Tuesday, August 28, 2007
Another benefit of statins? Not so fast...
This morning, you may read or hear about statin medications (cholesterol-lowering drugs) being shown to ward off Alzheimer's disease. While this could be welcome news for the millions who are at risk of developing the disease, I am urging caution. True, there is some older research that shows people who take statins may be less likely to develop Alzheimer's dementia. But when we investigated, we found that other touted studies like ACT, the Adult Changes in Thought study, found no apparent real benefit of statin medications on Alzheimer's dementia.

So, why all the fuss? A new study, which was supported by the National Institute on Aging, looked at the brains of people who had received statin medications and those who did not. More specifically, the researchers examined the brains of 110 people aged 65 to 79 after they died. They did find fewer of the tangles and plaques that are so often thought to be a sign of the memory-robbing Alzheimer's disease.

Still, no doctor is likely to be ready to prescribe statin simply for the purpose of preventing dementia. There are a few reasons. First of all, this study was rather small and it also wasn't randomized, meaning a population of people on statins wasn't directly compared with a group not on the medications. It is also important to remember that statin medications, like any drug, could have side effects. Some of the ones to watch out for are muscle pain, liver problems and nausea.

Statin medications are a multibillion dollar business. It seems the makers of these drugs are constantly coming up with new uses for them. What are your experiences with these medications? Did they work and did you experience any side effects? Would you take them to try to prevent Alzheimer's dementia?
My maternal grandmother, and my mother, both died of Alzheimer's Disease. My brother, who is 4 years older than I am, is showing signs of it. I have made an appointment with my doctor to see about going on statins. I will do anything possible to avoid getting this disease, which I consier the worst thing that can happen to a person.
Wasn't it just a couple of years ago that the latest info on statins was that some people taking statins seemed to have an INCREASE in forgetfulness? It seems that many patients were saying that they became more forgetful while taking statin drugs (and I know some people to whom this happened). I believe the companies refuted the information, stating that the addition of statins and the onset of forgetfulness was coincidental, and there was also disagreement among physicians as to the reliability of the information. I think it would be wonderful if new information (of any kind) could not be released until a standardized study was completed, and the statistics were also standardized. Sometimes if there is 12% fewer results (or even less), the study will be announced by the media as if it is an incredible breakthrough in information. I, for one, will wait until it is a consistent finding of several studies.
I have been taking statins for 2.5 years. Beyond initial muscle soreness, I've not had any other side effects. Strokes and heart disease, both, run in our family, without any occurances of Alzheimers. If taking statins offer any other benefits ... I see no reason not to investigate this study further.
Dr Gupta, thank you so much for your thoughtful and insightful comments. I have been reading yor blog for some time and get better medical advice here than just about anywhere else. I am a young woman, 26 years old, and I dont worry about Alzheimer's as of yet. Please do keep us informed about any new developments on this front. Thanks again and God Bless you.
Dear Dr. Sanjay Gupta,

The use of Statins to prevent Alzheimer's dementia is bad news.
Someone already with a beginning stage of dementia should should get a prognosis to be sure whether it is really caused by Alzheimer.
There are other types of psychotropic drugs, micro-nutritional apporaches, etc. to tackle the disease.

Statins drugs, such as Lipitor, Crestor etc. work directly on the liver to block an enzyme involved with cholesterol production. Because Statins reduce inflammation, it slows down dementia, but only a few studies have confirmed this.

If a senior has high cholesterol, heart problems and high blood pressure (inherited), I would say go ahead an use Statins.

But to prevent Alzheimer's dementia specifically, I would not recommend Statins on myself or anyone else.

Drug companies don't sell medicine to heal, but -according to the way they advertise their drugs- they sell happiness and life in a pill.
Dear Dr. Sanjay :D

Thank you very much for helpful information.

My mom underwent open heart bypass surgery. April 26, 2001.
The very thought of the terrible surgery makes me tremble. That's true. I have a great interest in her health since then.

My mom's doctor said that taking statin medications daily will lower blood cholesterol levels by up to 40 percent.
Saturated fats can contribute to the buildup of plaque inside arteries and raise blood cholesterol levels.

I didnt's know that statin medications have such side-effects as nausea, muscle pain and liver problems. But in case of my mom that kind of side-effects are not seen yet..... so I have to watch it in the future.

Taking drugs is one of the biggest problems in our modern society. We should challenge to medicines on the negative side.

Sadly medicines for human beings are two-faced. One is curing functions of diseases and
the other one is side- effects. :(

Thanks a lot. I'm absolutely enjoying your blog. Take care and
God bless you..... ^^
Dr. Gupta,
Thank you for your warning about statins. I took them for a few months and the pain in my legs and feet became unbearable.
I don't believe anyone should take these drugs unless no other method works to lower cholesterol.
I think you hit the nail on the head with these sentences, Dr. Gupta: Statin medications are a multibillion dollar business. It seems the makers of these drugs are constantly coming up with new uses for them. People need to be wary of the promotion of miracle drugs whose patents have expired, which means the manufacturer has a very high incentive to find a new indication for their use to allow them to apply for a new patent. A few important things to think about when analyzing this new study:

This was not a study of people in the general population taking statins to determine their impact on Alzheimer’s disease. This study looked at people prescribed statins for high cholesterol as a part of their routine medical care. People who take statin medications for high cholesterol are not by-nature similar to the general population, so this study cannot be taken as evidence that statins should be prescribed to the general population. What this study says is that people with high cholesterol who chose to take statin medications were less likely to have some of the pathological markers of Alzheimer’s disease, determined post-mortem. There is some evidence in the literature that high cholesterol levels are associated with increased Alzheimer risk, so statin use in this population would decrease Alzheimers risk by reducing cholesterol level. Again, this effect would be specific to a population that is at-risk for Alzheimers because of something that can be directly improved by statins (cholesterol).

Dr. Gupta was correct to point out this was not a randomized trial and that has serious consequences for interpreting the results. When you aren’t randomizing, you have to be very careful to control for every possible confounder to make sure your results are not actually an effect of something different between the two groups at baseline. There are a handful of things within the high-cholesterol population that correlate with Alzheimer’s Disease that do not appear to have been controlled for in the newest study. One of these things is smoking, which is associated with both high cholesterol and a higher incidence of Alzheimer’s Disease. The positive effect of statins that appeared in the data may be due to baseline differences in smoking (or some other covariate) between the statin and non-statin groups.

There are some animal studies suggesting that statins impact neurons associated with Alzheimer Disease at the receptor level. However, this most recent epidemiological study certainly offers no evidence of a causal relationship between statins and Alzheimer’s Diease or that statins would be beneficial to anyone taking them. More research is needed and this is stated very clearly by the authors of the study in their abstract: "Additional study is needed to examine whether statin use may be causally related to decreased development of Alzheimer disease-related neuropathologic changes."
The research article points to several limitations of the study including:

"The overall lower mortality rate in the statin users (19%) compared to the nonusers (26%) could reflect either a statin-induced reduction in mortality or differential mortality due to treatment indication (for example, statin treatments may have been withheld from more medically ill subjects). Because statin use may thus be related in multiple ways to mortality, and because the assessment of Alzheimer's Disease neuropathology can occur only after death, the possibility of confounding is substantial. Thus, our findings should be extrapolated to living populations with the greatest caution, if at all."

The article also goes through a summary of previous studies that showed no effect of statins on preventing AD or on preventing progression of AD.
Dr. Gupta,

As one of the researchers who conducted the recent study on statin drugs and brain changes associated with Alzheimer's disease, I want to clarify some information in your column.

First, we hope readers understand that our research is not funded by drug companies. It is supported by the National Institute on Aging, which is part of the federal National Institutes of Health.

And second, you have cited our earlier study (we are the ACT team) that showed no benefit of statins on dementia. However, with more years of follow-up, we did find that statin therapy is significantly associated with a reduced risk of developing Alzheimer’s disease, particularly among younger persons.

As you know, medical advances often happen one small step at a time, and sometimes individual studies contradict each other. Over time, researchers try to put such puzzle pieces together, and occasionally we discover that our findings connect in surprising and newsworthy ways. We feel this is true of our study of brain tissue. But just because a discovery is news does not mean it's time for doctors and patients to change the course of care.

You are absolutely right that it is too early for doctors to recommend statins to prevent or treat Alzheimer's disease. Much more research is needed. Fortunately, there are randomized trials now underway, so we may have more definitive results relatively soon. In the meantime, our team is not making any recommendation regarding treatment based on this study.

But there are things people can do to reduce their risk. First, stay physically active. According to research that our group published last year, regular exercise is associated with a delay in the onset of dementia and Alzheimer's disease. We discovered this by following 1,740 members of Seattle’s Group Health Cooperative, aged 65 and older, for six years. We found that people who exercised three or more times a week had a 30 to 40 percent lower risk for developing dementia compared with those who exercised less. In another study last year, we found that higher levels of physical function may be linked to delayed onset of Alzheimer's. There's also growing evidence that other lifestyle factors, such as being engaged in social networks and participating in mentally stimulating leisure-time activities may delay onset of Alzheimer's and the general decline that occurs in old age.

The bottom line: Stay active physically, socially, and mentally. And if you have a chronic condition like high blood pressure, high cholesterol, or heart disease, be an activated patient. Learn about your condition and take care of it with the advice of your doctor.

Thanks for your interest in our research.

Dr. Eric B. Larson, Group Health Center for Health Studies, Seattle
You have got to be kidding. I am a 48 year old male, who acknowledges that I should be on statins, but after trying 4 statins and statin combos found the side effects so debilitating that I had to quit. The side effects were : sigificant weight gain ( 18 lbs on a 5' 8" frame), muscle soreness, lethargy and depression.My doctors tended to deny the validity of the effects. Now I just eat right, work out a lot and hope for the best.
perhaps a quarter teaspoon of Snake Oil daily would be just as medically sound.
Everytime I have taken statins I feel as if I am crippled, can hardly walk. Legs and feet hurt so I stopped taking them. Just wondered if anyone else had the same problem. Took me awhile to connect them.
Many readers have commented on the side effects of statin therapy for hypercholesterolemia and many of their concerns are valid and need to be addressed. With any medical intervention, the doctor and patient must evaluate the benefit of instituting a particular therapy with the costs associated with its use (physical, mental, financial, etc). For some patients, the muscle pain associated with statin use is an acceptable side effects, for others it is not. One decision is not intrinsically better than the other and it is up to the individual patient to determine what is acceptable and what is not.

With that being said, there is good evidence to link Alzheimer's with a protein called ApoE, a protein involved in the transport of cholesterol in the bloodstream. A particular mutation (the E4 form) in the ApoE gene seems to lead to an increased risk of developing Alzheimer's plaques. Indeed, some authors have gone to name ApoE-4 as the main precipitating factor in the formation of the plaques. Therefore, it's conceivable that medical alterations in ApoE-4 function by way of statins could change the propensity for it to form the Alzheimer's pathology. Whether statins will prove a valuable tool in preventing Alzheimer's, its too early to tell. The possibility is interesting nonetheless.
Americans deserve information regarding red yeast rice.

Red yeast rice can provide statins with somewhat reduced risk.

Over-the-counter red yeast rice derivatives do not contain statins. These products have no cholesterol lowering potential.

Red yeast rice containing statins became regulated due to big pharma, and can only be obtained with a prescription.

Red yeast rice is not a panacea, but America is essentially denied this ancient potential remedy. Many statin drugs derive statins from, what? Red yeast rice.
I have a condition know as temporal arteritis. I have been on prednisone for 2 years ( I relapsed after a year). I would like to know how common this is. I get the feeling because it happens mostly to women, over a certain age it does not get much notice. I want to get off so much medication. Any info would be very helpful.

Thank you.
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