Dr. Jagdish Hiremath shares his opinion on use of statins to bring down LDL levels and the controversy surrounding it.

Atherosclerosis has been the chief cause of morbidity and mortality all over the world, more so in modern day India. The main bane of atherosclerosis is low-density lipoprotein (LDL cholesterol). Many a guideline has come and gone but the importance of LDL has remained paramount. There is a direct linear correlation between LDL levels, atherosclerosis, and cardiovascular morbidity, mortality.

Any method by which the LDL can be reduced is directly beneficial to the patient and there also is a reverse linear relationship between this. Diet, exercise, non-statin medication and various other methods bring down the LDL value marginally but are never significant enough to halt or regress atherosclerosis.

Statins have been the cornerstone in the attempt at lowering LDL for nearly 25 years. The earlier trials of statin starting from 4S to the latest trials show a direct correlation with outcome and LDL levels. It is true for primary as well as secondary prevention.

Statins and LDL levels came under a cloud because of social media related news that LDL is produced by the liver and that the dietary component doesn’t matter. This false propaganda, unfortunately, has had an impact on a large population because of the convenience and popularity of the statement that 'eating anything is allowed'.

The European as well has American guidelines clearly state good, bad, and intermediate food (seen in the table below). They also advocate control of carbs in addition to fats.

1. 30% of contribution to LDL comes from dietary source and therefore it is important to control dietary source of cholesterol.
2. The liver production of cholesterol can be controlled by statins and with these two methods used effectively, LDL levels can be lowered, and it would be beneficial.

Most of the doctors above the age of forty do consume statins for themselves, and this indicates that it is something which is of benefit!

Statins are the second-most effective drugs in human medical history in saving lives, next only to antibiotics. The correct use of statin to bring LDL levels below 100 mg% in most above 40 years of age and below 70 mg% in high-risk populations helps reduce the cardiovascular burden of humanity. The side effect profile of statin in long-term use is remarkably good and “Statinnayers” should better realise they are doing injustice to the society.

This article was originally pulished on 24.12.18

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.