Study: Obesity is a significant comorbid problem with statins

reference

Sugiyama T, Tsugawa Y, Tseng CH, Kobayashi Y, Shapiro MF. Different temporal trends in calorie and fat intake between statin users and nonusers among US adults: Gluttony in the era of statins?JAMA Intern Med.April 24, 2014. Epub ahead of print.

design

This study involved a repeated cross-sectional design using data from participants in the National Health and Nutrition Examination Survey (1999–2010).

Participant

A nationally representative sample of 27,886 adults age 20 or older

Target parameters

A linear model was created to calculate calorie and fat intake. Changes in body mass index (BMI) between statin users and non-statin users were also measured.

Key findings

Statin users consumed 192 more calories per day in 2009 to 2010 than in 1999 to 2000. This increase in calories was associated with a weight gain of 6 to 11 pounds over the same period. No significant changes in eating habits or weight gain were observed in non-statin users. During 2009 to 2010, calorie intake was 9.6% higher for statin users (P=0.2) than in the period 1999 to 2000. In the same period, no significant changes were observed in the non-user group. Over time, fat intake increased by 14.4% in statin users (P=0.007), but did not change for non-users. The BMI increased by 1.3 in the statin users and only 0.4 in the non-user group (P=0.02). These new findings suggest that BMI increased more quickly in the group of people taking statins than in the group not taking statins. It also shows that over time, calorie and fat intake increased in people taking statin drugs.

Effects on practice

There is overwhelming scientific evidence that elevated cholesterol and triglyceride levels significantly increase the risk of death from cardiovascular disease. However, it is important to note that more than half of the people who die from a heart attack or stroke each year have low to normal cholesterol levels. This fact has led to more intensive lipid-lowering strategies with statins to reduce low-density lipoprotein cholesterol to even lower levels. The statin debate is about risk vs. benefit. It has long been known that statin medications have many side effects, including:¹

• Statin-induzierte Myopathie und Rhabdomyolyse, die tödlich sein können
• Hepatotoxizität und verminderte Leberfunktion
• Neuropathie: Das Risiko einer Nervenschädigung ist bei Statinkonsumenten 26-mal höher als in der Allgemeinbevölkerung
• Beeinträchtigte geistige Funktion bei längerem Gebrauch
• Möglicherweise erhöhtes Diabetesrisiko, insbesondere bei Frauen
• Erhöhte Muskelschädigung durch körperliche Betätigung und verminderte körperliche Leistungsfähigkeit
• Verschlechterung des Energieniveaus und Müdigkeit nach Anstrengung in etwa 20 % der Fälle.

This latest study highlights the potential harm associated with these medications. Obesity is a major comorbid factor in many diseases, including cardiovascular disease and stroke.^2.3And yet, more than two-thirds of American adults are overweight or obese, putting them at significant risk for these diseases—the very diseases that statin drugs are supposed to prevent.⁴

The fact that these drugs contribute to the obesity epidemic is clinically concerning; However, other factors call their use into question. The effectiveness of statin medications has been studied and research shows that statins actually do not reduce the risk of cardiovascular disease in the majority of people taking these medications. A comprehensive literature review published in 2013 by Sultan and Hynes focused particularly on large-scale, randomized, controlled trials and concluded that there is “a categorical lack of evidence supporting the use of statin therapy in primary prevention.”⁵

In November 2013, the American College of Cardiology and the American Heart Association announced expansion of statin usage guidelines, which will certainly lead to even more patients being prescribed these medications.⁶Basically, more Americans will take an ineffective drug with known harmful side effects that are likely to cause weight gain. This is a major disadvantage for patients. Before these medications are used in clinical practice, alternative treatment options should be explored. Additionally, an integrative approach that includes nutritional counseling, lifestyle counseling (e.g., exercise, stress management, sleep), and appropriate nutritional supplements should be used to assist patients in discontinuing statins. This is something patients are already looking for, as 25% of adults taking statin medications stop taking them within 6 months and as many as 60% stop taking them within 2 years.⁷Integrative practitioners can play an important role in supporting this patient population.