Recently there have been several news stories with contradictory health information; obesity has reached a peak, obesity is still rising. Running leads to a longer life, but marathon runners don’t live longer. Supplements don’t work, except when they do.
One of the latest stories is that people who take statins are gaining weight faster than those who don’t. Have statins become a crutch or do statins cause weight gain? Are we healthier now that we can have our steaks with a side of statins?
What did the study look at?
To assess the question of statins and weight gain the authors used a large database called the National Health and Nutrition Examination Survey (NHANES) which was a large study conducted from 1999-2010 that collected data on tens of thousands of Americans, looking at illnesses, medication use, diet, supplement use and other items.
For this study, 28,000 people were evaluated:
- those with high cholesterol and taking statins
- those with high cholesterol and not on statins
- those without high cholesterol and not on statins
They compared calorie and fat intake between statin users and nonusers in 1999-2000 and 2009-2010. In 2010, statin users were eating almost 250 calories more a day than they did in 2000. They were eating more fat, as well as having gained more weight than non-statin users. However, statin users did have lower cholesterol.
What the study did not assess was if the rate of heart attacks changed in the groups – the study wasn’t designed to answer that question. But is that the only question that matters?
The reason why it matters is that diabetes rates, linked to weight gain and obesity are still on the rise. Are people being helped if they lower heart disease risk by taking statins but raise their risk of developing diabetes?
Possible explanations of the data
- Doctor effect – are doctors advocating medication over healthy lifestyles? It is easier and takes less time.
- Patient effect – are patients interpreting taking statins as a free pass to keep the same lifestyle they had before medication? Again taking a pill a day is easier than maintaining a healthy lifestyle.
The truth is probably a little bit of both.
How does this affect my practice?
I’m a strong proponent of preventing disease. We prevent heart disease by not smoking, controlling blood pressure and reducing the Low Density Lipoproteins that clog our arteries with statins. Central to this, and what I recommend with or without medication is lifestyle – a healthy and active one! Doing so may avoid the need for medication or allow us to use a lower dose – reducing side effects!
What we don’t know from this study is if people had an increase in heart attacks despite their lower overall cholesterol levels – meaning the increase in calories, fat and weight offset the benefit of taking a statin. Or, did the statin allow people to safely lead a more permissive lifestyle? Can you have your steak if you have your statin too?
The study did show an increase in diabetes – presumably related to the weight gain in the statin users. They consumed about 250 calories a day more in 2010 than in 2000 – which can lead to almost 10 pounds a year in weight gain!
So when I discuss taking statins with my patients, I always frame it as a component of a plan to reduce the risk of heart disease. If diet and exercise reduce risk enough, medication can be stopped and risk reassessed. Even if lifestyle does not reduce risk enough to stop medication, it may minimize the need for dosage increases.
For those that do not alter their lifestyle, they run the risk of developing diabetes. While statins will reduce some of the risk of heart disease, diabetes carries its own risks – kidney, nerve and eye damage – which statins won’t protect against.
My role as an Internist is to look at a person as a whole – evaluate all their risks and how they relate to each other. So this study serves as an example that we can treat a singular problem, but if that is our whole focus, we lose sight of the person and may not truly improve their health.
The path to wellness begins with a proper diagnosis