidelines by the American College of Cardiology and the American Heart Association, the ATP3 guidelines were replaced – or were they? Many doctors have not adopted the newer set of guidelines and feel the old ones made more sense.
“What is the difference and how does it affect me?” you might ask. The new guidelines base the recommendation for cholesterol medication on a 10 year risk score for heart disease/stroke. It takes into account the following variables: age, sex, race, total cholesterol, good cholesterol, blood pressure, diabetes, and smoking status. 5% is moderate risk, 7.5% is high risk, and we now match statin dose with the risk level (Lipitor 40/80 or Crestor 20/40 are the high dose statins. Statins are a class of medications that reduce blood cholesterol levels; they do this by blocking the action of a specific chemical in the liver that is necessary for making cholesterol.)
Thus, everyone will eventually have a recommendation for statin use as they age – EVERYONE, except those that have contraindications such as liver disease. (A contraindication is a specific situation in which the drug should not be used because it may be harmful to the person in question.)
Conversely, the older ATP3 guidelines would not recommend statin therapy for most people if their LDL (bad cholesterol) was below 100 with diet/exercise therapy.
The change came based on several studies that showed it was not nice to discriminate against people just because their cholesterol was “beautiful.” Giving statins to people with LDL below 110 reduced the risk of heart attack/stroke by 30-40%, the same amount of reduction we saw within the high LDL group around 160. It seems it is the “magic” of the statin and not the specific level of the person’s LDL that reduces the risk of vascular disease.
None of my patients seem to want to take a CHOLESTEROL pill, so we nickname them, MAGIC pills. Now everybody wants one, and everyone can benefit, even if your cholesterol is beautiful.
Side effects of statins are relatively minor and mostly include muscle aches, muscle weakness, and liver enzyme elevation. A new finding on Lipitor shows a 2-3 point average rise in glucose which is unfortunate but not a major concern in all cases. Please discuss this with your doctor and ask for your risk score at your next office visit.

Dr. Robin Dale is a native of Denham Springs and 1993 graduate of DSHS. He began private practice in 2004 in Denham Springs, later joined Ochsner in 2006, and transitioned to Our Lady of the Lake in 2015 and just recently reopened his private practice in 2016. (225) 380-1771; RobinDaleMD.com or follow him on facebook @robindalemdfammed

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