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The frightening finding of recent medical research is that even with no history of heart disease and normal cholesterol levels, you are at risk for a heart attack.

Findings about Statin Drugs and Heart Disease in the JUPITER Trial

The even more frightening finding of the recent medical research is that despite the fact that physician researchers now know that there is at best a tenuous connection between cholesterol levels and risk of heart disease, the recommendation is to use statins - cholesterol lowering drugs - that are already considered to be low.

Statin drugs include the well-known Lescol, Lipitor, Crestor, Mevacor, Zocor and Pravachol, also known as fluvastatin, atorvastatin, rosuvastatin, lovastatin, and simvastatin, among some prescription drugs that combine a medication and niacin, and also the herbal remedy red yeast rice (which is a naturally occurring form of lovastatin, the same drug found in Mevacor). These drugs all interfere with an enzyme the liver uses to make cholesterol, about 85 percent of the body's cholesterol coming not from food but made from saturated fats in the liver.

The latest major study of statin drugs and heart health was the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin, also known as JUPITER. This study was reported in the medical literature in December 2008, published in the distinguished New England Journal of Medicine.

The authors of the JUPITER study followed 17,800 volunteers in a two-year trial. Half of the volunteers were given a placebo, and half were given Crestor, a statin drug. When the researchers considered just the volunteers who had lower cholesterol levels at the end of the trial (which wasn't everyone in the study), they found that the volunteers who had taken Crestor had a 54 percent lower risk of heart attack and a 48 per cent lower risk of stroke. The authors conclude that these findings mean that everyone should take a statin drug, even if diet, exercise, or nutritional supplementation are already bringing cholesterol numbers down.

Maybe Cholesterol Isn't Really the Problem

The doctors behind the JUPITER study are among the few to admit that other research studies have found that lowering cholesterol, even LDL cholesterol, really is not what is cracked up to be. A huge, five-year study called the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) found that if you had about a 1 in 140 chance in any given year of getting a heart attack without a statin drug, you would have a 1 in 150 chance of getting a heart attack with a statin drug—improvement, but not very much.

The JUPITER study found that LDL cholesterol levels did not tell the whole picture. Only when participants in the study had both high LDL and high readings of a market of inflammation called CR-P did taking a statin help. But if they did have both high levels of the "bad" LDL cholesterol and they were suffering from some kind of inflammation, then the statin drug greatly reduced the risk of heart attack and stroke.

Reasonable Conclusions from an Important Study

The JUPITER trial tells us that some people who have high LDL greatly benefit from treatment with Crestor. Unfortunately, doctors who do not take the time to read the study twist the findings around to suggest that all people who do no have LDL need to take the medication. (The makers of all the major statin drugs, by the way, funded the study, and also fund the press reports about it.) It is easier to write a prescription for Crestor than it is to order a CR-P test to find out whether someone really has the inflammation that with high cholesterol levels causes the risk of heart attack or stroke.

Why You Don't Want to Take Statin Drugs If You Don't Have To

Every trial for every statin medication before its approval for sale has found very few side effects. Every statin medication has side effect rates that are "higher in real world use," as the pharmaceutical companies like to describe them.

Most of the side effects of statin drugs are mild. They are most likely to cause mild stomach upset (loose bowels, possibly heartburn) and muscle pain. The muscle pain may be due to muscle tissue breaking down. When there is extensive breakdown of muscle tissue, a condition caused rhabdomyolysis, the kidneys can be overwhelmed with breakdown byproducts. Renal failure requiring dialysis can result. Rhabdomyolysis is rare, affecting fewer than 1 in 2000 users of statin medications, but it is a life-or-death emergency when it occurs.

A more common condition during the use of statins is mild memory loss-but since users of the statins don't remember to call the doctor, they usually do not get treated.
 

Read More: The Pros And Cons Of Taking Statin Drugs

Why Your LDL Cholesterol Numbers May Be Inaccurate

Another consideration in whether you should be taking statin drugs is whether you even have high LDL cholesterol. The blood test you have drawn at the doctor's office does not actually measure LDL cholesterol. It measures total cholesterol, and HDL or "good cholesterol," and triglycerides. Then the lab uses a standardized equation to estimate LDL. Actually measuring LDL is quite expensive.

The problem with this method is that it subtracts 1/5 of your triglycerides from your total cholesterol number when it computes LDL. If you have been eating lots and lots of sweets, your triglycerides will go up. This makes your computed LDL number go down. If you have been dieting to lose weight, or if you are a diabetic, you have been really careful about controlling your blood sugars, your triglycerides will go down. This makes your computed LDL numbers go up.

Ironically, the less attention you pay to your diet, the more likely your computed LDL numbers are to go down. The more attention you pay to your diet, the more likely your computed LDL numbers are to go up. It's more than just unfair. If your doctor relies on just LDL to make your medication prescriptions, you may be put on a statin drug that you do not need.

So what should you do if your doctor wants to put you on Lipitor, Crestor, Mevacor, Lescol, or Zocor? Make sure there has been a test for C-reactive protein, or CR-P. This test will tell your doctor if you have some kind of arterial inflammation. Then make sure that your LDL numbers are not a fluke. If you have both high LDL and high CR-P, however, probably a statin drug will help your health.

  • Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ. JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008 Nov 20.359(21):2195-207. Epub 2008 Nov 9.
  • Walsh J. Coronary events with lipid-lowering therapy: the AFCAPS/TexCAPS trial. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1999 Feb 3.281(5):416-7. author reply 417-9.
  • Photo courtesy of stuartpilbrow by Flickr : www.flickr.com/photos/stuartpilbrow/3574896454/

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