Ten Common Myths about Statins and Cholesterol - 2 of 3


by Duane Graveline, MD, MPH


Myth 4.) LDL Cholesterol Level is the Best Marker of Cardiovascular Risk.

This has never been correct.  Since 1955 we have been led to believe that LDL cholesterol was a primary marker of cardiovascular (CV) risk, but now we have learned the truth. Cholesterol is irrelevant to CV disease and is probably the most important biochemical in our bodies. From memory synapse formation, to lipid raft information processing, to insulation of nerve transmission as a component of myelin sheaths, as an active component of the vital processes of exocytosis and endocytosis, and dozens of critical cellular processes that we are only just beginning to understand.

Almost all our cholesterol is found in the cell membranes. An average of 20% of all the molecules in these cellular membranes is cholesterol. Over the past decade there has been a huge increase in the research publications documenting the action of cholesterol-rich structures within these membranes.

Lipid research now describes an amazingly busy schedule for cholesterol molecules. To say that our bodies run on cholesterol, comes very close to describing what has been learned just in the past few years.

Additionally, cholesterol is the precursor for a whole class of hormones known as the steroid hormones that are absolutely critical for life as we know it. Such hormones include estrogen, progesterone, testosterone, aldosterone, cortisol and calcitriol (vitamin D).

These hormones determine our sexuality, control the reproductive process, and regulate blood sugar levels and mineral metabolism. Beyond this is the production of bile acids. Bile makes it possible for us to emulsify fats and other nutrients. Without bile, we could not digest and absorb the fats in our diet and would slowly starve.

Atherosclerosis (hardening of the arteries) is an inflammatory process having a number of triggers such as transfats, smoking, homocysteine, oxycholesterol, inherent coagulation and thrombotic deficiencies and abnormal omega-3 / omega-6 ratios. The JUPITER study has shown the validity of (hs)CRP as the best currently available marker of cardiovascular disease.

Cardiovascular Risk Factors


 

Myth 5.) The Only Significant Side Effect of Statins is Muscle Pain.

From the very beginning of statin marketing, muscle damage was stressed. We were told that in just under two percent of statin users, muscle pain and weakness could be expected. This would often be accompanied by liver inflammation. We were also told that ordinarily, these adverse reactions would go away with dosage reduction.

From this evolved the routine of doing enzyme determinations on the blood every few months. Clearly, the original focus of statin side effects was on muscles and the liver. In truth, those that have studied adverse reactions have noted that cognitive dysfunction such as amnesia, confusion, disorientation, forgetfulness and dementia, appear at least as frequently as myopathy.

Additionally, I suspect that emotional and behavioral adverse reactions are also appearing as often as cognitive. These are the reports of aggressiveness, hostility, sensitivity, depression, paranoia, suicidal ideation, homicidal ideation and road rage like reactions.

Another often reported adverse reaction is peripheral neuropathy. Neuropathy has been warned about from the very beginning as an expected side effect, but we were never told that it would be permanent and it is nearly always unresponsive to traditional treatment.


Myth 6.) If Your CPK Level is Normal, You Have No Statin Toxicity.

CPK (creatine phosphokinase) elevation, when it occurs, is a definite marker of underlying muscle inflammation. But many cases of myopathy have been identified where the CPK level was within normal range. So the value of CPK as a reliable marker of statin damage is negligible.

No longer can a doctor say that a normal CPK result indicates there is no evidence of statin damage. The patient’s history is by far the most valid indicator of statin toxicity with symptoms of statin damage ranging from cognitive dysfunction to emotional and behavioral disorders to the muscle pain and weakness of myopathy, the burning extremity pain of neuropathy and the progressive helplessness of ALS-like conditions.

Myth 7.) Statins Have No Significant Cognitive Effects.

Any doctor making the statement that statins have no effect on cognition is grossly uninformed.  Frank Pfrieger made the importance of cholesterol in brain function public knowledge in 2002. At that time, in the journal Science, he revealed that cholesterol was his long sought after synaptogenic factor for memory formation. 

He said he had been searching 20 years for this elusive substance without which memory formation is impossible. He then went on to say that in humans, our glial cells had been charged with the responsibility of synthesizing cholesterol upon demand for this function of memory.

This was the first time that doctors learned that blood cholesterol was not available to the brain. The LDL-cholesterol molecule was too large to pass through the blood-brain barrier. Brain cholesterol needs had been supplied by glial cells, on a synthesis-on-demand basis, for memory synapse formation.

For the elderly, studies have repeatedly shown better memory function in those with high cholesterol.1,2 In fact, the higher the cholesterol, the better the cognitive performance. Cholesterol is essential for proper cellular function and the brain contains 25% of all the cholesterol in the body.

Glial cells, responsible for producing much of the brain’s cholesterol, are affected by statin drugs just like any other cells in the human body, with the result being excess cholesterol inhibition leading to cognitive dysfunction.

References:

  1. https://www.ncbi.nlm.nih.gov/pubmed/18757771
  2. https://www.ncbi.nlm.nih.gov/pubmed/26892577

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

July 2016



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