Overprescribing Statin Drugs

I recently met with a new primary care physician. At the close of the appointment, the doctor ordered a lipid panel to check cholesterol levels. After the results were posted, his nurse called to report that the doctor had prescribed a statin (cholesterol-lowering) drug that he would like me to start right away.

There was no discussion and no further testing. 

What was this horrific cholesterol level that prompted such an emergent response? Here are my results paired with the standard range in parentheses for reference:

Total cholesterol: 285 mg/dL (< 200 mg/dL)
Triglycerides: 69 mg/dL (< 150 mg/dL)
High-density lipoprotein (HDL): 77 mg/dL (> 40 mg/dL)
Low-density lipoprotein (LDL): 194 mg/dL (< 99 mg/dL)
Cholesterol to HDL ratio: 3.7 (3.5—5.0)

The metrics considered elevated are LDL, the so-called “bad” cholesterol and total cholesterol. The nurse did not say a single word about my stellar triglycerides or exemplary cholesterol-to-HDL ratio.

I sheepishly admit that I gave the poor nurse an earful. I first inquired as to what other risk factors indicated heart disease risk—and got no response. I then questioned the wisdom of being concerned about heart disease in a patient who received a stage 4 cancer diagnosis in his mid-30s. That’s when the stuttering on the other end of the line began. 

The nurse had not read my chart and had zero context for the prescribing of the drug to an actual person with a medical history, instead relaying a doctor’s reaction to a small set of lab numbers. (For the record, I showed the results to my oncologist, who was unconcerned and did not encourage taking a statin.)

© Brandon LaGreca

If my now-fired doctor (or his nurse) had bothered to ask about my medical history, I would have told them that my cholesterol has been elevated my entire adult life. A previous physician deemed it genetic (familial hypercholesterolemia) and not clinically relevant for treatment, provided I had no other signs of or risk factors for heart disease.

A more comprehensive evaluation of heart disease risk could include measuring homocysteine, calcium score, high-sensitivity C-reactive protein, and blood sugar markers while factoring in other risk factors such as blood pressure, weight, and smoking history. Moreover, the notion of “bad” LDL is heavily nuanced—more on that in a moment.

The central problem is that statin drugs (like all drugs) are not a free ride on the human physiology train. They come at a cost to the body with side effects that accrue over time. For statins, this includes muscle pain and weakness due to their depletion of the essential nutrient coenzyme Q10, as well as low libido, depression, and loss of mental clarity due to their excessive depletion of cholesterol.

A growing body of research questions the science that purports the benefits of statin drugs for primary prevention, that is, prescribed to a patient to prevent heart disease. That debate is beyond the scope of this discussion. The salient point is to question the assumption that high cholesterol is a major risk factor for cardiovascular disease.

Elevated cholesterol and LDL were the only factors influencing my doctor’s decision to proceed with cholesterol-lowering treatment as a preventative strategy. Yet research suggests that high cholesterol does not neatly correlate with heart disease, particularly when half of all heart attacks occur in patients with normal cholesterol. 

Advancements in lipid science have led to development of the Cardio IQ Ion Mobility profile to rectify this clinical observation. This profile breaks down the so-called “bad” LDL into subtypes based on particle size. Small and dense LDL is considered to be the atherogenic subtype of LDL. In addition to the percentage of dense LDL, an LDL particle number is reported. Together these numbers are a better predictor of heart disease risk than overall LDL.

This means we can no longer state that elevated LDL is categorically “bad” as a risk factor for heart disease. For a patient with elevated LDL reported on a traditional lipid panel but displaying low dense LDL and an LDL particle number within the normal range on a Cardio IQ Ion Mobility profile, the risk of heart disease (barring other cardiovascular risk factors) is lower than conventionally thought. 

In my humble opinion, it is medically negligent to prescribe a statin drug to a patient who has elevated LDL on a standard lipid panel but low atherogenic risk as documented on a Cardio IQ Ion Mobility profile. The health care practitioner that pushes for statin use, given the weight of this evidence, is acting out of sync with current medical research.

A portion of this blog post was excerpted from Brandon’s monograph, How to Order Your Own Bloodwork and Why You Should,” available on Amazon.

March 11, 2020

Categories: Rants

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