If you're not taking a statin drug already, it's pretty likely that a doctor will try to prescribe you one soon—at least 12 million Americans currently take one of these cholesterol-lowering medications. Statins reduce the risk of heart attack or stroke for certain groups of people, so medical authorities say that they can be hugely beneficial.
But there's mounting evidence that these drugs aren't right for everybody. As my colleague Barbara Kantrowitz wrote about the other day, a new study found that statins don't help people without prior history of cardiovascular disease, and can actually be harmful.
And another recent study found that taking statins might be deadly for people who've suffered a hemorrhagic (ie bleeding) stroke that involved bleeding in the small blood vessels of the brain. New research published in the journal Archives of Neurology found that people who had such a stroke may be at increased risk of a second stroke if they take statins.
To get some perspective on the benefits and risks of cholesterol drugs, I spoke with Dr. Ronald Scheib, the medical director of Miami's Pritikin Longevity Center and Spa (which is the only residential cardiac rehabilitation program to be covered by Medicare).
Dr. Scheib emphasized that statins can be very helpful for certain groups of people: Those who have a large number of risk factors for a heart attack or who've already suffered a heart attack, and can't reduce their risk factors through lifestyle modifications alone.
As for people who've suffered hemorrhagic strokes, he says that this new research suggests that statins are probably safe for people who experienced bleeding in the larger, deeper blood vessels in the brain, but not for people who experienced bleeding in the small vessels of the cerebrum. "Think of circulatory system of the brain as a tree," says Dr. Scheib. "The vessels at the base and deep in the brain are wide and thick, but they get smaller as they spread out across the brain. This is purely conjecture, but I suspect that the reason that statins are associated with a recurrence of stroke in these small vessels is that by reducing plaque in the linings of the blood vessels it also makes the vessels more likely to break and leak."
Dr. Scheib emphasizes that statins don't appear to cause this problem in the larger vessels deeper in the brain and can benefit people who've suffered other kinds of strokes.
He adds that he does think statins are overprescribed. "For example if I see woman who has elevated cholesterol but doesn't have other risk factors I wouldn't recommend a statin," he says. "You have to add up the risk factors and look at things including a patient's genetic history, diabetes status, blood pressure."
The Pritikin Center encourages patients to make diet and exercise their primary strategy for improving cardiovascular health, and he attributes America's craze for statins, in part anyway, to laziness. "As a society we want an easy way out," says Dr. Scheib. "If you weigh 240 pounds it's easier to take a pill than to lose 40 pounds."
He acknowledges, though, that statins are essential for certain people. "There are some people who've recently had a heart attack, and have known plaque in their arteries, who have to take a statin. And we do run into people who do everything perfectly and still can't get their risk factors under control because of genetics, so statins are probably right for them. But that's not the rule, that's the exception."