Do Statins Work for Everybody? A UCLA Cardiologist Weighs In
For people with high cholesterol or increased cardiovascular risk, statins seem to be a common answer. Yet a heart doctor explains why this particular treatment might not work for everyone.
According to the Centers for Disease Control and Prevention (CDC), nearly 94 million U.S. adults ages 20 or older have high cholesterol levels. The CDC also mentions that 54.5% of U.S. adults (around 47 million) with particularly high numbers could benefit from cholesterol medication. In many cases, statins are a go-to medication that healthcare professionals prescribe to patients with higher cholesterol levels. Yet the research around widespread statin use for lowering LDL “bad” cholesterol levels is continually up for debate.
A recent 2022 study review found the evidence to be “weak or inconsistent,” while another 2022 evidence report evaluating 26 different studies found statin therapy as primary prevention reduced all-cause mortality and cardiovascular event risk. It seems statin use for a patient is based on a case-by-case scenario.
The Healthy @Reader’s Digest spoke with Dr. Norman E. Lepor, MD, FACC, FAHA, FSCAI, an attending cardiologist at Cedars-Sinai Heart Institute and a professor at the David Geffen School of Medicine at the University of California in Los Angeles (UCLA). Dr. Lepor weighed in on why statin use doesn’t always work for everyone, and what the current research suggests are the most successful treatments for high cholesterol.
Why is it not recommended for everyone to use statins?
In recent years, statins have been widely recommended for adults to prevent major cardiovascular events, but recent research has found that it actually isn’t wise for everyone to take them. According to 2021 research published in the British Medical Journal, while statins are widely used to prevent heart disease, there can be some side effects. Those statin side effects can include muscle pain, liver and kidney problems, and certain eye conditions.
However, the researchers clearly stated that for people with existing heart disease, the benefits of using statins far outweigh the risk of these effects. But for people without a history of heart disease who were looking for healthy steps to take for primary prevention (that is, prevention before any risk of heart disease occurs), the benefit-to-risk ratio for statin treatment was less favorable.
Plus, statin therapy requires patients to take a pill on a regular schedule, which can be difficult for people in some circumstances. This is one reason Dr. Lepor offers another possible solution to his patients.
Researchers have found easier risk-preventing alternatives.
“Statins actually block the enzyme in the liver that leads to the synthesis of cholesterol, and this leads to a reduction of cholesterol by virtue,” says Dr. Lepor. “But what’s interesting is the liver has its own appetite for cholesterol; it likes to maintain the cholesterol levels within it. So when you slow the liver’s ability to synthesize cholesterol, it actually has a receptor that brings in more LDL cholesterol.”
In addition to recommending a daily statin pill, Dr. Lepor will recommend a medication that patients only have to take twice a year (after an initial injection and another at three months in the first year) called Leqvio, which actually removes a particular protein known for blocking the liver from collecting LDL cholesterol. “It’s pretty interesting, because [unlike statins], it is a medicine that an HCP administers twice a year,” he explains. “So one of the problems we have with cholesterol modification is people stop taking their drugs. But what’s nice about a drug you only have to take twice a year is that you certainly resolve some of the issues with a patient being compliant.”
The PCSK9 protein regulates how many LDL receptors the body has. So if you have a high PCSK9, then it’s more likely you’ll also have high cholesterol. Dr. Lepor explains that the antibodies developed by researchers—known as PCSK9 inhibitors—attach themselves to the protein and remove it from having activity.
Curious if you are eligible for a PCSK9 inhibitor treatment? Be sure to talk to your doctor about your cholesterol levels to better understand your heart risk and develop a medical plan that works well for you.