Reference
Sugiyama T, Tsugawa Y, Tseng CH, Kobayashi Y, Shapiro MF. Different time trends of calorie and fat intake between statin users and nonusers among US adults: Gluttony in the time of statins? JAMA Intern Med. 2014 Apr 24. Epub ahead of print.
Design
This study featured a repeated cross-sectional design using data from participants in the National Health and Nutrition Examination Survey (1999–2010).
Participants
A nationally representative sample of 27,886 adults aged 20 years or older
Outcome Measures
A linear model was created to calculate caloric and fat intake. Body mass index (BMI) changes between statin-users and non–statin users were also measured.
Key Findings
Statin-users consumed an additional 192 calories per day in the 2009-to-2010 period than they did from 1999 to 2000. This increase in calories was associated with a 6 lb–to–11 lb weight gain in the same time frame. There were no significant changes in eating habits or weight gain observed among non–statin users. In the time period from 2009 to 2010, the caloric intake of statin-users was 9.6% higher (P=0.2) than the 1999-to-2000 period. No significant changes were observed in the nonuser group during that same time frame. Over time, fat intake among statin-users increased by 14.4% (P=0.007) but did not change among nonusers. BMI increased by 1.3 among statin-users and only increased by 0.4 in the nonuser group (P=0.02). These new findings indicate that increase in BMI was faster in the group of individuals taking statins as compared to non–statin users. It also demonstrates that over time, calorie and fat intake increased in people taking statin medications.
Practice Implications
The scientific evidence overwhelming demonstrates that elevated cholesterol and triglyceride levels significantly increase the risk of death due to cardiovascular disease. It is important to note, however, that more than half of the individuals who die from a heart attack or stroke each year have low-to-normal cholesterol levels. This fact has led to more intensive lipid-lowering strategies with statins to drive low-density lipoprotein cholesterol down to even lower levels. The statin debate is one of risk vs benefit. It has long been known that statin medications have many side effects including1
- Statin-induced myopathy and rhabdomyolysis, which can be fatal
- Hepatotoxicity and decreased liver function
- Neuropathy: the chances of nerve damage are 26 times higher in statin-users than in the general population
- Impaired mental function with prolonged use
- Possible increased risk of diabetes, especially in women
- Increased muscle damage caused by exercise and reduced exercise capacity
- Worsening energy levels and fatigue after exertion in about 20% of cases.
This latest study further illustrates the potential harm associated with these drugs. Obesity is a significant comorbid factor in many illnesses, including cardiovascular disease and stroke.2,3 And yet more than two-thirds of American adults are overweight or obese, putting them at significant risk of these diseases, the very illnesses that statin medications are purported to prevent.4
The fact that these drugs are contributing to the obesity epidemic is clinically concerning; however, other factors call into question their use. Efficacy of statin medications has been examined and the research demonstrates that statin medications do not, in fact, reduce cardiovascular disease risk in the majority of the people taking these drugs. A comprehensive literature review published in 2013 by Sultan and Hynes focused specific attention on large-scale, randomized controlled trials and concluded that there is “a categorical lack of evidence to support the use of statin therapy in primary prevention.”5
In November 2013, the American College of Cardiology and the American Heart Association announced the expansion of the statin-use guidelines, which will surely mean that even more patients will be prescribed these drugs.6 Basically, more Americans will be taking an ineffective drug with known harmful side effects that will likely cause them to gain weight. This does a huge disservice to patients. Alternative treatment options should be explored before employing these drugs in clinical practice. In addition, an integrative approach that involves dietary counsel, lifestyle advice (eg, exercise, stress management, sleep), and appropriate dietary supplements should be used to help patients discontinue statins. This is something that patients are already searching for, as 25% of adults on statin medications discontinue use within 6 months and as many as 60% discontinue within 2 years.7 Integrative practitioners can play a significant role in assisting this patient population.
