Statins recommended in cases where benefit outweighs risk
DEAR DR. ROACH: I'm a 74-year-old woman with good cholesterol numbers and normal blood pressure. I've exercised regularly since I was 17 (that's 57 years), and weigh 98 pounds. I have no history of heart attack or stroke. Still, my doctor is giving me a strong sales pitch to take a statin with no mention of potential harsh side effects and no liver enzyme test. A letter from my doctor's office states, "Even when your cholesterol levels are at goal, I recommend taking cholesterol medication to reduce your risk of heart attack and stroke."
There seems to be a disturbing trend to drug seniors just because they are getting old. One drug, then another, and another. Can you comment on this? I suspect my doctor is not the one pushing this medication, but rather the corporate structure above him.
ANSWER: Statin drugs are effective at lowering the risk of heart attack and stroke in people who are at increased risk. Risks for heart disease certainly include high blood pressure, high LDL and low HDL cholesterol, being sedentary, and a poor diet, and age alone (as well as being male) is a risk on its own. At times, there are many people with pretty good cholesterol numbers who will benefit from treatment with a statin drug because of other risk factors they may have.
Of course, a physician should always be honest about the benefits and risks of any treatment. Benefits can be estimated with a risk calculator, such as the one at tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/.Risks include muscle aches, although this risk is probably small. In a very large review of published trials, 26.6% of subjects in the placebo groups reported muscle aches, compared with 27.1% of subjects treated with statins.
Serious muscle damage is rare. Serious liver damage is also rare, and routine measuring of liver tests is no longer recommended. A few people treated with statins will progress from borderline diabetes to diabetes.
A prescription for a high-dose statin is available widely for less than $10 for a three-month supply. In people for whom the benefit outweighs the risk, making a recommendation for a statin is to help the patient, and is of utter indifference to "corporate structure." Speaking personally, I have never had an administrator (I've worked in academic medicine my entire medical career) second-guess any prescription I've written, nor told me I am prescribing too much or not enough. My choices have always been made between me and my patients.
DEAR DR. ROACH: I have read various articles about the health benefits of collagen. Is this product beneficial to the aging body or just another current health fad? -- B.C.
ANSWER: Collagen is a connective protein found in most meat. It can also be taken as a supplement, at generally a higher cost than you would pay from consuming it as food. I have read that the sources of some of the supplemental collagen sold is from parts of the animal likely contaminated by heavy metals, such as lead and cadmium.
The amino acids in the collagen protein are certainly necessary for good functioning of the body, but it's not at all clear to me that collagen is especially helpful for symptoms. And it's not clear that collagen needs to be taken as a supplement.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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