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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.


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.