The work published in JAMA Internal Medicine stimulates some reflections on the use of statins within the current health and social environment.
The team of Californian and Japanese researchers, who carried out the research (all actively working on primary epidemiological units), confirmed that the use of statins can become a double-edged sword.
Indeed, it has been documented that statin users tend to simultaneously control their diet during the first couple of years of use, by putting in place those eating behaviours that should lead the values of cholesterol, triglycerides, fat mass and glycaemia back to normality.
With time passing by, however, we tend to witness a gradual and progressive laxity among statin users towards food choices: in 10 years, those patients treated pharmacologically to reduce the risk of heart disease have increased their fat intake by almost 15% and the daily amount of calories by 10%, while subjects who did not use statins maintained a careful dietary attention over time.
Eurosalus readers know that statins, beyond their likely beneficial role on cholesterol reduction, may also generate a range of side effects of considerable importance (as it has been documented by the infamous case “Lipobay”), and that the real aim of the treatment is not to simply reduce cholesterol, but instead to reduce the cardiac risk, which is testified by many more parameters than the single value of fat in the blood.
If we assess cardiac risk, it is clear that even if cholesterol levels are getting lower while glycaemia is instead maintained high and weight gain occurs, as from these findings it seems to happen, cardiovascular risk would not be reduced, but possibly it may even increase.
The research published in JAMA is a large-scale study, carried out on nearly 30.000 American over-20 adults, monitored between 1999 and 2010 in a famous epidemiological study, NHANES (National Health and Nutrition Examination Survey), which represents an important endpoint for the American cardiovascular epidemiology.
In statins-treated subjects, it appeared that the first two years of treatment saw a significant reduction in calories intake, and then followed by a steady increase in the daily introduced amount of calories and fat from the third year, with clear consequences also in terms of weight increase.
In practice, the use of statins may become a sort of false reassurance in relation to cardiovascular risk.
Especially today, with obesity and diabetes truly becoming new social pandemic forms while every nation is paying higher and higher bills for the therapeutic assistance of this type of pathologies, we should carefully consider whether to accept the public and industrial strategy encouraging the use of statins, without taking the right steps to keep the increase in calories intake and weight-gaining under control in those using them.
The authors of the abovementioned article believe that the main goal of statins treatment, as of many other drug-based therapies, should be to let patients reduce that part of risk that can not be reduced without pharmacological intervention, not to give instead (often at the expense of the government) the chance to maintain unhealthy eating habits.
Professor Rita F. Redberg, academic at the University of California, San Francisco and chief editor of JAMA Internal Medicine, wrote an editorial note on the role of cholesterol control as primary goal of a therapy, which may distract the patient from the benefits that can derive if triggered to change his/her lifestyle, in order to help people to put in place a personal change that can really reduce the risk of heart disease.
I continue to highlight statins as potentially excellent drugs, sometimes essential, but that at some time in their history have started to be prescribed according to criteria that have little to do with health-care and much instead with possible commercial interests.
Before choosing to extinguish or to stop an alarm signal of the body (i.e. the high cholesterol values), it is much more important to understand how metabolism is reacting to it.
We should understand the role of sugar, of artificial sweeteners, making us fat even with zero calories, and of the lack of physical movement, which are all problems standing upstream the intake of fat in the diet.
Through this way of thinking, for years, at SMA, we have been following people seeking help for hypercholesterolemia problems through specific therapeutic course aimed at setting the whole metabolism and the entire energy management in motion, obtaining enormous benefits not only on cholesterol values but also on the entire body, helping people to rein their own destiny rather than hide behind a pill.