Statins for everyone?

Should you take a statin to prevent heart disease?

Should you take a statin to prevent heart disease?

Preventing a disease, before it occurs, seems intuitively obvious. But when it comes to taking medicine to prevent a disease before it occurs, people tend to be much less comfortable. Not only are there the concerns about the “medicalization” of healthy people, there are good questions about benefits, risks (like side effects), and costs. Cardiovascular disease will kill many of us, so there’s been decades of research studying how to prevent that first heart attack or stroke. But even if you’re born with good genes and do everything possible to prevent heart disease (e.g., don’t smoke, exercise regularly, eat a healthy diet, moderate your alcohol, and keep your weight down) you’re still at risk of heart disease. And if you have one or more risk factors for disease, your lifetime risk goes up dramatically. Once you’ve had your first heart attack or stroke, the effectiveness of medical therapy has been established. Drug therapy with medication like the “statins” class of cholesterol-lowering drugs reduces subsequent deaths from cardiovascular disease. Given their unambiguous effectiveness, and the high likelihood that many of us will eventually have cardiovascular disease of some sort, the idea of “pre-treating” otherwise-healthy people with drug therapy to possibly prevent that first event has been held out as a potential public health strategy. There’s new evidence that tests this hypothesis, and the results are surprising. Continue reading

Does Coenzyme Q10 Relieve Statin-Induced Muscle Pain?

Editor’s Note:

Today’s guest post is from a pharmacist who blogs under the pseudonym Avicenna, who looks at the evidence supporting the use of Coenzyme Q10 to treat statin-related muscle pain.

My pharmacy stocks plenty of natural health products (NHPs) and ensuring they can be used safely is challenging, given the limited information available on safety, quality, purity, and efficacy. Answering patient questions is always interesting and often very challenging, as they can often be non-specific. A typical question like “Is product ‘X’ good for treating condition ‘Y’?” can be difficult to answer without gathering some further information.  My usual response is, “Let’s talk about this. I want to make sure I give you an answer that is right for you, given your medical conditions.”

I recently spoke with a patient taking atorvastatin (Lipitor), a cholesterol-lowering medication from the “statin” family, who was complaining about muscle pain, and asking about Coenzyme Q10 (CoQ10) for treating that pain. Treating or preventing statin-related muscle pain is a common question, given the popularity of statins and the frequency of the complaint: About 1 in 15 develop this symptom. Before diving into the efficacy of CoQ10, let’s review statins.

Statin Benefits

If you have high blood pressure, are overweight, diabetic, or sedentary, you should know your cholesterol levels: Keeping them in the normal range will lower your death risk in the short and long term.[1] If you need drug therapy to reduce your cholesterol levels, you’re probably on a statin. Statins are a class of highly effective cholesterol-lowering drugs that work to inhibit HMG-CoA [3-hydroxy-3-methyl-glutaryl-CoA] reductase. Statins work by lowering cholesterol points (e.g., low-density lipoprotein (LDL), triglycerides) and/or moderately increasing good cholesterol (i.e., high density lipoprotein (HDL)). High levels of “bad” cholesterol is a contributor to heart disease and other negative cardivascular outcomes. It clogs the arteries that feed oxygen to the heart, and is involved in the process of blood clot formation. Continue reading