Heart disease? Prescribed statins? Maybe take them, if you want to live.

July 12, 2023 1:04 AM

America’s Most Popular Drug Has a Puzzling Side Effect. We Finally Know Why. -- The reason statins can make your muscles sore or weak was unclear—until scientists accidentally stumbled upon an answer. By Sarah Zhang ~~~ Why So Many of Us Die of Heart Disease -- Evolution doomed us to have vital organs fail. For years, experts failed us, too. by Olga Khazan. It seems that many people are down on statins, and do not want to take them even if they can take them, perhaps the same type of fear as anti-vaccine people.
posted by dancestoblue (57 comments total)

I have huge interest in cardiac health, because I've had huge problems, death etc. Successfully treated, he popped a stent in, as good of care as can be found; I am extraordinarily fortunate.

One of the first medications my cardiologist wanted me on once out of the coma was a statin, I put it into my mouth and damn near immediately started itching like hell, hives, a common reaction with statins. And my doc told me that almost certainly if I've got this reaction to one statin I'll have it with all of them.

And since my cholesterol levels are pretty rocking (that fortunate thing again; my heart attacks not from clogged/clotted arteries but rather a genetic gift from my mother, a huge kink in the widow-maker artery, fixed no problem with that stent) he said "Hey, we'll just use these two drugs here." and we have, and it's dropped the numbers even more.

So these articles are not for me, they are for us, the collective us. And I think it's worth posting here -- if one life is saved, it's a win.
posted by dancestoblue at 1:05 AM on July 12, 2023 [10 favorites]

Here's hoping that they can cure the muscular side effects. They're no joke. My mother took statins, and they left holes in the muscles in her legs. She's been off the statins for years, and she still has trouble walking.
posted by unreason at 2:34 AM on July 12, 2023 [7 favorites]

It is interesting. I've more or less got off the diet crank train, and in fact my cholesterol now is the best it has ever been (as is my blood pressure which is fab) thanks to legumes and oats and a total fibre intake north of 40g every day and a lot of decent exercise. But recently the recommended levels in my country have been reduced even more than I've pushed my LDL level down and I think I'm about to have a conversation with the doctor about statins because my lipids are now officially "borderline". And I'm probably going to say hey, these tweaks I've been making to my diet are really making a difference, how about another 6 months to see how far I can push it that way. I just have an irrational aversion to pills every day. It's not about the supposed side effects, I just don't want to take pills every day. I know it's stupid.
posted by i_am_joe's_spleen at 2:56 AM on July 12, 2023 [4 favorites]

Thank you for this! I learned about this side effect of statins in a previous job, but one of the doctors I sometimes worked with expressed skepticism that it was a real thing. I guess he thought patients were whiny and non compliant or something. This attitude from doctors frustrates me a lot and so it’s nice to see evidence supporting and explaining the patient experience here.
posted by eirias at 3:04 AM on July 12, 2023 [14 favorites]

Assuming every rejection of a type of drug is like the anti-vax people is gross. For one thing, no one’s refusal to take a statin is going to directly harm the public. For another, these side effects seem less extremely rare and/or completely made up. I’m all for social pressure on public health choices, but these are private health choices. I have some personal experience in medicine being better at dealing with populations than individuals, and permanent disability to show for it, so if we could not pretend that the current medical institutions are infallible authorities that can’t be questioned unless one thinks drinking bleach is a good treatment plan, that’d be super-helpful. Thanks.
posted by vim876 at 3:31 AM on July 12, 2023 [54 favorites]

Well, out there in diet crank land, many are trying to claim that cholesterol and in particular LDL don't matter. And part of their package is absolutely vilifying statins as unnecessary and dangerous, when you could just be eating MEAT and FAT cause they're healthy. And a lot of those folks also subscribe to crank beliefs about COVID. This has the unfortunate effect of poisoning the well when people want to explore the genuine and documented side effects of statins. It is a frustrating time to be a cardiologist I'm thinking.
posted by i_am_joe's_spleen at 3:39 AM on July 12, 2023 [10 favorites]

That second link isn’t working for me - anyone else struggling with it?
posted by glaucon at 3:57 AM on July 12, 2023 [1 favorite]

A doctor tried to put me on a statin a few years ago. After a.) getting my cholesterol tested and finding out my levels were actually better than those of the cardiologist she referred me to, and b.) learning the word "rhabdomyolysis", I opted out of taking the thing.
posted by Mr. Bad Example at 4:00 AM on July 12, 2023 [3 favorites]

Yes, broken for me, too. Found it with a search.
posted by antinomia at 4:01 AM on July 12, 2023 [2 favorites]

Evolution doomed us to have vital organs fail. ….. if one life is saved, it's a win.

dancestoblue - this is great information, and I am glad to have this information. Thank you for posting this.

I do disagree with the two statements above. I don’t think the vital organ failing is a design flaw, I think it’s the system off-switch, and possibly a benevolent one.

I am like you, i_am_joe’s_spleen, in not wanting to take pills every day, in part because I have a long history of significant side effects to lots of meds that are well-tolerated by most folks. I also just don’t like the idea in a get off my lawn way. I am also changing my diet significantly to address healthy heart objectives.

Here’s the thing: I have two parents in their 90s and I am watching one of them slide down the really difficult dementia slope (the other one also needing lots of care). Managing this requires so much care and so many phone calls and so much time and so many resources, many that just don’t exist or require so many hoops to get, and I’m not even touching on the how awful and heartbreaking all of the fear and confusion (theirs) is, and how much worse this is going to get once we get to the “have to move them to an old person warehouse” step.

A life is not saved; it is extended. We all die. For me, and dear god for my *children*, I want the heart to go before the cognitive systems begin their shut down, and I am making plans to make sure that happens. There are far, far, far worse things than dying before my 80th birthday. I’ve had a good run. I am ok with not being here.
posted by Silvery Fish at 4:07 AM on July 12, 2023 [41 favorites]

My mother took statins, and they left holes in the muscles in her legs. She's been off the statins for years, and she still has trouble walking.
posted by unreason at 4:34 AM on July 12
A horror show. I wonder/hope since they found an illness that does the same damn thing, and have a chemical to stop and even reverse damage for some people, fingers crossed over here for your mother.

I just have an irrational aversion to pills every day. It's not about the supposed side effects, I just don't want to take pills every day. I know it's stupid.
posted by i_am_joe's_spleen at 4:56 AM on July 12
I was visiting a friend and when I dumped out the two bags of medications I take -- one bag morning, one bag night -- my friend was amazed. Cardiac stuff, manic depression stuff, vitamins out the wazoo, anti-allergy stuff (Texas) and god alone knows what all else. I don't think your aversion is stupid, nor do I think taking fistfuls of pills is lame. It is what it is. I know that I'm lucky for for cardiac meds and the manic depression meds also; to me taking the stuff is religion, as it's done so much for me.

one of the doctors I sometimes worked with expressed skepticism that it was a real thing. I guess he thought patients were whiny and non compliant or something. This attitude from doctors frustrates me a lot
posted by eirias at 5:04 AM on July 12
SSRI's, so. many.shrinks. plus just regular docs think anyone who reports brain zaps is loony toons, and I got on and off maybe five or six of them, no problem. But then I got onto another one, and it was fine, I had no problems with it, but really, I didn't need it, the welbutrin really does all I need. Well, I go to getting off this one SSRI and I was barking mad, it was pure hell to get off of it, I asked my doc for enough that I could step off of it one tiny bit at a time and my doc gave me that look, like "Oh brother, here's a dope who read the Sunday supplement in the newspaper." I was furious and this doc, who knows me well, over 20 years and he totally discounted what I was going through. It was what I was living, not something that I heard about. I stood tall but it was clear he had me pegged as a wack-job. Closest I've come to firing him and going out into the world but out there are other docs with their ideas...

Assuming every rejection of a type of drug is like the anti-vax people is gross.
posted by vim876 at 5:31 AM on July 12
You are correct. I'll contact the mods, maybe can get that either removed or at least a strike-through.

It is a frustrating time to be a cardiologist I'm thinking.
posted by i_am_joe's_spleen at 5:39 AM on July 12
I love my cardiologist, he literally brought me back three times, I pay attention to what he says. But I'd bet dollars against dimes he'd think me loony toons if I did not take statins; in a way, I'm grateful that I'm allergic to them.
posted by dancestoblue at 4:08 AM on July 12, 2023 [15 favorites]

What I get from this is an ever-increasing impression that our bodies are Rube Goldberg mechanisms.
posted by clawsoon at 4:12 AM on July 12, 2023 [10 favorites]

((dancestoblue, just read your last post, and what incredible self-love you’ve committed to, and I am super glad in your journey all of those meds are available to make your life livable and I hope joyous, or close to. Different journeys, and I honor yours.))
posted by Silvery Fish at 4:14 AM on July 12, 2023 [7 favorites]

This is an interesting combination of articles.

The first article: We've found the exact mechanism which explains why so many people taking statins experience muscle weakness.

The second article: In properly controlled trials, statins cause no more muscle weakness than placebos. It's a psychological effect, not a physical one.

Obviously the only way to sort out this contradiction in a way that modern American public will accept is a cage match.
posted by clawsoon at 4:28 AM on July 12, 2023 [16 favorites]

Oh lord, I just got prescribed these last week, and they give me wretched heartburn. Blech.
posted by outgrown_hobnail at 4:38 AM on July 12, 2023

Dropping this here in case it’s helpful to anyone reading this thread — it’s in the category of “unsolicited advice” so feel free to scroll on past.

I was an RDN and I have a loved one with high cholesterol from genetic causes, so I’ve done some deep dives into this particular topic. A diet change that can be highly effective at bringing LDL down is to use mostly beans and lentils for your protein, and to go for oats and barley as much as you can for your carbs. These foods are high in soluble fiber, which binds to cholesterol and carries it out of your system when you poop.

Your digestive system is very good at recycling cholesterol, so that binding is necessary to keep it from just getting reabsorbed.

Avoiding saturated fats (animal fats and tropical oils) in favor of other plant oils is also helpful for getting your body to produce less cholesterol.

But do keep in mind that some people just have bad luck with genes so if diet and lifestyle changes don’t bring your numbers down low enough to avoid needing to take meds that is not your fault.
posted by antinomia at 4:51 AM on July 12, 2023 [15 favorites]

I read the articles with my usual feeling of "it's complicated." Medicine is not nearly as advanced as it thinks it is, and doctors are not nearly as all-knowing as they think, but the general public is both too credulous and too suspicious at the same time, and doctors can't make up their minds about what they want us to know. I've had a physician mock my use of the correct medical terms as "Dr. Google," for instance, when it was just that I was a well-educated athlete who was familiar with my body and with common overuse injuries. "Belief" is not a useful concept, nor is "disbelief." I guess "trust, but verify?"

I take almost no pills, but it's not because I'm against them. My kid is on ADHD meds and bipolar meds and they have made a huge difference; my husband's tadalafil for his BPH made both of us very happy, and he insisted on taking it all the way through hospice :) plus he was on statins as well, and a whole boatload of things at the end that helped a lot (though the synthetic THC was a Very Bad Idea for him and resulted in a fall due to confusion). I just don't end up needing that many meds, and I forget to take the ones I'm prescribed (asthma inhaler, for instance). I just went through minor oral surgery without antibiotics because the doctor didn't explicitly tell me to fill the prescription (yes, the ADHD is inherited).
posted by Peach at 4:53 AM on July 12, 2023 [7 favorites]

FYI, for those wondering if the muscle problems are real, they objectively are. The doctors ran tests when my mother got them, and there are literal holes in her muscle tissues.
posted by unreason at 4:53 AM on July 12, 2023 [12 favorites]

Well, I go to getting off this one SSRI and I was barking mad, it was pure hell to get off of it, I asked my doc for enough that I could step off of it one tiny bit at a time and my doc gave me that look, like "Oh brother, here's a dope who read the Sunday supplement in the newspaper."

dancestoblue I also had a hellacious time discontinuing a SSRI. I wonder if it's the same one. Had to try 3 times.

The FDA requires drug companies to detail the onboarding experiences to their drug, but there is no requirement for documentation, nor scrutiny of, the discontinuation experience. So your doctor was pretty ignorant to give you that attitude.
posted by Professor_Fancypants at 4:54 AM on July 12, 2023 [9 favorites]

My cholesterol levels were fine but my doctor strongly suggested I start on a statin due to my age. I put it off for years but finally relented this year. He warned me about the muscle issues (which he experienced himself) so I looked around and saw there was some evidence (trials were mixed) that Co-Q10 helps alleviate those symptoms. So far, I've been doing fine. Placebo effect? If so, I'm okay with it.
posted by tommasz at 4:54 AM on July 12, 2023 [2 favorites]

I recently started statins and went off them almost immediately because of debilitating muscle weakness and also digestive side effects I wasn’t willing to live with after several years of severe illness that included fecal incontinence. I am very committed to maintaining my capacity to poop in a normal way at normal intervals these days. I might have given them more of a chance if I hadn’t spent the last 8 months recovering strength and ability after being badly weakened and reconditioned by that same illness, but maybe not. Like others, I have a tendency to get the unusual and rare side effects, and it has made treat lent of chronic conditions challenging over the years.

I liked Silvery Fish’s reminder that “a life is not saved, it is extended.”
posted by Well I never at 4:57 AM on July 12, 2023 [8 favorites]

Cholesterol is a fight for me, and I got prescribed a stronger statin a few months ago. My father had some heart attacks and so the doctor is cognizant of my family history there. I really should do a better job on the diet side of things. I don’t eat horribly but not as well as I probably should. The problem there for me is that it just feels like a full time job managing all my meds, trying to keep my still-too-high weight to a dull roar, stay active, and figure out how to maintain a better diet plan when I have trouble using even small batches of fresh produce quickly enough that it doesn’t go bad. All this on top of daily life and little details such as “work.” Sometimes all that maintenance just seems like too much.

Then there’s the “oh fuck” moment that gives me motivation to keep it up. A few months ago, my uncle on my mom’s side of the family texts a pic of himself at the top of a local hiking trail. Two hours later he drops dead of a heart attack. It was so sudden, here one moment and then just like that, gone. When I was a kid, he was the father figure that my own father wasn’t able to be. It still doesn’t seem real to us that he’s gone. Watching my aunt having to deal with all the aftermath - cremation, life insurance policies, all of his stuff, legalities, etc… she is super organized and it’s still overwhelming to her, and she still has so much to do after a few months. If I can save my wife as much of that trouble as possible, well, that’s my goal right now. So I’ll keep popping the statins and try to figure out a path forward to maybe get healthier.
posted by azpenguin at 5:10 AM on July 12, 2023 [11 favorites]

I was on statin L with no problems. I was switched to statin C because reasons, and experienced pain in my legs. I switched back to L and the pains went away over a few weeks.

Now there was never any test or even physical examination to find the cause of the leg pain, so it could have been something unrelated like an inflamed nerve in my back. But based on my experience, for someone with strong reasons to take a statin, a change to a different med with a somewhat different activity might be worth a try.
posted by SemiSalt at 5:16 AM on July 12, 2023 [1 favorite]

The muscle side effects are no joke. My (ex)MIL started to take statins and had immediate health problems that were eventually diagnosed as the statins causing weakness in her heart muscle. Going off them made no difference and she declined slowly over the next several years.

That's kept me wary of them (I'm borderline high cholesterol) even though I know it's only a tiny fraction who are effected.
posted by CheeseDigestsAll at 5:32 AM on July 12, 2023 [4 favorites]

Mod note: Moderator added the strike through to the post, per user's request and to avoid having to delete comments.
posted by Brandon Blatcher (staff) at 6:41 AM on July 12, 2023 [8 favorites]

Soo I had a heart attack a few months back and am now on a big dose of statins. I was planning to live for another half-century or so, and so longterm effects are very much on my mind. Reading these articles with interest.
posted by Zarkonnen at 6:45 AM on July 12, 2023 [4 favorites]

It ain't just muscle weakness

My anecdatum - prescribed statin L. Next morning, high as a kite, as they used to say. Went for the morning walk, at the two mile mark, suddenly fainted next to a stone wall which missed my head by maybe an inch. One life potentially saved.

Context - high cholesterol runs in the family. So does living into our nineties.

One size does not fit all and YM clearly MV. Good luck to all.

(Big market for statins, by the way. Just saying, as they say.)
posted by BWA at 6:45 AM on July 12, 2023 [3 favorites]

I have genetic cholesterol and heart issues, and just turned 40. Two years ago, I was told that I would need statins but that they could wait until I was 40. I tried to alleviate my cholesterol with diet, and it was trending positively, but at my next check up was still in the danger zone. This meant that I had until one more checkup to continue the positive trend or go on statins. Then the a bunch of life drama hit and I stopped the exercise and good diet... this is the reminder to me that I need to keep it up despite life drama or I'll be compounding my problems.
posted by tofu_crouton at 7:02 AM on July 12, 2023 [9 favorites]

I just have an irrational aversion to pills every day. It's not about the supposed side effects, I just don't want to take pills every day. I know it's stupid.

If it's stupid, lemme join you in the stupid corner because I don't wanna either. It's kind of like how I also don't wanna fuss with my hair all the time or keep having to readjust bits of my makeup or whatever else, at some level I'm still just an eight-year-old who rolled out of bed in the morning in summer, pulled on a pair of shorts and a random t-shirt and was like "okay, I'm good."

The last time I got an exam, my cholesterol and blood pressure were just across the border into "high", but I was also chalking it up to "this is the tail end of 2+ years of Covid isolation and recovering from a broken knee, so I have been way less active than usual". I upped the beans and veggies and started walking to work more often again; I haven't been back to see if that's helped, but I think it may have done.
posted by EmpressCallipygos at 7:28 AM on July 12, 2023 [7 favorites]

I have been on a very high dose of atorvastatin since my quadruple bypass surgery 19 years ago and feel lucky to have never had any noticeable side effects. It makes up a bit for the unlucky cholesterol/heart disease genes, I guess. I have also been taking CoQ-10 for almost as long, to forestall or mitigate any side effects, so maybe that's helping?
posted by briank at 7:32 AM on July 12, 2023 [8 favorites]

SemiSalt I was on statin L with no problems. I was switched to statin C because reasons

Would you mind naming Statin L vs C (generic is fine)? I can't find them listed as such in the articles, there are multiple brand/generic names that could match, and don't want to guess.

I'm lucky: I've not seen or recognized muscle soreness issue in the 20 years I've been on simvastatin due to genetically-based high LDL and a family history of heart issues. That said, everyone is different and there may be medications that are as effective but less painful for folks.
posted by bacalao_y_betun at 7:41 AM on July 12, 2023

As far as I know, I have had my cholesterol measured only one time, when I was in the hospital being treated for pernicious anemia which had gone undiagnosed until reaching an advanced stage, and my LDL was astronomically high. My hematologist walked into the room and said 'you have an LDL of 4330, but not a trace of heart disease. I guess you don’t survive a hematocrit of 10 if you have heart problems'.

That was 16 years ago when I was already 5 or 6 six years older than my father was when he had a heart attack. I think we really do not understand why coronary arteries get clogged up with cholesterol, and that when we finally do, the statin craze will be seen as a red herring and something of a public health disaster, comparable to but on a much larger scale than all those years we told ulcer patients they had psychological problems when the true cause was an infection.

I think statins do prevent cholesterol from being deposited in coronary arteries and reduce the incidence of heart attacks, but not for the reasons we currently think.
posted by jamjam at 8:26 AM on July 12, 2023 [4 favorites]

In the second article, the interviewee says

These very robust immune systems are in some ways like a post–Cold War nuclear arsenal, in which you don’t have that threat anymore, but these weapons are still lying around. That’s why we see all these autoimmune diseases, and also we see such a high prevalence of atherosclerosis.

This is a really bold statement! Are we really blaming heart disease and autoimmune conditions on not getting enough viral and bacterial infections? I thought that was a very fringe idea without much support?
posted by congen at 8:48 AM on July 12, 2023 [1 favorite]

Would you mind naming Statin L vs C (generic is fine)?

L is atorvastatin and C is rosuvastatin. They are the two top-selling statins. L and C refer to their brand names.
posted by slkinsey at 8:52 AM on July 12, 2023 [3 favorites]

My mother took statins, and they left holes in the muscles in her legs.

What I got was raw patches on my ankles/lower calves, leaking lymph. My doctor didn't seem to believe it was a side effect, but I had them for months before I had the lightbulb moment that they had started when I went on the med, stopped taking it, and they went away.
posted by tavella at 9:10 AM on July 12, 2023 [4 favorites]

L and C refer to their brand names.

Lipitor and Crestor, I would wager.
posted by briank at 10:23 AM on July 12, 2023

Yep my mother and brother both had ridiculous amounts of muscle pain and weakness on statins and they did go off them. It was ridiculous, my mom was chalking it all up to old age but my brother is an athletic dude in his mid 30s, suddenly tottering around and struggling to carry groceries. My brother had to stop them just briefly because his prescription got fucked up and his full strength and mobility returned within two days. He told my mom, who also stopped, and lo and behold she too was moving around like new.

And when they reported this, both of their doctors were like huh! wow, I guess I shouldn't have given you the maximum dose of the strongest possible statin for your mildly elevated cholesterol without ever telling you to try literally anything else at all.
posted by We put our faith in Blast Hardcheese at 10:35 AM on July 12, 2023 [10 favorites]

My dad died of a heart attack at a relatively young age (70, so not super young) so my doctors were eyeing me for statins from an early age. I take them several days a week because I can't tolerate even a low dose every day. I have enough pain from everything else wrong with me that I can't handle muscle pain as well.

I'm one of those people who has the giant pill case worth of pills. I sympathize with the feeling of not wanting to take them either. But I don't want to die so I take the pills and do the injections and go to the doctor and all that. I was diagnosed with my first chronic illness when I was 18. I had about three months of adulthood when I was not (known to be) sick, and for those three months I thought I had a serious injury. Enjoy your health and freedom from meds if you have it.
posted by gentlyepigrams at 10:44 AM on July 12, 2023 [11 favorites]

I'll leave this here with no comment, since it's been awhile since I have watched it through, but I remember it was interesting and informative.

Medlife Crisis on YT: Statins Explained in 10 Minutes (by a cardiologist)
posted by snoboy at 11:27 AM on July 12, 2023 [4 favorites]

From talking to my parents, there are far too many doctors for whom any concerns about "muscle weakness" or "fatigue" are dismissed with "You're getting old! That's part of life!".
posted by meowzilla at 11:59 AM on July 12, 2023 [4 favorites]

I had a major heart attack. I got stents and was prescribed high-dose statins plus medication for my high blood pressure.

I questioned the statins. I didn't have a high cholesterol count. I felt terrible when taking them. Also, I found out that one (low probability) side effect is development of type 2 diabetes--and it seems to be irreversible if it happens (note, I am not a doctor). Type 2 diabetes runs in my family--and it isn't the 'overweight, no exercise lifestyle', it is something genetic, probably related to why there are also lots of heart attacks in the family. Several ancestors died early before insulin was discovered. So taking a medicine with this side effect really stresses me out.

That's when I ran into the health plan bureaucratic army. It was really like an army. You do not question statins!. If I run late on filling my prescription, I get emails, text messages, and phone calls. If I am late in refilling my blood pressure medicine (something I consider way more important), nothing--they don't seem to care.

My doctor won't listen--she's probably doesn't want to face the wrath of the same 'medical plan statin army', and won't remove the prescription or even reduce it to a lower dose. So, I dutifully refill my prescriptions and keep the bureaucracy happy. (Am I actually taking them? Hmm...).

By the way, 5 years later, my health, and my cholesterol count, are doing great.
posted by eye of newt at 12:31 PM on July 12, 2023 [3 favorites]

My GP has been hesitant to put me on statins, though my cholesterol is higher than it should be. I was referred to a cardiologist for a chronic heart condition and she recommended that I get a CT scaling test, which costs $50 out of pocket (at least in my health system) but lets you know if your cholesterol is clogging the arteries around your heart. So that's another option to explore if you're hesitant to (or can't) go on statins.
posted by carrienation at 12:36 PM on July 12, 2023 [3 favorites]

My GP has been hesitant to put me on statins, though my cholesterol is higher than it should be.

Minus any other indicators of impending heart attack (ie: you are relatively active, relatively young, can move normally, have some interest in increasing your fiber intake), statins vs no statins isn't a big difference, statistically. Of course, as you age that equation starts to change. So just because you have high cholestrol in your 30-50s doesn't necessarily mean you need start a drug you will be on for 40 years.
posted by The_Vegetables at 12:46 PM on July 12, 2023

Well, out there in diet crank land, many are trying to claim that cholesterol and in particular LDL don't matter.

This parallels a more mainstream reevaluation/adding of nuance to the picture, I think - LDL may not be the most direct indicator of cardiovascular risk, many people have good results even in terms of the traditional indicators from diets relatively high in animal fat and so on - but people just love to run to the opposite extreme and “everything you know is wrong.”

Personally I kinda believe (albeit on limited direct evidence) that there is a lot of individual variation in how people respond to diet that we’re only beginning to understand.

I did some reading on statins when my mom was somewhat reluctantly starting on one and it seemed like the evidence for a reduction of mortality there was quite solid, though.
posted by atoxyl at 12:58 PM on July 12, 2023

As I recall that Medlife Crisis video, snoboy (autocorrected to 'snobby', thank goodness I noticed that), the major study he talks about that showed a low incidence of side effects had a 'run-in period' in which participants took statins for several weeks before data started being collected.

He might have even mentioned that, but what he did not mention was how strongly that could have biased the study toward the low side effect outcome, because all the people who had the immediate effects such as we’re hearing about in this thread would have dropped out instantly, and the people who just didn’t like the effects would have dropped out in disproportionately high numbers as well.

I really like him in general and I think he has a lot of integrity, but that is a pretty glaring omission, and I take it as one indicator of how great the pressure is on cardiologists to go along with the consensus on statins — the few who haven't have suffered tremendous reputational damage, and there are anecdotal accounts of Big Pharma using very aggressive tactics against them. Statins are a multi-billions cash cow.
posted by jamjam at 1:07 PM on July 12, 2023 [4 favorites]

There are a couple of skeptic-researchers who've built their careers on questioning the research on statins. I've read some of their articles (example), and while the skeptics accuse the statin researchers of manipulating stats, I think the skeptics make errors of their own. For example, two of the trials they cite were stopped early for ethical reasons after crossing the threshold for showing clear clinical benefit, which placed an upper limit on the level of benefit that could be shown. The survival curves from longer-term trials show a progressively larger absolute benefit with longer duration of treatment. As another example, they point out that relative risks, in isolation, can be misleading, but this is true of their preferred measure of absolute risk reduction as well. Finally, the examples chosen by the authors to illustrate their point are 2- to 5-year trials of drugs that are intended to be taken for much longer.

While I'm not an expert in this space, I can tell you that US Medicare and commercial insurance companies have established statin therapy as a quality measure. Since they don't want to waste money on stuff that isn't cost-effective, most quality measures are thoroughly vetted annually, which includes updating the literature reviews. If new evidence comes to light that is persuasive, analysts and quality measurement folks across the healthcare system will pay attention.
posted by acridrabbit at 1:39 PM on July 12, 2023 [8 favorites]

As another example, they point out that relative risks, in isolation, can be misleading, but this is true of their preferred measure of absolute risk reduction as well

Yeah I am not fond of this wrangling over absolute vs. relative risk measures because it would seem obvious that neither is really meaningful without context?
posted by atoxyl at 2:21 PM on July 12, 2023

Was on the M Statin, had no symptoms and little fx on my lipid levels. Was switched to the L statin, and pronouced memory issues emrged that lasted months after discontinuation. Like someone else in this thread said, higher than normal LDL runs in my family, as does living into your 80s and 90s, with no heart attacks.
What disturbs me is if I ask for concrete evidence of atherosclerosic processes in my cardiac vaculature, my docs can't get the tests approved from my ever-caring health insurance cost-containing administrators. Just trust a cheap overly broad screening blood test, they say.
Its useful mentioning that all the efficacies attributed to Statins are for post-heart attack patients. Last I checked, the pre-cardiac event prophilactic effects have yet to be documented, despite many many studies.
So for me at least, its a fear-pitch from the pharma Corps, and to me at least, thats horribly suspect in the greater context of pharma sales.
PS I've done all the diets including strict vegan. Whay lowered my lipids most was controlling carbs and sugar. But my docs don't care about that until my A1c is high enough to trigger insulin insensitivity ka-ching syndrome.
posted by Fupped Duck at 2:48 PM on July 12, 2023 [6 favorites]

Another data point: I've been on statins for 25 years without side effects - at this point I've outlived my Dad
posted by mbo at 3:17 PM on July 12, 2023 [7 favorites]

Statins are a multi-billions cash cow.

its a fear-pitch from the pharma Corps

Lipitor is often quoted as the best selling prescription drug of all time, but it’s generic now. I was surprised to see that it still has a couple billion in annual sales - it appears that this is because of an international market for name-brand drugs that I don’t really understand.

Anyway by the time drugs are as basic a part of the medical algorithm as statins are today, I mostly don’t think the “Pharma cash cow” framing is that accurate. The big bucks right now are in more niche but higher-priced drugs for cancer, autoimmune conditions etc. (plus COVID, of course).
posted by atoxyl at 3:18 PM on July 12, 2023 [6 favorites]

"Its useful mentioning that all the efficacies attributed to Statins are for post-heart attack patients. Last I checked, the pre-cardiac event prophilactic effects have yet to be documented, despite many many studies."

That doesn't seem to match the first few results I see when I search "evidence for statins in primary prevention rct", for example here. Can you expand on that?
posted by i_am_joe's_spleen at 4:16 PM on July 12, 2023 [2 favorites]

Anyway by the time drugs are as basic a part of the medical algorithm as statins are today, I mostly don’t think the “Pharma cash cow” framing is that accurate.

That's ridiculous:

New York, March 02, 2023 (GLOBE NEWSWIRE) -- The global statins market size reached US$ 15 Billion in 2021 and The global Statins Market is projected to reach US$ 22 Billion by 2032. The global market for statins is estimated to expand at a CAGR of 3.5% during the forecast period. Increasing incidence of high cholesterol & obesity is expected to drive the global statins market. North America enjoys the biggest share in the global statins market, with the U.S. leading the way.

Statins account for slightly more than 1% of all Pharma revenue.
posted by jamjam at 5:04 PM on July 12, 2023

Anyway by the time drugs are as basic a part of the medical algorithm as statins are today, I mostly don’t think the “Pharma cash cow” framing is that accurate.

Seems correct. I don't see a single statin on this list:
https://www.drugdiscoverytrends.com/50-of-2022s-best-selling-pharmaceuticals/
posted by superelastic at 5:25 PM on July 12, 2023

The AHA/ACC/etc Guideline on the Management of Blood Cholesterol is your gold standard. Their recommendations for primary prevention differ depending on patient age and risk factors. The short version, minus lots of little caveats, is that statins are recommended for primary prevention in older and high risk patients with elevated LDL. The guidelines provide extensive details for their recommendations, rationale, strength of evidence, and data sources, for those interested in such things. Cost effectiveness is included among the considerations.

On a population level, statins save lives, and have very good risk vs. benefit. My cardio professor used to joke that they should put them in the water. Tolerance is high but not universal. YMMV, obviously. As with all things medical, be wary of anecdata.
posted by dephlogisticated at 6:12 PM on July 12, 2023 [9 favorites]

Statins account for slightly more than 1% of all Pharma revenue.

Seems correct. I don't see a single statin on this list:
https://www.drugdiscoverytrends.com/50-of-2022s-best-selling-pharmaceuticals/

My point is that that they are now to a significant extent on the commodity end of the pharma market and will only be more so in the future. They are yesterday’s blockbusters. Tons are sold but that’s increasingly split between generic manufacturers - it’s not where the big names are focusing their marketing efforts*.

* though as I said in my first comment, that may be a slightly U.S.-centric view. Apparently name-brand Lipitor still sells in China. But in the U.S. it’s only doing $100m/yr which is nothing compared to the real Pfizer cash cows.
posted by atoxyl at 7:19 PM on July 12, 2023 [1 favorite]

I've refused to take statins-- what I heard about permanent muscle damage and transient global amnesia was just too scary. I'm doing reasonably well on Repatha. My nurse practitioner very kindly got my insurance to cover Repatha so I'm only paying $15/month, though it took some stubbornness on my part-- she likes and trusts statins.

By the way, red rice yeast, a "natural" remedy for high cholesterol, is a statin.
posted by Nancy Lebovitz at 8:26 AM on July 13, 2023 [2 favorites]

For me statins = pain and weakness. My first doctor poo-pooed, but reluctantly had conceded that that the Lovastatin insert mentioned pain symptoms. Since then, I've tried multiple variations on statins and have muscle pain with every. single. one. I've been through three (male) doctors now and have been called both overreacting and non-compliant. The third asshole flat out lied to me, saying that steroids didn't cause muscle pain. I fired the SOB with extreme prejudice.

My wonderful new (female!) primary said that many people have adverse reactions to steroids, and it's well documented in the literature. She didn't shame me on my diet, weight, and exercised, just reviewed my history, laughed, and said I'm one of the umlucky ones that got a bad draw in the genetic crapshoot. And there's other drugs out there that we can try. I love her! There are no less than three issues that I have been trying to resolve and being blown off and told that I'm old, fat, female, a whiner, depressed and have anger issues.

She addressed all of them, fixed two, and we'll work on the third next month. YEAH! Oh, and the depression and anger? Well, that resolved when I finally was heard, and when the issues affecting my f****** quality of life were taken care of. And I'm slowly losing weight because I can move without hurting.

I suggest if your doctor is an asshole, fire them. If you're a woman, get thee hence to a woman who will validate your health experience. Get thee hence to a woman anyway. Support women in STEM!
posted by BlueHorse at 2:53 PM on July 13, 2023 [7 favorites]