The Connection Between Inflammation and Cardiovascular Disease

Continuous inflammation in our bodies from the foods we eat is a serious concern.  In the U.S., a person’s average diet is excessively high in flour, sugar, and bad fats, including trans-unsaturated fatty acids and omega-6 fatty acids.  Cardiovascular disease (CVD), including type-2 diabetes, occurs because of this persistent inflammatory state. It is unsurprising that doctors prescribe statins to 25% of Americans older than 45.

The Role of Statins in Addressing Inflammation

A study published in 2008 provided medical doctors with a rationale for prescribing statin therapy to individuals with evidence of an inflammatory condition. The JUPITER study, or Justification for the Use of Statins in Primary Prevention, introduced the concept of “statins for all.” This idea became widely accepted in mainstream medical practice. Most M.D.s believe that elevated levels of C-reactive protein (CRP), a marker for inflammation, make you a candidate for statin therapy. This applies even if you exercise, are thin, don’t smoke, or have low cholesterol. A patent having a blood cholesterol level of >199 mg/dL is a definite reason for their prescribing of statins.

This JUPITER trial used 8,901 participants with ages from 60-71 and a median excessive weight body mass index (BMI) of 28. Researchers placed patients into treatment and placebo groups and monitored them for close to 2 years. Those taking statins had 141 major CVD events compared to 251 events in the placebo group. Statistically, this amounted to a 98.4% chance of not having a CVD event in the statin group versus a 97.2% chance of not having an event in the placebo group. This difference was only 1%, yet researchers acclaimed this study for successfully demonstrating the benefit of statin therapy in reducing fatal and nonfatal cardiovascular events. However, one must ask: Is a 1% reduction in these problems worth the potential side effects?

Overprescription of Statins: Insights from the MESA Study

A 16-year study, called the Multi-Ethnic Study of Atherosclerosis or MESA led by Johns Hopkins University in Baltimore, Maryland, ended in 2015.  It used 7,000 individuals who mirrored the type of patients in the JUPITER trial.  Results showed that only those patients with advanced atherosclerosis, i.e., thickening and narrowing of the heart arteries with calcified plaques, benefited from statin therapy. The study concluded that healthcare providers over-prescribe statin drugs.

Common Side Effects of Statin Therapy

When on statin therapy, the most common side effect is an abnormal condition of the skeletal muscle, called myopathy. The symptoms include muscle weakness, heaviness, stiffness, cramps, and pain. If severe, this can lead to a condition called rhabdomyolysis. This occurs when damaged muscle releases harmful chemicals into the circulation, potentially causing a life-threatening kidney problem. Other side effects include irritability, aggression, fatigue, memory loss, cognitive defects, nerve damage, and erectile dysfunction. Researchers have also identified statins as a potential cause of liver disease and Alzheimer’s disease. Researchers estimate that 5% of those undergoing statin therapy will experience serious side effects.

During the initial treatment with statins, many people do experience muscular symptoms. These usually resolve within 2 weeks. An immediate risk for persistent muscle symptoms can include the following: age over 80 years, females with a low BMI, major surgery or trauma, infections, multisystem diseases, such as diabetes, and excessive consumption of grapefruit or cranberry juice.  Muscular pain most commonly occurs in the large muscles of the thighs. Those who are physically active are more likely to experience symptoms than will sedentary individuals. A person with a family history of muscle complaints is more likely to experience statin toxicity. The risk is also higher for those who have had muscle symptoms when taking other medications. It has also been noted that those with a history of chronic low back pain can experience exacerbations when starting statin therapy.

In 2012, the FDA issued a warning that consuming a statin can cause memory loss and confusion. These effects can occur from the beginning of the drug use and persist for many years, regardless of age. Additionally, statins can cause excess sugar to remain in the blood, known as hyperglycemia. This increases the risk of developing type-2 diabetes. It is estimated that 1 in 255 individuals using statins will develop diabetes.

Long-Term Risks of Statins in Geriatric Populations

In March 2017, the medical journal Drugs and Aging published an analysis from the Australian Longitudinal Study on Women’s Health. Researchers followed 8,372 Australian women between the ages of 76 and 82 for 10 years. Half of the participants took statins, while the other half took a placebo, for an average of 6.5 years.  5% of the women on statins were diagnosed with a new onset of diabetes. This disease proved to have a dose effect: The risk of diabetes was 17% when on the lowest dose and 51% when on the highest dose. Researchers estimated that every 5 years of statin treatment would result in 131 individuals developing diabetes. Thus, it was determined that in geriatric women on statins, the risk of acquiring diabetes was 33%, and the higher the dose, the greater the risk.