Should I Take a High-Dose Statin?

In 2004, before and after the NCEP issued its guidelines, questions arose about high-dose statins. In one of the studies that the NCEP cited as evidence behind issuing the lower optional LDL goal for people at the highest risk, the people who got their LDL levels below 100 were taking a high-dose statin.

That led many people to start wondering if they should take the same. My philosophy is that it’s safest to start on the lowest dose that you and your doctor think will give you heart benefits and then adjust upward if need be. Why? The higher the statin dose, the higher the risk of side effects.

Though statins are prescribed for their cholesterol-lowering power, as more people take them, we’re finding that they may help with other things, too. Doctors won’t prescribe statins for any of the following problems just yet, but that may change in the future.

  • Alzheimer’s disease. A series of observational studies has linked statin use with a reduced risk (of 39 percent to 74 percent) of Alzheimer’s disease and other forms of dementia. Because damage to blood vessels can cause agerelated memory loss, it makes sense that lowering cholesterol may help prevent it.

And the drugs may even protect brain cells as well as the arteries that nourish them. A 2002 German study indicates that the statins can enter these cells, affecting cholesterol metabolism in the brain itself. Scientists speculate that the statins may even reduce the brain’s production of beta-amyloid, the protein that causes much of the damage in Alzheimer’s disease.

  • Cancer. A number of studies have shown that statins might prevent colon and prostate cancers. Others have suggested an increased risk of breast cancer linked to statin use, and still others have shown no effect. Though the evidence is obviously far from conclusive, researchers have come up with a few theories of how statins might stop some cancers.

One is that statins stop activation of the proteasome, a complex of enzymes that chops up proteins like a little cellular garbage disposal. If the proteasome isn’t working right, the garbage piles up, and the cells die off instead of proliferating.

Other research suggests that statins block various “go” signs in intracellular signaling pathways that rev up cancerous cell division. And sometimes their good old cholesterol-lowering effects may come into play. A study published in 2003 found that statins kill off the acute myelogenous leukemia cells that seem to need high cholesterol levels to survive.

  • Multiple sclerosis (MS). A small study indicated that an 80 mg dose of simvastatin may reduce the progression of multiple sclerosis in people with a kind known as relapsingremitting. Researchers think statins’ power to fight inflammation might be the reason behind this finding.
  • Osteoporosis. In animal experiments, statins helped form new bone. Several studies in people suggest that these drugs may prevent osteoporosis and broken bones. However, others haven’t shown the same effect.
  • Kidney function. A large 2004 study indicated that the kidney function of people with heart disease and high cholesterol declines as time goes by. Patients in the study treated with a statin, however, didn’t see this decline. What’s more, those whose kidney function was starting to decline saw a reversal of this development.
  • CRP levels. It’s known that statins lower C-reactive protein levels. Keep in mind that we’re still not sure whether lowering them helps combat heart troubles.
  • Stroke. A few studies have noted the 25 percent lowered stroke risk that comes along with taking a statin. Some strokes are caused by changes in the walls of the arteries leading to the brain similar to the changes in the arteries to the heart that cause a heart attack. Statins’ effects on the arteries may be the same whether they’re in the heart or brain.
  • Peripheral artery disease. An effect of narrowed arteries, this disease causes cramps, numbness, or tingling in the legs and buttocks when a person walks. In a study of almost four hundred people with peripheral artery disease, people who were taking a statin could walk farther and faster without problems than those who weren’t.
  • Other heart benefits. Aggressive cholesterol-lowering therapy, with or without statins, has also been shown to slow the buildup of fatty plaque inside arteries and even, in some cases, to reduce it. Statins may also stop the buildup of calcium deposits on the heart’s “exit valve.” Known as aortic stenosis, this narrowing can cause chest pain, dizziness, fatigue, and breathlessness.