Dr. John Moran explains when it is really necessary to resort to statins.
1.8 million people in England alone currently take statins and they are the most widely prescribed class of drugs, and the most expensive item on the NHS drugs bill, costing over £700m a year.
Statins are drugs used to lower cholesterol and reduce the risk of stroke or coronary heart disease. They work by blocking cholesterol production in the body through inhibiting an enzyme called HMG-CoA. They may also help the body reabsorb the plaque which has accumulated on the artery walls, preventing the life-threatening blood clot which could lead to a stroke or heart attack.
One clinical trial concluded that statins reduce the risk of developing coronary heart disease by around a third, if taken over a period of three years.
Sounds too good to be true? Some medical experts think so.
By blocking the HMG-CoA enzyme, statins not only deplete the body of cholesterol but also the beneficial natural substance, co-Enzyme Q10, an antioxidant and cellular energiser which is present in healthy hearts.
Statins also have potential side effects, ranging from the moderate to severe. Moderate symptoms include nausea, diarrhoea, constipation, lack of sex-drive, and muscle aching; severe side effects are an increase the production of liver enzymes which can eventually damage the liver, and severe muscle pain and tenderness (statin myopathy).
In severe cases the muscle cells can break down and release a protein called myoglobin into the bloodstream. Myoglobin can impair kidney function and lead to kidney failure.
Last year, plans were outlined to make statins available over the counter from pharmacies, and in January this year, the National Institute for Clinical Excellence recommended that GPs prescribe statins to anyone with a 20 per cent chance of having a heart attack or stroke over the next ten years. Many GPs have voiced concerns over this suggestion, including Dr John Moran.
Dr Moran of the Holistic Medical Clinic in London’s Wimpole Street began his career in the early 1970s in dentistry, before moving to the Medical Commission in 1979. He then became interested in women's hormonal health and worked at Mary Stopes for seventeen years, training in psychosexual and sexual medicine. He has since become interested in the role of nutrition in health care, and last year finished his post graduate masters in nutritional medicine.
"I have concerns about people being able to buy statins over the counter without supervision, because I think in many cases there are much better ways to lower cholesterol."
"The patient won't have been given any advice from their GP, the pharmacists won't know their family history, and how can you tell what their blood pressure is? But, if people are in a high risk category - by that I mean if they are overweight, they smoke, have high blood pressure, atherosclerosis, or a history of coronary heart disease - then they very much need to go on to statins because the track record of what they do is extremely good."
Dr Moran says it is people who have no high risk factor who should first try alternatives to statins.
"People with marginally high lipid profiles - by that I mean their total cholesterol is over 6 and their LDL is over 4 shouldn't necessarily resort to statins."
"The first line of treatment in my opinion, should be with diet and exercise. If this does not work, then they should resort to statins, but we should not be advocating them as the first line of defence in people with no high risk factors."
"My concern is not about the correct NRC guidelines, my concern is that people who do not have any of the high risk factors help themselves to a statin when they are better off looking at nutritional things that can help, in particular the Mediterranean diet."
"Statins have two reactions. They work in the liver by lowering the amount of cholesterol the liver actually produces. Their other is anti-inflammatory, stabilising unstable plaque in the arteries. But nutritional substances can also do this. Fresh garlic is one of the best natural anti-inflammatories, as are essential fatty acids such as cod liver oil and flax seed oil. Many natural antioxidants also have anti-inflammatory action, as do probiotics which help feed healthy gut organisms, oats and soya. As far as lifestyle is concerned, regular exercise and no smoking is very important."
"Often, gut health affects liver health. Your gut is the seat of your immunity so if you have an unhealthy gut, then prebiotics are in order. Prebiotics are foods such as asparagus, artichokes and onions. I know you can buy probiotics yoghurt drinks, but out of the millions of bacteria in these products, only 5% survive by the time they reach your colon, so either eat natural sources of prebiotics, or take a good quality supplement."
The other issue which Dr Moran doesn't think is being adequately tackled sufficiently is the evidence that statins affect the body's production of co-Enzyme Q10.
"If people do have to go onto a statin, they really ought to take co-Enzyme Q10, which is depleted when you take statins."
"It has been a bone of contention with a few people as to whether they is any evidence to show that co-Enzyme Q10 is depleted when taking statins. However, several studies have shown this to be the case, and the symptoms of a lack of co-Enzyme Q10 are muscle cramp and muscle pains, which are very common when people go on to statins."
"My wife has got familiar hypocholesterol and she is on a statin quite rightly, and she gets muscle cramps if she doesn't take co-Enzyme Q10 too."
"In Canada and the States, but in particular Canada, most stains are taken with co-Enzyme Q10 as a matter of course. In this country you can get co-Enzyme Q10 prescribed on the national health under its proper name, but patients will have to ask their GP about it."
Rachael Hannan: 2006
Published on 50connect.co.uk