Author: Dr. Michelle Durkin on 4 August 2020
Well, the short answer is it depends.
Statin therapy is standard first-line treatment for primary prevention of atherosclerotic cardiovascular disease in patients with elevated low- density lipoprotein cholesterol levels, those with diabetes mellitus who are 40 to 75 years of age, and those determined to be at sufficient risk after a clinician–patient risk discussion.
Currently more than 2.5 million Canadians are taking a statin despite the main take-home message from the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease that "the most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life." They go on to emphasize a healthy diet, moderate exercise, and smoking cessation.
We are at a point in time where both doctors and patients have focused too much on medication while paying too little attention to the lifestyle guidelines that do much more for cardiovascular (and whole-body) health than a pill ever will.
This single-minded focus is the most obvious when there is a family history of cardiovascular disease.
But how much is family history and how much is a learned family lifestyle?
Scientific research shows that what your genes determine is only about 20%, the rest of it is lifestyle and environmental factors that either turn your genes on or off. That means you can control up to 80% of the outcome if you focus on lifestyle alone.
Pharmaceutical companies also report the benefits of statins based on relative risk, not absolute risk. If you use relative risk statistics, statins can reduce the risk of death from heart disease by about 29%. If you use the same statistics to report absolute risk, the reduction is between 1-3%.
In order to help patients accurately determine the benefits of statins for them personally, I use the following risk calculator:
It is the only calculator that I have come across that will actually illustrate to the patient the absolute benefit of statin therapy for them. It will also show the risk of known side-effects. Only then can a patient can make an informed decision.
Regardless of whether you decide to take a statin or not, I believe if you don't address your lifestyle you are doing yourself and your family a disservice.
And those are the patients I want to work with. Those that decide regardless of whether they take a statin or not, they also want to work on the most important side of the equation - lifestyle medicine.
Now I would love to hear from you! What do you think about statin use? Leave a comment below and I'll be back next week with another edition of Doctor as Teacher Tuesday!
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