THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
Statins are by far the most common prescription cholesterol drug class in the United States, and that is not at all surprising, especially among older people. The benefits of statins are undeniable – as you will find out soon – but there have been questions about the right time to start using them or who to use them at all. I will dig deep into all of these today.
Statins are prescription medications that help in lowering cholesterol levels in the body. This is certainly interesting, considering cholesterol isn’t even bad in itself. The body needs a small amount of cholesterol in the blood to build the structure of cell membranes and also produce a lot of important hormones and vitamin D in the body. Cholesterol travels through the blood on proteins known as lipoproteins.
However, when cholesterol levels start to rise in the body, problems follow. If there is too much cholesterol in the blood, the cholesterol and other substances harden and may form deposits called plaques, which block arteries. This affects normal blood flow. When the plaques rupture, blood clots can also form.
Not all cholesterol is built the same, though. There are two main types – low-density lipoproteins and high-density lipoproteins, denoted by LDL and HDL, respectively. LDL is regarded as bad cholesterol because it is the main source of cholesterol buildup in blood arteries. On the other hand, HDL is regarded as good cholesterol because it helps remove cholesterol from the blood. Both LDL and HDL constitute the total cholesterol levels in the body.
Ideally, the total cholesterol levels in the body should not exceed 200mg/dl, while LDL should not exceed 100mg/dl. For people with heart conditions or at risk of one, the recommended LDL level is even lower, at 70mg/dl. Doctors usually consider cholesterol levels and make a decision on if statins are needed.
For most people with a low risk of heart disease, doctors will not give statins unless LDL levels are approaching 200mg/dl. However, people with high risk for heart disease are commonly prescribed statins even if they don’t currently have high cholesterol levels. Statins have proven to be excellent in reducing LDL cholesterol levels, with a decrease of up to 55 percent noted. Consequently, statins can decrease the risk of heart conditions.
While the benefits of statins are not in dispute, there are still unanswered questions about their use. One such question is the best age for older adults to start using them. Most of the studies that have been conducted on statin use for older adults consider adults below the age of 75. These studies conclude that statin use is essential for reducing the risk of heart conditions like stroke and heart attack, regardless of if they currently have heart diseases. For people older than 75 that have been diagnosed with heart disease, statins are also recommended.
The area of contention is statin use in people over the age of 75 that currently do not have heart disease. Right now, there are no studies that offer definitive proof that statin use in this population is clinically significant. This isn’t to say these drugs should not be used among people in this age class, but there’s just not enough proof to justify their use among these older adults. Regardless of the status, it is essential to communicate with your doctor before taking statins.
There are also questions on if the dose of statins should be increased if the drugs don’t seem to be working optimally. This is certainly a conversation to be had with your doctor, but increasing the dose may be a reasonable therapeutic intervention. However, as you would expect, increasing the dose increases the side effects of the drug. Some side effects include headaches, nausea, muscle and joint ache, dizziness, and gastrointestinal disturbances. These side effects may be even more pronounced for older adults and may significantly affect their quality of life.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist & Board Certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ & House call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://www.washingtonpost.com/wellness/2023/05/22/statins-cholesterol-aging/
- https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statins/art-20045772#:~:text=Low%2Ddensity%20lipoprotein%20(LDL)%20cholesterol.&text=If%20your%20risk%20is%20very,don’t%20have%20high%20cholesterol.
- https://my.clevelandclinic.org/health/treatments/22282-statins
