Debunking myths: Lifesaving and beneficial role of Statins

Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal

In the realm of modern medicine, few drugs have stirred as much controversy and debate as statins. These drugs, hailed as miracle compounds by some, and terribly vilified by others, belong to a class of medications designed to lower cholesterol levels in the blood. Among their most prominent uses are in the prevention and management of cardiovascular diseases as well as neurological disorders such as strokes, all of which remain the leading causes of death worldwide.

The most well-established benefits of statins lie in their ability to significantly reduce the risk of cardiovascular events, including heart attacks, strokes, and coronary artery disease. Numerous large-scale clinical trials have unequivocally demonstrated the effectiveness of statin therapy in preventing blood vessel events related to the heart and the brain, as well as prolonging life in individuals at risk.

However, most regrettably perhaps, social media postings have sparked intense concerns about the safety and efficacy of statins, potentially undermining their vital role in combating heart disease and neurological conditions. These efforts have gone viral and caused people to have major concerns regarding the need for and safety of these medicines. Some patients have been induced to even stop them in toto.

It is absolutely true that disinformation and misinformation about medications, particularly statins, can do real harm. While individual concerns and side effects deserve discussion, dismissing an entire class of life-saving drugs can have dire consequences. In this article, we will briefly delve into the scientifically proven benefits of statins, shedding light on their indispensable contributions to both heart health and neurological well-being and in the process, address some of the concerns expressed by the detractors of their use as well.

Statins, like atorvastatin, simvastatin, and rosuvastatin, etc., are cholesterol-lowering drugs widely prescribed for cardiovascular risk reduction. They work by inhibiting an enzyme crucial for cholesterol production in the liver. Statins lead to lower levels of low-density lipoprotein (LDL), the so-called “bad” cholesterol, that builds up in blood vessels, contributing to atherosclerotic plaque formation, which narrow down and even block vital blood vessels and ultimately lead to heart and brain problems.

Moreover, statins have been shown to exert beneficial effects beyond simply lowering cholesterol levels. They possess anti-inflammatory properties, stabilize plaque formations within blood vessels, and improve the inner lining of blood vessels or endothelial functioning, all of which contribute to their overall cardioprotective and neuroprotective effects. Furthermore, statin therapy has been associated with a decrease in the need for invasive procedures such as coronary artery bypass surgery and angioplasty, offering both clinical and economic benefits.

While lowering LDL Cholesterol is their primary function, statins offer multiple heart-protective benefits beyond just numbers. They are as follows:

1. Plaque Stabilization: Statins stabilize existing atherosclerotic plaques, reducing their vulnerability to rupture, a key trigger for heart attacks and strokes. Studies like the REVERSAL trial show even small drops in LDL levels significantly reduced plaque volume and improved its stability.

2. Anti-inflammatory Effects: Chronic inflammation fuels atherosclerosis progression. Statins possess anti-inflammatory properties, reducing inflammatory markers and improving vascular function. This dampens the inflammatory cascade implicated in plaque formation and rupture.

3. Improved Blood Vessel Function: Statins improve the elasticity and relaxation of blood vessels, allowing for better blood flow and lowering blood pressure, further reducing cardiovascular risk.

4. Reduced Blood Clotting: Statins modestly reduce the risk of blood clots, another key contributor to heart attacks and strokes.

The brain, like the heart, is highly vulnerable to damage from poor blood flow and inflammation. Research reveals statins offer potential benefits for brain health as well. They are as follows:-

1. Reduced Stroke Risk: Multiple studies, including the SPARCL trial, demonstrate statins significantly reduce the risk of both ischemic (clot-related) and haemorrhagic strokes.

2. Cognitive Decline and Dementia: Research on the link between statins and dementia is ongoing. While some studies have not shown conclusive benefits, others, like the PROSPER trial, suggest statins may slow cognitive decline and reduce the risk of dementia, particularly in high-risk individuals. This potentially arises from statins’ anti-inflammatory and vascular protective effects in the brain.

3. Neurodegenerative Diseases: Early research suggests statins may offer benefits in neurodegenerative diseases like Alzheimer’s and Parkinson’s by reducing inflammation and promoting brain cell survival. However, more research is needed on these aspects.

Despite their benefits, concerns about statin use exist. Notwithstanding the overwhelming evidence supporting the benefits of statins, concerns and misconceptions persist, fuelled in part by sensationalized claims on social media and other platforms. The most common of these side effects include the following:-

1. Muscle aches and body pains: This is the most frequent side effect, usually mild and manageable. Switching statins or modifying the dose often helps.

2. Liver enzyme elevation: Rarely, statins can elevate liver enzymes. Regular monitoring and dose adjustments address this concern.

3. Increased diabetes risk: Statins slightly increase the risk of Type 2 diabetes, but the benefit of their cardiovascular protection far outweighs this risk in most individuals.

4. Brain function and dementia: Studies suggest statins do not negatively impact brain function and might even protect against cognitive decline.

It is crucial to remember that any medication comes with potential side effects. Weighing the individual’s risk factors, medical history, and potential benefits against the side effects is of paramount importance in making treatment decisions. The benefits of statin therapy in preventing cardiovascular events far outweigh the potential risks, particularly in individuals with a high risk of heart and neurological disease.

Statins are evidence-based, life-saving medications that demonstrably reduce heart disease and stroke risk. They offer broader benefits like blood vessel plaque stabilization, improved blood vessel function, and potential neuroprotective effects. While individual concerns deserve attention, dismissing statins based on misinformation can have detrimental consequences. Consulting your doctor and making informed decisions based on scientific evidence is crucial for protecting your heart, brain, and overall health.

Finally, this author is on long-term statin treatment. He has been under the care of the very best of cardiologists and neurologists of our Motherland. They are all my very dear friends and as a patient, I have respected and valued their expert opinions. I have had no hesitation whatsoever to take their considered scientific advice and be on statins for quite a few years, right up to the present time.

This article was formulated with published scientific evidence and some added help from Artificial Intelligence.