Be Cautious of Statins If You're Over 70: Top Heart Doctor

Thursday, 24 Oct 2013 10:18 AM

By Charlotte Libov

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Older people should be cautious when considering whether to take a cholesterol-lowering statin drug, says one of the nation’s top cardiologist.
 
Every day, millions of Americans take Lipitor, Zocor, Crestor, or another of the popular heart medications – but for people over 70 the benefits should be weighed with the potential risks, says Chauncey Crandall, M.D.
 
“Research presents a mixed picture on statins when it comes to people in the 70-and-over age group, with some studies showing that statins carry risks, and others saying they have benefits,” says Dr. Crandall, chief of the Cardiac Transplant Program at the world-renowned Palm Beach Cardiovascular Clinic.
 
SPECIAL: These 4 Things Happen Right Before a Heart Attack — Read More.

The decision to take a statin drug is easy when patients have high cholesterol and underlying heart disease. But statin use is controversial when heart disease is not present.
 
A new report by the American Medical Directors Association (AMDA) recently recommended against the routine prescription of statins in people older than 70 or those who have “limited life expectancy.”
 
There is no evidence showing that lowering cholesterol in people over 70 translates to a lower death rate from heart attacks, cardiovascular disease, or any other cause, the report said. In addition, the AMDA warned that side effects like mental confusion and muscle problems could lead to more serious consequences in elderly people.
 
Statins, developed a quarter-century ago, were originally viewed as having few side effects, but in recent years the U.S. Food and Drug Administration has added warnings  about increased risks of diabetes and cognition problems. A rare form of muscle damage has been long known, and a recent research cited a 9 percent increase in cataracts in statin-users, although there have also been findings that statins lower cataract risk.     
 
Such mixed findings are a prime reason why the question of whether to prescribe statins preventively for people without heart disease remains clouded, Dr. Crandall noted.
 
“A lot of doctors now believe that coronary heart disease is one of the drivers for Alzheimer’s disease, and they say that they’ve seen an improvement in people on statins, so many of them are arguing in favor of them. There is also the possibility that statins decrease inflammation, which can have a positive effect as well,” he added.
 
On the other hand, statins are powerful drugs and their side effects can be more problematic in the elderly, he noted. “If a person has heart disease and high cholesterol, I would be apt to recommend statins. However, if the person doesn’t have heart disease, than I always prefer to take a non-drug approach,” said Dr. Crandall, author of the Heart Health Report newsletter.
 
“I think the question is still not answered. The approach has to be customized to each patient and also re-evaluated periodically. I don’t believe in keeping patients on statins forever if they can make lifestyle changes and lower their cholesterol naturally,” he said.
 
SPECIAL: These 4 Things Happen Right Before a Heart Attack — Read More.

To lower cholesterol without statins, Dr. Crandall recommends adopting a plant-based diet, taking 2 grams of plant sterols daily, and walking for an hour a day. In addition, studies show that adding certain foods to the diet, including oats, soy, and nuts, along with plant sterols, lower cholesterol by 14 percent, which is equal to a statin drug.
           
 

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