 Hi guys, this is Dr. Ahmet Ergen. I'm an endocrinologist, Diabatologist, and a diabetes education specialist. Today we are going to talk about are statins worth it? So I treat my patients with statins and we get to this discussion all the time and I'm not by any means against statin or for statin and that's why I am going to tell you how you should make a good discussion with your doctor. Now a lot of YouTube videos that you'll be watching there will be doctors who are like just do diet just diet you don't need any medication or they'll say oh you need the medication you know you gotta take this medication the world doesn't work that way nothing is black and white if somebody is trying to give you a picture of conspiracy theories that are out there they're like oh you're you're supporting pharmaceutical companies you're that you're that no we swear by god that we do not harm first and our goal as doctors to help patients but sometimes you know the conflict of interest may get in the way and definitely we don't want that and then by the way just so you know statins are generic drugs it's not a money maker drug so if a drug is generic it means that there are a bunch of generic companies making it it's like not any better than producing cookies at this point but anyways do you really need statins what are the benefits what are the risks what are we really treating here are we treating the LDL are we treating cholesterol what are the other benefits right we will discuss about that and and then what is the treatment goal let's start with number one who really needs statins well statins have been shown to reduce the risk of heart attacks between 25 to 50% now that depends on the study population right the higher the risk the more risk reduction you can show and I'll talk to you about in a minute how statins really do that but before that I will tell you the general guidelines that a lot of doctors will use and you like it or not your doctors will use these guidelines and some of them are familiar with the newest guidelines some of them are not but if they're not you can always discuss with them so basically statins are indicated if you're high risk now what is high risk in our previous video we discussed about that if you watched that video I don't know which video it was I forgot already but basically if you're from Ingham risk score is more than 10% by the way risk score does not include the diabetes so even you have diabetes if that scoring system does not include diabetes you need to double that risk because diabetes always doubles your risk of heart attack but typically if your risk is more than some people say 7.5 some guidelines say more than 10% overall risk in the next 10 years of having a heart attack then statins may be worth it now why are there so many people out there that are against statins right and they have a point you know they will say that people are over treated everybody is on statins and there are risks associated with statins then what is the point you know I can just fix my cholesterol with just the diet now is that the whole story really well not that easy not that simple the statins was interesting in that you know doctors will tell you I'm putting in a cholesterol medication and statins are known as a cholesterol medication but what is interesting when they did the studies they never actually tried to bring people's LDL down what they did they just put people on statins and some people's LDL came down a lot some people's LDL the back cholesterol came down a little bit but everybody got almost the same benefit so the question is was LDL lowering related to the risk reduction and risk reduction happened typically in less than two years now how come that LDL puts you to risk in 50 years in your blood it took like 50 years to give you almost a heart attack almost you know because we're talking about the prevention here or you had a heart attack and now we put you on statins and you're suddenly don't have a heart attack wait a minute so that doesn't make any sense because that should take some time for your body to recover from it because you built up the cholesterol for decades now the answer to that they found that actually statins what they do actually they work like a cement they will stabilize the plaque typically what happens what causes the heart attack is your arterial wall will have a plaque like a little accumulation of cholesterol and that plaque will rupture because it's unstable think like a earthquake happening you know because the earth is unstable sometimes it will cause an earthquake and then that earthquake can cause a lot of damage right and the body is trying to heal that damage by adding more platelets now that can be a little too much because your coronary arteries are very tiny so that clotting if you already have underlying thrombus we call it atherosclerosis that will lead to a sudden heart attack you know that's why you can go from 20% or clog to 100% within minutes that's how heart attack happens now statins have been shown to actually prevent that damage from happening to begin with and in some cases actually has been shown to reverse that plaque formation so what does that tell you if you don't have any plaque the statins will not do anything so as a result you know sometimes doctors will order coronary artery calcium score because calcium will typically accumulate in those plaques so if your calcium score is low then you don't have any plaque to deal with so you're not really reducing any risk so it's not necessarily statins yes they're helping to prevent the accumulation but to get benefit from statins just by preventing the LDL from accumulating on your arterial wall it may take decades for you to get benefit but you get benefit immediately if you are high risk so I hope you understand the difference here yes if your LDL is high overall you know most of your life you will have a problem in your arteries because that small accumulation will lead to a problem in decades but statins will reduce your risk almost immediately within a few years by taking them so they have anti-inflammatory features they prevent the rupture of the plaque not always that's why not everybody who takes statins are not guaranteed and we never say to our patients they take the statins you'll be okay no we don't say that we say that take this eat this monounsaturated polyunsaturated fats stay away from saturated fats as much as you can the saturated fats do not cause clocks but overall when your LDL levels are high and that's true excessive carbohydrates creating a lot of VLDL and triglycerides because the byproduct of VLDL is LDL so as a result you know you want to prevent VLDL formation and that can be done by eating more polyunsaturated fat and monounsaturated fat these are like we discussed about this like olive oil you know the nuts avocado things like that nature but if you eat a lot of saturated fat you don't really have much room left for the polyunsaturated fat does it make sense here because you know sometimes people try to label things as bad or good in life almost nothing is absolutely bad or absolutely good it's the ratio of how much bad and how much good you have same thing with total cholesterol if you have a lot of good cholesterol with like HDL a lot of HDL even if your LDL is a little bit high that may not be a big deal again total cholesterol over HDL ratio if it is less than four you know you're fairly good now on the other hand that is for non-diabetics when you are diabetic the goal is to keep the LDL below 100 because we know that as the LDL goes up your risk of having cardiovascular disease in the long run let's say you got diagnosed with diabetes at 45 now you're 65 it's been two decades two decades if your LDL was high yes it definitely caused that much on you now if you don't believe LDL causes any problem I'll give you a very simple example of a familial hyperlipidemia the only problem they have in their lipid panel is LDL elevation their triglycerides are good HDL is good everything is good except the LDL and their LDL is very high like in the 250 to the 500 or more and these people die from heart attacks in their 20s 30s and late 40s so yes LDL causes damage and in decades now statins as we discussed will reduce your risk immediately but you need to be high risk to begin with so what is your high risk you calculate that with your doctor you know if your overall risk is more than 10 to 20 percent definitely I would suggest taking statins if you have elevated C reactive protein which is inflammation if you have inflammation in your body you may have inflammation from other diseases like you may have lupus you may have rheumatoid arthritis you may have other inflammatory disorders you may have chronic kidney disease those are the diseases that creates inflammation in your system and when you have inflammation in your system even if you don't have any insulin resistance or any other factors you will still be prone to have cardiovascular disease that's why a lot of patients with lupus end up with cardiovascular disease so we are trying to target their LDL because they're typically diagnosed when they're younger and in decades they can end up with even even if we treat their lupus well they may still have a heart problem so inflammation is a big factor if you're C reactive protein sometimes they check ultrasensitive CRP if it is high that's another reason in Jupiter trial for example looked at people as a primary prevention and the only thing they looked at was the CRP level if the CRP level was more than two they treat these people and even without any heart attack in the past people who took the statins in this case was Roosevelt statin they had 50 less chance of heart attacks in just within two years so that's impressive now people will say you know statins are bad for you because it will cause say memory problems it will cause diabetes it will cause muscle pains and so forth let's go over that a little bit just to be honest with you there is no clear evidence convincing evidence that it causes memory problems actually there are some studies saying that it actually helps the memory problem because a lot of dementia can also happen from vascular causes like your blood vessels in your brain will get clogged up and that will definitely lead to dementia as you can imagine some studies show that actually it helps prevent the dementia so there is no evidence when it comes to that and I have like 85 years old they're in statins they're like super sharp I'm no wrong they've been taking statins forever now when it comes to the muscle pain muscle pains can happen up to 10 percent of people typically it happens in more susceptible people so if you have a small frame if you're an older female if you drink a lot of grape approved juice that does that but you know there's some risk factors that some people tend to have more muscle pains than the others but most of the time it is actually in your brain here's why the studies showed that actually when we gave placebo and told people that you're taking statins but we are actually not giving them statins it's called a placebo controlled trial and those people who took placebo 30 30 came and said I have muscle pain because of the statins you put me on how do you explain that well you can explain that by law of attraction you know if you think that it's going to happen to you it will happen to you so you just have to be positive sometimes and if you think that that medication will help you it will probably help you more than likely it will help you if you think that that medication is going to harm you then it'll harm you so that's called law of attraction if you don't know anything about it that's something that you look into but the bottom line is placebo effect is there and it is strong in reality 10 percent of people get some sort of muscle pain sometimes coenzyme q helps and sometimes doesn't but if you ask me and if i'm a high risk for heart attacks i rather have a little bit of a muscle pain than the heart pain right and also another big problem with the muscle pain is doctors prescribe typically very high doses of statins and they try to bring the LDL down as much as possible but what's interesting when you double the cholesterol medication or statin dose when you double the dose you're only getting another 5 percent reduction in your LDL so it's really not necessarily good for you so sometimes what i end up doing in my practice is that you know i never start a very high dose of statins to begin with because sometimes you know let's say you take rose of a statin or crest or five milligram if your LDL comes down and everything looks good what's the point of giving 40 milligrams because those side effects are typically related to the dose and if you're taking very high dose of statin then you will probably have more chances of muscle problems so i even have given statin medications like every other day or half of the lowest dose and it still helps you it will still help you everybody metabolizes statin drugs differently there are some other medications such as gen 5 brazil there's medications like some HIV medications that can increase your risk of statin induced muscle pain so the bottom line you can negotiate with your doctor when it comes to statin dose and don't not give up if you're high risk you know giving up on a medication that can save your life that would be too expensive although the drug is very cheap they're like a couple bucks nowadays in the united states come on so as i said if you are high risk i think it's worth it if you are having muscle problems you can switch statins you can reduce your dose you can do all sorts of tricks if your doctor doesn't know how to do it ask for a referral again i'm not saying that these drugs are golden drugs and we never say these drugs are the only way and there are some other classes coming in nowadays like we have for example patients who are using pcsk9 inhibitors that are great when you have statin intolerance they also reduce your LDL quite a bit and remember LDL is not necessarily just what you eat or drink it is most of the time genetically determined look i'm in a very healthy diet myself okay and i exercise like crazy i eat well but my LDL does not come down and because i'm coming from a family with heart problems so what i have to do i have to do something about it so i'm taking a very low dose of statin medication to help prevent the heart disease because i'm almost 40 you know before you know it's gonna be 50 i don't want to end up with that problem in my 50s although there's my personal choice not that i necessarily need statin but based on my own research and evidence i think that i should be on statin because i think LDL of 190 is a little too excessive but if you're diabetic try to keep your LDL below 100 but LDL is not the only problem as you know by now the HDL has to be up if you're a male has to be more than 40 if you're a female has to be more than 50 the higher the better because if discussed so the ratio of total cholesterol over HDL is important but your LDL cholesterol is important as well now also a lot of doctors will freak out if your liver enzymes go up a little bit that is not a big problem and here's why everything goes to your liver okay so alcohol can increase your liver enzymes a little bit you know even the foods and stuff that you eat a little increase your liver enzymes a little bit what is interesting that statins even have been studied on people who have cirrhosis people who have chronic liver disease it's not a contraindication in most cases so i would suggest that if you have a harvest for heart attacks or if the statins causes a liver enzyme elevation which is very common there is no reason unless it's more than three times elevated the levels there's no reason to stop the medication also if you have a fatty liver disease which is very common in insulin resistance those people you know we tell them to die at an exercise and sometimes they just don't listen you know what can you do we still have to protect them we have to still do something for them and they're typically high risk patients for cardiovascular disease as well now their enzymes can be a little elevated from fatty liver but that's again not a contraindication to start a statin therapy as long as this monitor there is very little chance from a significant liver damage from statin that's like super super super rare so i hope guys that helped you understand if you need to be on statin or not and if you did please give a thumbs up share with your friends leave comments and questions and please be nice we are a nice community we are trying to help each other have a wonderful day