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Wednesday, April 30, 2014

Pass the Fried Chicken, I'm on Lipitor!

It is true that statins have been shown in randomized controlled trials to reduce the risk of a first cardiovascular event.  The number of patients needed to treat to prevent one event is relatively high, as I have previously discussed, but it is true that there can be a role for statins in primary prevention.

The problem is that the real world doesn't function like a clinical trial.  People who are on a statin know that they are taking a medication with the purpose of lowering their cholesterol.  An important question that I've wondered is, how much does knowing that one is taking a statin affect behavior?

Anecdotally, I can tell you I've had conversations with patients in which they have rationalized less than ideal diet choices by stating that they are taking a cholesterol-lowering statin.  Or more blatantly, the person who goes out for a decadent dinner and then doubles up on his statin dose.

Source:  kevinmd.com

There is a study that was published in JAMA Internal Medicine this week on that subject.  This was a retrospective study looking at the caloric intake of statin users and statin non-users.  The study found that statin users increased their caloric intake by 9.6% and fat intake by 14.4% over the course of the ten year period studied, while non-users had no significant change in caloric or fat intake over that time.  Further, the statin users' body mass index (BMI) increased by 1.2 kg/m2 during that time, while the non-users BMI increased by only 0.4.

So, the increased calorie and fat intake and weight gain of a statin user may negate much of the beneficial effect of the statin medication.

What's a clinician to do?  I think it's important that we make sure our patients realize that a statin medication is not a carte blanche to eat whatever and however much they want.  But I think we also need to be judicious in choosing who we put on a statin as well, and make sure that their risk is appropriate to justify the statin prescription.

2 comments:

Unknown said...

People who don't follow a strict cholesterol diet and double the dose of statin instead...forget that following the diet and exercise are basics to be followed to keep the level of bad cholesterol in control.

edwardhoward said...

Took Lipitor 20mg for about 5 years. It kept my lipids under control well, but developed severe leg aching and muscle cramps, especially at night. Went off it and within a week, all these reactions disappeared.