By Dr. Duane Graveline, M.D., M.P.H.
When the use of statins is accompanied by undesirable, intolerable and even dangerous side effects the question of alternatives inevitably arises.
The usual course of action is to try another statin but only rarely does this resolve the problem for, regardless of drug company promotional hoopla, all statins are HMG Co-A reductase inhibitors and as such work only in one way - to inhibit the reductase step on the mevalonate pathway of cholesterol biosynthesis.
True, some statins seem more prone to one type of side effect than another but a dispassionate review of data shows them to be remarkably similar. Remember the Baycol rhabdomyolysis crisis? Baycol took the rap but rhabdomyolysis did not disappear, far from it. Now the combined numbers of rhabdomyolysis deaths from the other statins since Baycol's withdrawal exceeds those originally caused by Baycol.
So, if another statin seems futile, what then? "What about my cholesterol and what about my risk status?" are questions raised and after 35 years of anti-cholesterol brainwashing, few people can easily comprehend that statins, originally felt to work solely as an inhibitor of cholesterol biosynthesis, now appear to work independently of cholesterol.
Many now believe that inflammation is the real cause of atherosclerosis. As I thoroughly discuss in my book, Statin Drugs Side Effects, statins appear to work their magic of lowering cardiovascular risk not by cholesterol reduction but by their inherent anti-inflammatory action.
This new effect of statins has only recently been brought to light and helps to explain why the pharmaceutical industry is now offering this drug for organ transplant victims and patients having such inflammatory based auto-immune diseases as rheumatoid arthritis and lupus erythematosis. Clinical researchers continue to document the increased irrelevancy of cholesterol as they review the results of long-term studies.
Statins work regardless of cholesterol response. Despite this evidence of a new inflammatory factor in cardiovascular disease risk, the nutritional and pharmaceutical world remains steadfastly focused on cholesterol, the villain.
After believing the cholesterol myth for 35 years, the truth is not easy to accept. Nevertheless, anxious patients should be told that it is not their cholesterol that determines their risk status, it is their personal and family history. Regardless of your cholesterol level, if your ancestors and blood relatives experienced premature heart attacks and /or strokes, you are at high risk.
When alternative therapy is indicated CoQ10, Omega 3, certain of the B complex vitamins and baby aspirin all have a role. For "high risk" people, consideration must be given to the addition of statin drugs at low doses for their established anti-inflammatory benefit with dosage based on reduction of inflammation, not cholesterol.
As I discuss in my book, Statin Drugs Side Effects, although much more study is necessary to validate this concept, available information suggests that dosages required for effective inflammation reduction are much less than that required for cholesterol reduction.
Individual sensitivities to a drug can vary considerably. I am certain my opinions are biased by my personal experience of Transient Globabl Amnesia associated with a 5mg dose of Lipitor for 6 weeks (for a period of 12 hours I was a 13-year old high school student again.)
As to diet, please refer to my page on Doctor Kilmer McCully's informative book, The Heart Revolution, and after consultation with your health practitioner, consider patterning your eating habits after it as much as possible. For more information on this subject, read my book Statin Drugs Side Effects.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Updated August 2011