STATINS AND DIABETES

Posted on August 12, 2012. Filed under: Uncategorized | Tags: , , |

Statin cholesterol-lowering drugs reduce risk for heart attack and premature death from cardiovascular disease but have significant risks. In 1975 our research showed how dramatically diet could reduce serum cholesterol (down 35%) and LDL (bad-guy cholesterol by 40%)(1). In 2003, editors of the Journal of the American Medical Association asked me to write an editorial about the side effects of statin drugs (2). Since then I have closely followed the mounting evidence related to the side effects of statin drugs. Now we should add diabetes to this list of risks or side effects.

In mid-August 2012 another study confirms that taking statins increases risk for diabetes (3) as well as risk for dementia and neurological diseases. These are common side effects of statins: stomach irritation; one in ten get muscle aching and some get severe muscle damage (4) or damage to tendons (5); and neuropathy (tingling or pain in legs) or damage to the nerves (6). Serious concerns related to statin use are these: more rapid loss of cognition with aging (7;8); occasional cases of serious neurological conditions such as Lou Gehrig’s disease (9;10).

Most people can lower their LDL (bad-guy) cholesterol by 33% through diet (including soluble fiber like oats and soy protein) and using supplements such as psyllium and plant sterols. For most adults, an LDL less than 130 mg/dl is desirable and less than 100 mg/dl is ideal. If someone has high risk for heart attack, their value should be 70-100 mg/dl. If you have heart disease of history of stroke—and you are less than 70 years old– your LDL should be in the 50-70 mg/dl range. Since statins accelerate loss of cognition for persons over 70 years, you should have your LDL in the 70-100 mg/dl range, no matter what your heart attack risk is. Details of my research on statins and LDL-cholesterol and that of others are provided on other Nutdoc posts. Best, Nutdoc

   1.   Kiehm TG, Anderson JW, Ward K. Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men. Am J Clin Nutr 1976;29:895-9.

2.   Anderson JW. Diet first, then medication for hypercholesterolemia. JAMA 2003;290:531-3.

3.   Ridker PM, Pradhan A, MacFayden JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis of the JUPITER trial. Lancet 2012;380:565-71.

4.   Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med 2009;150:858-68.

5.   Marie I, Delafenetre H, Massy N, Thuillez C, Noblet C. Tendinous disorders attributed to statins: a study on ninety-six spontaneous reports in the period 1990-2005 and review of the literature. Arthritis Rheum 2008;59:367-72.

6.   de Langen JJ, van Puijenbroek EP. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med 2006;64:334-8.

7.   Xiong GL, Benson A, Doraiswamy PM. Statins and cognition: what can we learn from existing randomized trials? CNS Spectr 2005;10:867-74.

8.   Elias PK, Elias MF, D’Agostino RB, Sullivan LM, Wolf PA. Serum cholesterol and cognitive performance in the Framingham Heart Study. Psychosom Med 2005;67:24-30.

9.   Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2008;71:344-50.

10.   Edwards IR, Star K, Kiuru A. Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: an analysis of individual case safety reports from vigibase. Drug Saf 2007;30:515-25.

 

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Should you take a statin drug?

Posted on October 17, 2009. Filed under: 1 | Tags: , , , |

If your blood cholesterol level is too high or your LDL- (bad-guy) cholesterol is too high you should follow a health-promoting diet to lower it. As outlined in my Blog “Lower your cholesterol” you can lower your LDL-cholesterol by 20-40% by following a low-fat and low-cholesterol diet and using soluble fiber (oats or psyllium), soy protein, and plant sterols. It is safer to lower your LDL-cholesterol this way and by taking drugs. If you cannot get to the LDL-cholesterol levels recommended by your doctor you may need to take a statin drug. You should read my blog “How low should your cholesterol be” to decide how low you want your LDL-cholesterol value to be and whether you should take a statin or other type of drugs.

Statin drugs lower risk of heart attack by about 25%, especially for men who are less than 60 years old (1). However they have side effects. They may cause muscle aching in one out of  ten people (2) with serious damage to muscles occasionally (3)  as well as problems with muscle tendons  (4). They also can affect liver function and irritate the stomach. I have seen all of these side effects in my patients.  Not uncommonly they may cause neuropathy (nerve pain or tingling) (5), infrequently cause decreased cognition and very rarely they can cause serious neurological problems such as amyotrophic lateral sclerosis (Lou Gehrig’s disease)(6-8). Because they may accelerate loss of cognitive function as people age, I agree with some experts who recommend that people over age 70 should not take them unless there are extremely strong indications (progressive coronary heart disease)(1). Informed patients receive better health care and I think you should discuss your need with yours doctors (primary care doctor and cardiologist or specialist) before deciding to take a statin drug.

Statin drugs decrease levels of Co-enzyme Q10 in the blood and body tissues such as muscles and heart (1). This can cause muscle aching and impair heart pumping action. Taking a supplement of Co-enzyme Q10 may protect from these problems. I recommend that everyone who takes a statin drug take at least a 100 mg gel capsule of Co-enzyme Q10 twice daily. I have done research with the brand Q-Gel® and am convinced that it is the most effectively absorbed form of Co-enzyme Q10.                                                                                                                                                                            1.    Golomb BA. Implications of statin adverse effects in the elderly. Expert Opin Drug Saf 2005;4:389-97.

    2.    Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med 2009;150:858-68.

    3.    Mohaupt MG, Karas RH, Babiychuk EB et al. Association between statin-associated myopathy and skeletal muscle damage. CMAJ 2009;181:E11-E18.

    4.    Marie I, Delafenetre H, Massy N, Thuillez C, Noblet C. Tendinous disorders attributed to statins: a study on ninety-six spontaneous reports in the period 1990-2005 and review of the literature. Arthritis Rheum 2008;59:367-72.

    5.    de Langen JJ, van Puijenbroek EP. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med 2006;64:334-8.

    6.    Muldoon MF, Ryan CM, Sereika SM, Flory JD, Manuck SB. Randomized trial of the effects of simvastatin on cognitive functioning in hypercholesterolemic adults. Am J Med 2004;117:823-9.

    7.    Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2008;71:344-50.

    8.    Edwards IR, Star K, Kiuru A. Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: an analysis of individual case safety reports from vigibase. Drug Saf 2007;30:515-25.

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