Monday, September 29, 2008

A Bright Side to Statins

In my earlier post, The Dark Side of Statins, I mentioned research indicating that statins may impede muscle repair. This latest finding claims that statins promote DNA repair enzymes and in so doing help protect the endothelium(inner lining of the blood vessels). The enzyme here is one involved in repairing what are referred to as "double strand breaks". These types of breaks are very damaging to the chromosomes because with the breaks bases fall away from the ends of the chromosome, so the more quickly this and other enzymes are brought into play the better the outcome. The news release can be read here.

It is important to remember that this study addressed the health and aging rate of cells in unhealthy arteries, which tend to age much faster than healthy arteries. Whether or not this statin will confer any substantial benefit to those with healthy arteries is a different question. Given the evidence that statins can induce side effects such as impaired muscle repair and there is also some evidence of cognitive issues arising with their use, there is little sense in advocating wide scale statin use for the general public. Remember the wonderful aspirin? Or how about the wonderful NSAID drugs, which turned out to be killing people and causing all manner of problems? These are great drugs but these are drugs to address specific pathologies and even then the long term use of the same may create more problems than those apparently solved.

We need to exercise some caution here. There is an emerging view that vast numbers of the public should be placed on statin drugs yet the real reason for this is because vast numbers of the public are leading lives destined to induce atherosclerosis and a host of other ailments. Claims that simply popping a statin will stave off the consequences of a poor lifestyle, even if these do have some validity, must be set against the enormous costs of drugs, the known side effects of drugs, and the unknown long term consequences of drugs.

All developed countries are faced with a number of huge health related issues. Health costs are out of control, hospitals are over crowded, and with an aging population the health burden is going to increase. We would all like to have our cake and eat it too. Eventually we will be forced to eat an apple, go for a run, and hopefully the medicine cabinet will remain empty for a very long time.

If you wish to maintain a healthy heart and cardiovascular system there is no great secret. It is as simple as regular light exercise, even just brisk walking, avoiding all drugs, legal or otherwise(excepting a couple of glasses of red wine with the evening meal), good stress management skills, and a healthy diet. Yeah, that's simple, but why can't I do it?


Anonymous said...

purely anecdotal, now know 7 individuals who have developed parkinson's disease to which they attribute(d) to having taken Lipitor for years. Dr. Xuemei Huang, MD, UNC Chapel Hill NC , has proposed a clinical trial to determine if statins 9esp lipophilic ones which easily cross the blood brain barrier) are positively associated with the onset and or worsening of Parkinson's. several studies have now show a potitive correlation between low cholesterol and Parkinson's disease 9and also low cholesterol and death).

John said...

Hi Ariel,

Statins inhibit HMG CoA, a rate limiting enzyme for the production of co-q10, a very important molecule in the electron transport chain that can act as a strong anti-oxidant. It is advisable that anyone taking statins should also take co-q10 supplements. In Japan this is often standard practice but uptake of this practice is slow elsewhere.

There has long been an assocation between mitochondrial dysfunction and Parkinsons Disease. In animal studies you can induce Parkinsons by administering some pesticides that are mitochondrial toxins,
rotenone is a prominent example.

However a recent paper, some notes of which I posted a few days ago, suggests that mitochondrial dysfunction is a consequence, not a cause of Parkinsons. It doesn't settle the question because mitochondrial toxins can induce Parkinsons disease.

Cholesterol is very important for the brain. Up to 20% of myelin, the fatty sheath that surrounds axons, is composed of cholesterol and cholesterol helps stabilise cell walls. Sometime ago there was a study which produced a paradoxical result, for elderly individuals, those 70 and over, raised cholesterol seemed to confer an advantage.

I have heard about the low cholesterol - depression linkage before but never investigated it.

It is a vexed issue and a problem here is that because statins are now so widely used and do save a great many lives there is a reluctance to look at the dark side of statins. This is very worrying because there is now considerable pressure to make statins widely available, in Britain there are even over the counter statins available. I think this is very dangerous.

Thanks for the reference, this is another piece to the puzzle.