A clinician reviews the evidence for statins, showing they cut heart attack and stroke risk by roughly 50 percent. He debunks claims they cause Alzheimer's or diabetes, citing meta-analyses of over a million patients, and explains that all statins are now generic, so Big Pharma incentives don't apply.
Topic today is going to be cholesterol medications, and in particular statins, which are very polarizing in this country. So I want to start by saying that statins have been out since approximately like 1986, I believe, is when the first one came out, and I was like an infant. And you'd be very hard-pressed to find any class of medications that have been studied, probably top 5, more than statins. The reason for this is very early on we realized that statins significantly decrease the risk of death from cardiovascular disease, including heart attack or stroke in this country, to the point where the most common data is it's approximately 50% reduction in heart attack or stroke. And in medicine, that is an overwhelming statistic. In medicine, even 10% budge, 5% budge is considered big. 50% is unbelievable. With that comes the general population and Google and the internet saying how awful, awful, awful these medications are. So I'd like to address it, and I'd like to first start by saying we need to be very careful that we don't have something called confirmation bias when we're doing research as doctors, as practitioners, as clinicians, as patients, as the general public. If you already don't want to be on a medication and you start doing research, I promise you, you're going to find something that validates your thought process. But that's not the right way of doing this. Confirmation bias is very real and we all do it. When we're doing research, we really should be looking on both sides, not just searching for articles that confirm what we want to know, because you will find it. Now, when we talk about side effects, a lot of patients say, "Well, statins cause Alzheimer's and statins cause dementia and they can cause diabetes and blah, blah, blah." And that's pretty much been debunked at this point. If you think about it just from a common sense perspective, cognitive decline including Alzheimer's dementia, that typically happens at older ages. Well, what else happens at older ages? Well, inside of our brain, the arteries inside of our brain start to be clogged with cholesterol. We start having more diabetes. We sleep less. We're more depressed. All of these things which can cause cognitive decline or dementia. Now, it just so happens that a lot of patients who are older also are on statins. And why? Because they have heart disease. They've had a stroke. They have high cholesterol. And so we have to be very careful to realize that correlation does not equal causation. Just because they're on the statin doesn't mean that's why they're having the medical problems. They had the medical problems and they're on the medications for other reasons. Most studies verify this. And again, if you're going for confirmation bias, you will find articles to the contrary, but giant, large meta-analysis of over a million— I think it was like 1.1 million people showed that statins do not increase the risk of dementia. They do not increase the risk of Alzheimer's. And if anything, there are studies that look at Alzheimer's patients already diagnosed, and those that were on statins for 3 years actually had a better cognition, something called a Mini Mental Exam, after 3 years than those patients that were not. Something else we need to keep in mind is this idea of Big Pharma. And although I can totally understand that, there's a lot of commercials and things pushing, and, you know, doctors making— think doctors making money off of whatever, but at the end of the day, these medications, if we're just talking about statins, they're all generic. Nobody's making money off of prescribing statins. I wish, but I've never ever ever made money by prescribing anything in my office. I think I've gotten 2 drug rep lunches a year, and truthfully it's just for education. It's a new medication that I want to learn more about and they happen to bring me lunch. But one thing you do have to be wary of, again, is not just research confirmation bias but provider confirmation bias. So if you're a patient and you say, "Nope, I don't want to be on medications," you will find a provider that will agree with you, and you will also find a provider who somehow will miraculously have things to sell you in their office instead of taking the medication. That person is making money by prescribing, not the general cardiologist who makes zilch by prescribing statins. We are trying to save your life. A 50% decrease in morbidity and mortality of cardiovascular disease is the most staggering statistic I've ever, ever, ever, ever seen in medicine. Also, there are different types of statins. There are hydrophilic and lipophilic. Lipophilic means it likes fat, hydrophilic meaning it likes water. Statins that are lipophilic are more likely to cause side effects like muscle cramps than those that are hydrophilic. And so when I'm prescribing these medications, I keep that in mind, just like I keep in mind blood pressure medications, looking at my patient and picking the right medication. Lastly, for people who say, "Oh, well, we need cholesterol. We need cholesterol for brain function." You do, but you don't need an LDL of 120, 130, or 140. If we think about this, look at an infant. An infant's brain is building and growing quicker than at any other stage in our life. New information, they're growing physically, everything's bigger and faster, bigger and faster. So if anyone needs a high cholesterol for brain function, it would be an infant. And an infant's general, like generally, statistically LDL ranges somewhere between 60 and 70. So if an infant does not need a high cholesterol for brain function, I assure you an adult does not. I hope everyone truly listened. I hope everyone does their own independent research. And more than anything, I hope everyone understands that all I'm trying to do is save some lives.
