On February 12, the Wall Street Journal provocatively questioned whether the ever-popular statins we take to protect ourselves from heart disease are causing memory loss, fuzzy thinking or mood disturbances. On February 13, the New York Times, asked the same question. Can a drug that helps hearts, be harmful to the brain? Are statins making us stupid?
The WSJ reported that Dr. Orli Etingin, the vice chairman of medicine at New York Presbyterian Hospital, and the director of the Iris Cantor Women's Health Center in New York, was speaking at a Project A.L.S. luncheon when she declared, "This drug makes women stupid." She told about the typical patient in her 40s, who after starting on statins is unable to concentrate or recall words. When tests show nothing remiss, and she goes off Lipitor, the symptoms vanish. When she starts back on them, the symptoms come back. Dr. Etingin says, "I've seen this in maybe two dozen patients. It's just observational, of course. We really need more studies, particularly on cognitive effects and women."
Most cardiologists see little cause for concern. "The benefits outweigh the risks," says Antonio Gotto, dean of the Weill-Cornell Medical School. "I would hate to see people frightened of taking statins because they think it's going to cause memory loss."
However, at the University of California at San Diego, researchers soon may be able to shed further light on whether or not statins can cause these disturbing memory/thinking/mood disturbances. They're nearing completion of a(the gold standard) randomized-controlled trial that looks at the effects of statins on thinking, mood, behavior, and quality of life. As a separate piece of this project, the UCSD group is collecting anecdotal reports of patients on their experiences with statins. With 5000 reports so far, muscle aches are the number one complaint and memory problems are number two. You can check out the UCSD Statin Effects Study here.
The UCSD lead investigator, Dr. Beatrice Golomb, says they have some very compelling cases linking statins with memory loss. Because these patients regained their memory and concentration once they went off the statin, it's very hard to chalk up the memory problems to just getting older. She gives the example of a 69 year old San Diego woman, named Jane Brunzie, who became so forgetful that her daughter wouldn't let her babysit for her granddaughter. She started to think her mother had Alzheimer's. Within 8 days of going off her statins her memory problems ended. But three more times her doctor started her up on a different statin, and within days, once more she had problems with getting the right words out. When she finally stopped the statins all together, she was back to herself within eight days.
There have been alot of observational reports and talk about these cognitive side effects for years, but the drug companies say there is no causal link between the two. In fact, a couple years back there was research on how often doctors actually minimize or dismiss the uncommon statin side effects their patients report to them, especially, if the side effect isn't listed on the drug's package insert. Guess what, side effects like memory loss, fuzzy thinking, and sleepiness, aren't on the Lipitor package insert.
There's no question that statins are necessary and can prevent future heart attacks and possibly strokes in high-risk patients, who actually have occlusive vascular disease. But since 2001 the number of people who are taking statins has skyrocketed. What used to be prescribed for those with vascular disease, is now prescribed for primary prevention in healthy men and women, who might be at risk of a "future disease".
This all started in 2001, when the US National Cholesterol Education Program's (NCEP's) guidelines changed the recommendations of who should start taking statins. Even for those of us who have no heart or vascular disease, depending on what other risk factors we have, like age (over 45 for men, over 55 for women), a family history of early heart disease, low HDLs, blood pressure over 140/90 mm Hg, or smoking, it's possible that we could be considered at moderately high risk if our LDLs are over 130, with an option to start statins for those of us with an LDL of over 100. So all of a sudden the number of Americans who are "eligible" to be on statins has grown from 13 million people to a possible 36 million.
In an article titled, Are Lipid-Lowering Guidelines Evidence-Based?, published last January in The Lancet, Dr. J. Abramson of Harvard, and Dr. J. M. Wright of the University of British Columbia, conclude:
Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years. High-risk men aged 30-69 should be advised that about 50 patients need to be treated for 5 years to prevent one event.
Statins did not reduce total coronary heart disease events in 10,990 women in these primary prevention studies. Similarly, in 3239 men and women older than 69 years, statins did not reduce total cardiovascular events.
What could be the possible explanation of these cognitive side effects? For one thing, cholesterol plays a crucial role in making sure our brains work properly and our brains are primarily made of cholesterol. However, the brain can't obtain cholesterol from our blood. It manufactures it from its own glial cells, which are responsible for stimulating the brain to make connections (synapses) that are essential for learning and memory. Could it be possible that when healthy people, whose cholesterol isn't too high to start with, take a statin that inhibits their cholesterol production to a low level, that their brain's production of cholesterol is also diminished, and that's why we're seeing reports of these learning and memory problems?
Although I could only find a handful of reports on memory problems linked to statins, there have been a number of articles, even going back to the 1970's that link suicide, aggression, depression, learning problems, hostility and mental health problems with low cholesterol levels. Here's the rub. Serotonin, the neurotransmitter necessary to feel good and to be happy, is associated with cholesterol. If your cholesterol levels are too low, your serotonin levels can also be too low, making you unhappy, hostile, possibly aggressive. Moderate cholesterol is associated with higher levels of serotonin. Dr. Jay Kaplan reported on this back in the mid-nineties. In an interview in Psychology Today he questioned the National Cholesterol Education Program recommendations that Americans over the age of two significantly lower their intake of fat and cholesterol:
Can this diet do harm? For people who already have low serotonergic activity, a low-cholesterol diet might shove them across some threshold that makes them more likely to do things they might not otherwise do.
The Bottom Line here, I'd take the advice of Dr. Nieca Goldberg, a cardiologist and the medical director of the Women's Heart Program at New York University School of Medicine:
She prescribes statins only for women who have elevated cholesterol and have had a heart attack. But for younger women with high cholesterol and no other risk factors, it's lifestyle changes, diet modifications and physical activity. Also, take a look at Janet Brill's book, Cholesterol Down, listed in my Books for a Healthy, Happy, Long Life.
For the NYT article and the interesting list of comments, including mine (#25) click here.