We live at a time where pharmaceutical use is unprecedented.  Whether it is a proton pump inhibitor for heartburn or a statin for high cholesterol, most Americans over the age of 50 are on one or more of these drugs.  Everything has side effects.  Everything from a cup of coffee to a beta-blocker, there is no exception to the rule.  Why it is we do not question the long term safety or unintended effects of drugs more closely is sometimes inexplicable.

While many individuals do require some type of pharmaceutical intervention to correct an imbalance, there are many others using potentially health-damaging drugs that do not clearly benefit from their use.  Statins rank high on this list.

What we know is that while statins do lower cholesterol, they tend not to change the quality of the cholesterol that is in circulation.  Small dense LDLs are the ones we need to be concerned with and large buoyant LDLs are the ones that protect us from heart disease.  Unfortunately statins cannot change the percentages of these as part of our total LDL population.  Furthermore, the past few years have seen more research question the safety of lowering a population’s cholesterol in the first place.

Ravnskov U, Diamond DM, Hama R, et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open. 2016;6(6):e010401. doi:10.1136/bmjopen-2015-010401.

Now there is an effort to prescribe statins for young children.

Wagner J, Abdel-Rahman SM. Pediatric Statin Administration: Navigating a Frontier with Limited Data. The Journal of Pediatric Pharmacology and Therapeutics : JPPT. 2016;21(5):380-403. doi:10.5863/1551-6776-21.5.380.

Statins inhibit the body’s production of cholesterol, systemically, by interfering with the HMGCoA reductase enzyme responsible for its synthesis.  Unfortunately cholesterol is needed by most of our body’s cells and organs, most notably our heart and skeletal muscle.  Numerous studies have now shown that individuals taking statins are more likely to suffer from cardiac or skeletal muscle mitochondrial myopathy.  Cardiac and skeletal muscle myopathies are conditions where the lack of cholesterol in these highly metabolic tissues prevents the mitochondria from functioning properly and can ultimately cause long-term damage.

Gluba-Brzozka A, Franczyk B, Toth PP, Rysz J, Banach M. Molecular mechanisms of statin intolerance. Archives of Medical Science : AMS. 2016;12(3):645-658. doi:10.5114/aoms.2016.59938.

It might be time to step back and think about how physiologically important cholesterol is to both the aging brain and the developing brain.  Statins may have their place in treating some individuals who have unique lipid disorders or where lifestyle change has not been effective.  Recommending them for those with cholesterol levels over, what looks more and more like an arbitrary number, 200 mg/dL without other serious risk factors or signs of imbalance, must be questioned.

John Bagnulo MPH, PhD. - Director of Nutrition