Question:
Do Statins really improve the risk of coronary artery disease?
Answer:
A paper published in this issue of the Annals of Internal Medicine, reviewed the association of statin therapy and cardiovascular outcomes, but found little difference between treated and untreated patients. As the current focus of statin therapy is to reduce low-density lipoprotein cholesterol (LDL-C), rather than increase high-density lipoprotein cholesterol (HDL-C), the conclusion was that persistent low levels of HDL-C may be responsible for ongoing risks of cardiovascular events such as myocardial infarction (MI) and cardiac death.
The ARBITER 6 trial that compared Niacin with Ezitimibe came to the same conclusion in 2009.
Perhaps however, this strengthens another point I made at the time in a previous blog: An atheromatous plaque, once present, will take a lifetime to resolve if such a thing is indeed possible (I think of this as too little, too late). Rather, I believe it is more likely that progression of atherosclerotic disease can be slowed or even stopped with judicious use of Optimal Medical Therapy (OMT). Improving HDL may well play an important role in accelerating this process. What these studies do not take into account are the side effects (flushing, itching and stomach upsets) that frequently accompany the high dosages required.
Let me know what you think,
Dr T