Deep South doctor disagrees with statin recommendation
By KEITH ROACH, M.D.
DEAR DR. ROACH: As a family physician, I must differ with you on your advice to the 71-year-old lady whose doctor wanted to start her on a statin. Using a Mesa score and her desire not to take any medicine, you advised her to decline the statin.
I am able to obtain generic Crestor with the GoodRx app and a pill cutter for 13 cents a day. I am 68 and have no muscle ache or other side effects. My cholesterol/HDL ratio dropped from 4.5 to 2.7, and I feel I am decreasing my chances of premature heart attack and stroke. I have friends who are exceptionally clean eaters and devoted exercisers, but they have worse lipid profiles than I do. I could not get nearly as good levels (cholesterol 157, HDL 60, LDL 80) when I dieted and exercised as hard as I could.
Living in the Deep South, I tried mostly in vain to get my patients to make long-term diet and exercise changes. With the arrival of affordable statins, I was able to make massive improvements in my patients’ lipid profiles. I am all for good diet and exercise, which I try to do, but I am a realist.
By disagreeing with the advice of her doctor, you may be giving ammunition to the patient to avoid taking inexpensive and easy to take medicine that could greatly improve her cardiovascular risk. — D.S.B.
ANSWER: Several people, including other physicians, also have disagreed with my advice in this column. I’d start by saying there are legitimate reasons to disagree, and there is not a single right answer that will be appropriate in all situations.
In the recent column, the best estimate of the letter writer’s risk of having a heart attack or dying from heart disease in 10 years was 5.3%, based on her cholesterol, blood pressure and coronary calcium score, along with her age and sex. Taking a statin like rosuvastatin (Crestor) would be expected to reduce her risk to about 4.3%. Some people would elect to take a statin to reduce their risk by 1%, but she indicated she “really hated” going on a statin and instead chose to reduce her risk through diet. The published guidelines do not recommend taking a statin drug with her low degree of risk.
My job is to provide objective information that readers can use to help with their own medical issues and to improve the communication with their doctors, so I do not lightly make a recommendation that conflicts with their doctor’s advice.
I feel statins are generally underused. Many people who would benefit from taking them are not. A few are taking them when they have very little benefit, and statins do have the potential for side effects, so should be used only by those most likely to get a net benefit.
DR. ROACH WRITES: A recent column on supplements generated many comments from readers. Many wrote that American diets are not healthy and therefore vitamin supplements should be helpful; however, study after study has failed to show a benefit in supplementing with vitamins at preventing critical events, such as heart attack and death. When there are good data to guide recommendations, I use them. I continue to believe that, with the exception of vitamin D in people at risk for deficiency, vitamin supplementation in apparently healthy people is unlikely to have any significant benefits and is likely a waste of money.