I've got some really motivated patients who have survived heart attacks or have had angioplasties. They listen when I encourage them toward a plant-based diet, they read Esselstyn's book Prevent and Reverse Heart Disease, they read Ornish's books, Mcdougall, Fuhrman, and so on. And then they make changes -- go plant-based, cut out the oil and the animal products, and learn to love things like kale and quinoa.
And then they ask -- I'm eating perfectly. Do I need a statin?
Great question. I'm a big advocate of less being more when it comes to medications, cutting down medication to the bare minimum.
Studies have been done on secondary prevention, that demonstrate that statins reduce risk of recurrent heart attack and can decrease plaque burden in the arteries. That said, so do whole-food plant-based vegan diets. So if you're on a vegan diet, do you need a statin too?
There will never be a study randomizing vegans to a statin or no statin -- it would simply be unethical. My recommendation is, statins are pretty benign medications. Most people tolerate them. I recommend that all patients with coronary artery disease and peripheral vascular disease, regardless of diet, take a statin. A statin has very little chance of causing harm, almost no chance of causing permanent harm, and yet may have benefit.
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I have been vegan (Esselstyn) for 5 years post-arrest/resuscitation, x6 bypass. I run 10k's, race bike time trials and road races and do duathlons. Despite very low lipid numbers, I have been afraid to stop the statin as I have read the studies re pleiotropic effects. I don't have obvious side-effects but wonder whether the statin effects my recovery and ability to generate power on the bike.
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