The FDA is adding new warnings to this popular drug. Here’s what you need to know now.
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If you’re over fifty in America, there’s a good chance you’re taking a statin. Nearly 22 percent of adults 45 or older take one of these cholesterol-lowering drugs, making them the most commonly prescribed medications in the world.
Last week, the FDA added new safety alerts to statin labels, including reported side effects of memory loss, confusion, and a higher risk for Type 2 diabetes. Not surprisingly, many people panicked. Medical message boards were flooded with questions like, “Will Zocor give me dementia?” and “Is Lipitor making me sick?” A cursory google search brings up dozens of sites claiming statins are dangerous, unnecessary, over-prescribed---even a corporate conspiracy. Still, the FDA insists that this new information should not “scare people off statins. The value of statins in preventing heart disease has been clearly established. Their benefit is indisputable.”
So what’s the real story? For answers, we turned to a source we truly trust, Dr. Steve Nissen, Cleveland Clinic Chairman of Cardiovascular Medicine. Named one of Time magazine’s 100 most influential people, Dr. Nissen is not only a leading cardiologist and researcher, he’s also a leading patient advocate. He has has led inquiries as to the scientific integrity of many big-name medications currently on the market. In other words, he’s not afraid to question the status quo. Here, he answers all our questions.
FOF: If you are currently taking a statin medication, should you consider stopping as a result of this report?
Dr. Nissen: No patient should stop a medication because she hears a news report. These decisions should always be made through a discussion with your doctor. Most authorities do not believe that these new warnings represent a major change in thinking about statin drugs. We’ve known for several years, for example, that statins do very slightly push up blood sugar. That means, if you’re just under the threshold for diabetes, you’ll cross over and be labeled as having diabetes. But, in those patients for whom the blood sugar did go up a little bit, the benefits of the drug remained the same. The diseases that statins prevent--like heart attack stroke--are still reduced equally well.
Still, it’s alarming how many people are on statins. Do you think these pills are over prescribed?
I do. Doctors need to stick with the guidelines, which are very carefully worded so that patients at high cardiovascular risk are recommended for receiving statins, and patients who are at low risk are not. There are a certain number of people--I’ll call them the ‘worried well’--who are treated with statins by their doctors but who don’t really meet the current criteria. Those people are better off using diet, exercise and other means to control their cholesterol elevation. But, there are equally large numbers of patients who meet all the criteria for receiving a statin and who aren’t on them. The key is to make sure the right patients get these drugs.
How do you know if you should be taking a statin or if you’re one of the “worried well”?
There is a risk calculator available online called the Framinghan Risk Score. If you put in your numbers (age, cholesterol, blood pressure, etc) it will give you your 10-year risk of having a heart attack. If you come out well under 10% risk for 10 years, your risk is low, and you likely don't need to be on a statin. If you’ve had a heart attack, you should be on a statin--period. If your LDL cholesterol reaches a certain level--above 160-190--we will treat you with a statin even if they have minimal other risk factors.
If your doctor says you need to be on a statin, but you are still concerned, what do you need to say to your doctor to make sure you’re getting the right treatment?
Ask exactly what calculations he or she using to determine your treatment. Did he or she use the Framingham or another similar tool? If you still have doubts, it is never a bad idea to get a second opinion.
What if you’re on a statin and you’re experiencing some of these side effects. Should you be worried?
Every drug has a degree of tolerability that differs from patient to patient. Good medicine is about customization. The goal is to find the drug in the dosage that works for you with the least side effects possible.
There are many sites on the web with experts who claim that these drugs are way over prescribed, and that there are “natural” alternatives to lower your bad cholesterol without jumping on a statin.
I have a very simple answer for those sites: nonsense. There are no “natural” alternatives to statins. The dietary supplement industry is unregulated, so they make these claims but there’s no science to back them up. Don’t be fooled by these promotions of dietary supplements---they simply don’t lower cholesterol.
So maybe there isn’t a supplement. But what about changing your diet and exercise? Can behavioral changes be a good alternative to statins?
A statin should always be coupled with behavioral changes. Good and prudent doctors always couple lifestyle changes with drug therapy. Using these behavioral changes as an alternative to a statin depends on your level of risk--every patient is a little bit different.
If you’re on the borderline of taking a statin, should these side effects be a motivation to make changes to your lifestyle so you don’t have to go one one?
It’s not that easy, and here’s why. Lifestyle changes typically don’t reduce cholesterol by more the 10-15 percent. Statins reduce cholesterol levels by 30-60 percent.If your numbers are high enough that you need a statin, the odds are good that you’re not going to get them down with diet alone, unless you’re willing to take on an extreme diet...and most people can’t sustain that.
Why would you be in a situation where your cholesterol levels are so high that there’s nothing you can do but take a statin?
It’s really about genes. Only 20 percent of cholesterol level comes from your environment...80% comes from your genes. That’s one reasons that diet can only lower cholesterol so much.
What about people who say that these drugs are being over-prescribed because of all the marketing being done by big pharmaceutical companies?
There’s a marketing element here absolutely. Having said that, we have probably saved more lives by lowering choesterol levels with statins than with any other drugs in the history of the medical profession. The only thing that comes close probably is penicillin.
If there is one single change you could be making to lower your bad cholestorol--apart from a statin--what would it be?
Reduce your intake of saturated fat in your diet--butter and meat.The FDA is adding new warnings to this popular drug. Here’s what you need to know now.
—————————————————————————————————
If you’re over fifty in America, there’s a good chance you’re taking a statin. Nearly 22 percent of adults 45 or older take one of these cholesterol-lowering drugs, making them the most commonly prescribed medications in the world.
Last week, the FDA added new safety alerts to statin labels, including reported side effects of memory loss, confusion, and a higher risk for Type 2 diabetes. Not surprisingly, many people panicked. Medical message boards were flooded with questions like, “Will Zocor give me dementia?” and “Is Lipitor making me sick?” A cursory google search brings up dozens of sites claiming statins are dangerous, unnecessary, over-prescribed---even a corporate conspiracy. Still, the FDA insists that this new information should not “scare people off statins. The value of statins in preventing heart disease has been clearly established. Their benefit is indisputable.”
So what’s the real story? For answers, we turned to a source we truly trust, Dr. Steve Nissen, Cleveland Clinic Chairman of Cardiovascular Medicine. Named one of Time magazine’s 100 most influential people, Dr. Nissen is not only a leading cardiologist and researcher, he’s also a leading patient advocate. He has has led inquiries as to the scientific integrity of many big-name medications currently on the market. In other words, he’s not afraid to question the status quo. Here, he answers all our questions.
FOF: If you are currently taking a statin medication, should you consider stopping as a result of this report?
Dr. Nissen: No patient should stop a medication because she hears a news report. These decisions should always be made through a discussion with your doctor. Most authorities do not believe that these new warnings represent a major change in thinking about statin drugs. We’ve known for several years, for example, that statins do very slightly push up blood sugar. That means, if you’re just under the threshold for diabetes, you’ll cross over and be labeled as having diabetes. But, in those patients for whom the blood sugar did go up a little bit, the benefits of the drug remained the same. The diseases that statins prevent--like heart attack stroke--are still reduced equally well.
Still, it’s alarming how many people are on statins. Do you think these pills are over prescribed?
I do. Doctors need to stick with the guidelines, which are very carefully worded so that patients at high cardiovascular risk are recommended for receiving statins, and patients who are at low risk are not. There are a certain number of people--I’ll call them the ‘worried well’--who are treated with statins by their doctors but who don’t really meet the current criteria. Those people are better off using diet, exercise and other means to control their cholesterol elevation. But, there are equally large numbers of patients who meet all the criteria for receiving a statin and who aren’t on them. The key is to make sure the right patients get these drugs.
How do you know if you should be taking a statin or if you’re one of the “worried well”?
There is a risk calculator available online called the Framinghan Risk Score. If you put in your numbers (age, cholesterol, blood pressure, etc) it will give you your 10-year risk of having a heart attack. If you come out well under 10% risk for 10 years, your risk is low, and you likely don't need to be on a statin. If you’ve had a heart attack, you should be on a statin--period. If your LDL cholesterol reaches a certain level--above 160-190--we will treat you with a statin even if they have minimal other risk factors.
If your doctor says you need to be on a statin, but you are still concerned, what do you need to say to your doctor to make sure you’re getting the right treatment?
Ask exactly what calculations he or she using to determine your treatment. Did he or she use the Framingham or another similar tool? If you still have doubts, it is never a bad idea to get a second opinion.
What if you’re on a statin and you’re experiencing some of these side effects. Should you be worried?
Every drug has a degree of tolerability that differs from patient to patient. Good medicine is about customization. The goal is to find the drug in the dosage that works for you with the least side effects possible.
There are many sites on the web with experts who claim that these drugs are way over prescribed, and that there are “natural” alternatives to lower your bad cholesterol without jumping on a statin.
I have a very simple answer for those sites: nonsense. There are no “natural” alternatives to statins. The dietary supplement industry is unregulated, so they make these claims but there’s no science to back them up. Don’t be fooled by these promotions of dietary supplements---they simply don’t lower cholesterol.
So maybe there isn’t a supplement. But what about changing your diet and exercise? Can behavioral changes be a good alternative to statins?
A statin should always be coupled with behavioral changes. Good and prudent doctors always couple lifestyle changes with drug therapy. Using these behavioral changes as an alternative to a statin depends on your level of risk--every patient is a little bit different.
If you’re on the borderline of taking a statin, should these side effects be a motivation to make changes to your lifestyle so you don’t have to go one one?
It’s not that easy, and here’s why. Lifestyle changes typically don’t reduce cholesterol by more the 10-15 percent. Statins reduce cholesterol levels by 30-60 percent.If your numbers are high enough that you need a statin, the odds are good that you’re not going to get them down with diet alone, unless you’re willing to take on an extreme diet...and most people can’t sustain that.
Why would you be in a situation where your cholesterol levels are so high that there’s nothing you can do but take a statin?
It’s really about genes. Only 20 percent of cholesterol level comes from your environment...80% comes from your genes. That’s one reasons that diet can only lower cholesterol so much.
What about people who say that these drugs are being over-prescribed because of all the marketing being done by big pharmaceutical companies?
There’s a marketing element here absolutely. Having said that, we have probably saved more lives by lowering choesterol levels with statins than with any other drugs in the history of the medical profession. The only thing that comes close probably is penicillin.
If there is one single change you could be making to lower your bad cholestorol--apart from a statin--what would it be?
Reduce your intake of saturated fat in your diet--butter and meat.
No reason to get your panties in a bunch any longer over light-to-moderate incontinence. One out of every two women 65 and older experiences the condition, which causes the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement that puts pressure on it, according to the website of the National Association for Continence. Recognizing the need for an aid, other than adult diapers, entrepreneur Bob Deerin created Wearever, a line of incontinence underwear. The panties look and perform just like normal undergarments, but have a sewn-in, absorbent “Unique-Dri” pads to trap liquid. “We want people who suffer from incontinence to be able to not only wear real underwear instead of diapers, but also to have a choice of attractive colors and styles,” says Bob. 
FOFitness guru Margo Kamin says she’s “eliminated all excuses” for not working out. Her fitness sessions don't require any equipment, or even a trip to the gym. She employs the use of resistance training, paired with video chat capabilities like Skype and FaceTime, to train her clients. Margo has clientele all over the U.S--some of which she's never even met in person! Read on to find out more about her video chat training sessions and why video training sessions are the new secret weapon for getting FOFit.
The bad news: loss of eyesight can’t be reversed. But, don’t panic: the changes you may notice in your vision may be related to hormonal shifts as you experience peri-menopause and menopause. According to Dr. Gullapalli Rao, a world-renowned ophthalmologist and founder of the L V Prasad Eye Institute, these types of changes are typical ails of aging and not necessarily cause for alarm. Here, Dr. Rao shares the different types of eye troubles FOFs commonly experience, which might be a sign for disease and which you can safely turn a blind eye to, so to speak.
Have you ever toasted “to good health!” while secretly wondering if your cocktail was going to harm your overall wellness? While any behavior can be overdone “it can’t always be all or nothing,” says Nutritional Therapy Practitioner and FOF Debra Meadow. “If you want to enjoy an adult beverage now and then, and you have no health contraindications, it’s okay to enjoy in moderation.”
Dr. Melina Jampolis, an internist specializing in nutrition and preventative medicine, favors significantly reducing red meat, but leaves some wiggle room if you’re a die-hard steak lover. “I believe that red meat can be consumed in moderation by most if you really enjoy it. According to The Alternative Healthy Eating Index [a “food pyramid” created at Harvard as a contrast to our standard American food pyramid] you should ideally be eating a 4:1 ratio of white meat and fish to red meat in order to decrease inflammation in the body. That is what I tell patients. If you are at high risk of heart disease or cancer (genetically or pre-existing condition) I would advise reducing red meat as much as possible.
Dr. Ulka Agarwal, chief medical officer for The Physicians Committee for Responsible Medicine, takes a hard-line against red meat and processed meat. [Note: PCRM is a nationwide organization of physicians, scientists, educators, and laypersons that “promotes preventive medicine, especially good nutrition, and addresses controversies in modern medicine.” It was founded by Dr. Neal Barnard, a noted researcher in the field of diet and nutrition and a longtime advocate of vegetarian and vegan diets.]
Dr. Robert Ostfeld, MD, a cardiologist at New York’s Montefiore Einstein Center for Heart and Vascular Care says cutting out red meat is a great first step...but cutting out all meat is ideal for optimum health.
FOFs are buzzing (and panicking) about last week’s article in The New York Times that examines a body of research from Dr. Martin Mainster and Dr. Patricia Turner, two ophthalmologists from the University of Kansas School of Medicine. Mainster and Turner claim that the gradual yellowing of the lens and narrowing of the pupil that occur with age prevent sunlight from getting through to key cells in the eye. They claim that this disturbs our circadian rhythms--the body’s natural clock--and leaves us at greater risk for a number of ailments, including insomnia, heart disease, cancer and depression. Their evidence is compelling: Based on their research, Mainster and Turner estimate that by age 45, the average adult receives just 50 percent of the light needed to fully stimulate the circadian system. By age 55, it dips to 37 percent and by age 75, to a mere 17 percent. "We believe the effect is huge," says Dr. Turner.
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