Statins: What Are we Preventing, Exactly?

Cholesterol has been plagued with a bad reputation over the years due to it association with increased risk of cardiovascular disease. With prescription statin use steadily increasing, patients are reporting more and more side effects. The decision between “preventative use” of a statin versus higher levels of cholesterol are becoming a strong debate.

Is cholesterol really the villain we have been told it is?

Cholesterol is a vital component in several physiologic processes that keep us alive and well.  For instance, cholesterol forms the backbone to a whole group of hormones made by glands in the body.  One of the side effects many men have developed in our practice from chronic use of statins is lower levels of testosterone. These lower levels not only impact erectile function, but also muscle mass and ability to heal from injury. In the elderly, this ability to heal becomes the difference between a healthy quality of life or a sedentary one. Another fallout that we commonly see relate to the ability to handle stress and sleep/wake cycles. Cholesterol is the backbone for cortisol, which has numerous physiological impacts on the body – from insomnia and anxiety to development of insulin resistance and inflammation – all of which also worsen cardiovascular health and develop risk of cognitive decline. At what point is high cholesterol a problem? It seems that over the years this delegated “number” gets lower and lower, forcing more and more patients to have to choose between a statin or not, and fear leads the choice due to lack of readily available information.

Studies like this one below are showing that above normal cholesterol levels in elderly folks older than 85 seems to contribute protection against cognitive decline.   Cardiovascular disease and cognitive decline in aging are complex processes, however studies like this help us get a better understanding of the big picture.

When does quality of life become more important than a simple number on a lab test? Personally, I would rather be active, cognitive and enjoying my elder years than dealing with the side effect fall out, which could result in disability, dementia and poor quality of life. There is always a balance, but I would think twice before signing up for a statin for “preventative” reasons. What exactly are you preventing?

Link: https://doi.org/10.1016/j.jalz.2018.01.009

Dr. Pingel and Dr. Jemison – http://www.pingelprogressivemedicine.com

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