I have written 7 blogs about statins, and I suspect you’re beginning to tire of my persistence. I love statins! I love the impact they have had on preventive medicine. I love that a reduction in sudden deaths has been scientifically credited to statins. I love that the quality and longevity of life have been improved by statins. I love that over the 34 years statins have been on the market, their safety has negated attempts to exaggerate their harmful effects. Statins have fewer adverse effects than aspirin and Tylenol which people take with impunity.
As you know, statins were marketed in 1988 as effective for lowering cholesterol. And indeed, they are. They have repeatedly demonstrated efficacy at lowering total and LDL Cholestrrol, the bad type of cholesterol, and raising HDL cholesterol, the protective type. Study after study has proven this assertion. Time also has revealed that in addition to lowering cholesterol, statins have an anti-inflammatory effect that contributes significantly to the prevention of arteriosclerosis and arteriosclerotic plaques. The combination of these two mechanisms of action have resulted in the practical benefits we see in everyday life.
What follows is a brief explanation of the two mechanisms and how they each prevent arteriosclerosis and the problems related to it:
Mechanism of Action No. 1: Reduction of Total Cholesterol and LDL Cholesterol
Statins block the enzyme, HMG-CoA reductase, that converts the precursor chemical, HMG-CoA, into the chemical that eventually becomes cholesterol. In so doing, the ultimate effect is to lower LDL cholesterol. When LDL Cholesterol is lowered, so is the Total Cholesterol. Lowering LDL cholesterol has the corresponding effect of elevating the production of HDL cholesterol. This process all occurs in the liver. Lower cholesterol levels translate into fewer, or smaller cholesterol plaques in our blood vessels.
Mechanism of Action No. 2: The Anti-inflammatory Effect on the Inner Surface of Blood Vessels
Through conducting tests* that measure inflammatory response in human tissue, scientists have discovered statins also reduce inflammation. It is inflammation that initiates the development of hardening of the arteries in arterial blood vessels. When the inner wall of an artery is damaged by high blood pressure or turbulent blood flow, the body’s immune system responds by producing C-reactive proteins which are associated with inflammation. The inflammation attracts white blood cells, platelets (cells that enable blood clotting), and cholesterol so as to repair the “damage.” The “repair” leaves a scar that continues to attract more platelets and more cholesterol until a plaque large enough to block blood flow results. When this happens in the coronary arteries, the result is either chest pain (angina pectoris) or a heart attack! Statins inhibit the inflammatory reaction by blocking the inflammatory effect of C-reactive protein.
- = erythrocyte sedimentation rate (ESR, sed rate), C-reactive protein (CRP).
All that’s left, now, is to put a statin drug in the water. By lowering cholesterol and suppressing the body’s normal inflammatory response, hardening of the arteries, especially the coronary arteries, is slowed down and almost eliminated. Statins are miracle drugs! They are safe miracle drugs! They reduce heart attack, stroke, and sudden death. When the first symptom of heart disease for 50% of the population is sudden death, it becomes very important to be aggressive in preventive treatment. Prescribe as large a dose as the patient can tolerate and get the LDL as low as possible.
Dr. G’s Opinion: For 30+ years medical science has had a class of drugs that has both proven efficacy and long term benefits hoped for early and realized over time. We are blessed that scientists were able to develop these drugs unaffected by politics, hype, and fraudulent data. Numerous attempts were made to instill fear in patients by over-dramatizing some of the adverse effects of the drugs. These allegations were quickly brushed aside when statins were shown to dramatically lower cholesterol and later, reduce the incidence of angina, heart attack, and sudden death. Here, patients could see the good statins were doing and ignored all the noise about very rare adverse reactions. Sensationalism sells newspapers, but it didn’t scare people away from statins. A lot of folks are alive today, or have lived longer, because of statins. I think that’s good. If we had statins in the water, who knows what the effect would be. But it would be good!
References: Ross HM. The Effects of Statins on Inflammation. VeryWell Health. 2022 Jan 13.
JainMK, Ridker PM. Anti-inflammatory Effects of Statins: Clinical Evidence and Basic Mechanisms. Nature Reviews Drug Discovery 2005;4:977-987.
Antonopoulos AS, et al. Statins as Anti-inflammatory Agents in Atherogenesis: Molecular Mechanisms and Lessons from the Recent Clinical Trials. Current Phama Design 2012;18:1519-1530.
