Over recent weeks there has been a flurry of research that has challenged the notion that lower levels of cholesterol are always better. In particular, there is evidence linking lower cholesterol levels with an increased risk of cancer (see here, here and here for more on this). In the light of this, it seems reasonable to question the rampant practice in medicine of encouraging individuals to drive their cholesterol levels down to recommended levels (that get steadily lower over time).
Recently, the British Medical Journal contained a review that explored the issue of raised cholesterol and its management. Its publication was followed by a letter in the journal from a UK general practitioner, Mark Struthers, who highlighted the recent evidence from the SEAS trial (covered here) which has linked with the taking of two cholesterol-reducing agents (simvastatin and ezetimibe) and an increased risk of cancer. Dr Struthers suggests, quite reasonably I think, that we should be cautious about the ‘collateral damage’ suffered in the war on cholesterol.
This letter has been followed, this week, by another which refers to Dr Struthers’ letter, this one coming from a consultant rheumatologist. The author expresses his concern that the protocols for lipid management seem to have resulted in a completely uncritical prescribing phenomenon, largely driven by targets and without regard for common sense.
He then goes on to highlight potential problems associated with the use of cholesterol-reducing statin drugs, by initially sharing with his first hand experience with the capacity of these drugs to induce muscular symptoms including weakness. The author goes on to describe how he finds it difficult to suggest that his patients with similar side-effects might stop their treatment, on the basis that many of them seem to have been programmed that this will result in them having an immediate heart attack. He ends by calling for a full reassessment of statins not least because, in his opinion, their benefits do not appear to outweigh their risks.
Reading this letter reminded me of the fact the ability of statins to cause muscle-related side-effects, and how often it seems to me that these side effects can be missed. Part of the reason for this appears to be that the side-effects of statins can start months or even years after the medication is commenced. Another problem is that there is some evidence that even when patients bring up the possibility of side-effects with their doctor (and there exists scientific evidence to support such a link), the doctor will tend to dismiss the association. It occurs to me, therefore, that if someone is having side-effects such as fatigue, muscle pain and muscle weakness as a result of taking a statin, then they can’t necessarily rely on their doctor for help.
Previously, I have written about this problem, and have discussed the ability of statins to cause the depletion of the nutrient coenzyme Q10 in the body. Lower levels of this substance does seem to be a common causative factor in the common side-effects seen with statins. More importantly, though, is the fact that in practice coenzyme Q10 supplementation very often relieves what can be really quite debilitating symptoms. Not only that, but last year saw the publication of a study which supports the effectiveness of coenzyme Q10 for the reversal of statin-related symptoms. See here for information about this and the recommended dosage of coenzyme Q10.
References:
1. Struthers M. Reasons to be cautious about cholesterol lowering drugs. BMJ 2008;337: a1493-a1493
2. Bamji AN. More reasons for caution with statins and other such. BMJ 2008;337:a1782
