Note: This is a very long post that includes the latest FDA statin warnings, as well as posts I have previously written that explain in more detail the side effects of statins--what they are, why they occur, and what increases your chances of experiencing them.
Last Week's Breaking News: FDA adds warnings to statin labels
While Drs. Steven Nissen & Marc Gillinov new book, "Heart 411: the ONLY Guide to Heart Health You'll Ever Need", minimizes the adverse effects of statins, the FDA has finally decided to publicly alert us to two of statin's more alarming side effects. All statins will now have label warnings to the effect that high-dose statins significantly increase the risk of diabetes, and statins can have cognitive side effects, albeit reversible.
Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, said, "There is no question that statins slightly increase the risk of a diabetes diagnosis and of slightly higher blood sugar, but I think this has no impact on the risk-benefit assessment. I know I can lower the [relative] risk of death, stroke and heart attack by about 30%" in patients at high risk of such cardiovascular events. (WSJ 2/29/12) Read the WSJ article here.
Dr. Eric Topol, one of the country's top cardiologist, and the former chairman of cardiology at the Cleveland Clinic (now at the Scripps Research Instiute) wrote a "must read" Op/Ed piece in the New York Times on March 4, 2012, The Diabetes Dilemma for Statin Users, with a decidedly different view of diabetes risk associated with statins.
Topol's Op/Ed was followed yesterday by NYT's health columnist, Tara Parker Pope's "A Heart Helper May Come at a Cost for the Brain"--highlighting the cognitive side effects of statins.
Joe & Terry Graedon of The People's Pharmacy, have been hearing about the side effects of statins from their listeners & readers for years--and passing these anecdotal reports on to the FDA. Read their latest post on the recent warnings here.
Dr. Beatrice Golomb of the University of California at San Diego, has been running one of the largest observational studies on adverse effects of statins for years--providing a database for people all over the world to self-report any side effect to statins that they have experienced. Read more about her work at UCSD here.
Statins are the most-prescribed drug on the market, with almost 21 million prescriptions written for them last year. There is no doubt that they are a life-saving drug for many--particularly for anyone who has already suffered a heart attack. However, their side effects appear to increase, as the dosage increases, and as patients get older.
It's time to recognize that muscle aches, weaknesses, & even some cognitive dysfunction can't always be blamed on a patient's age. Sometimes the statin is to blame.
If a radical shift in one's diet can lower cholesterol, blood pressure, reduce the risk of heart disease & diabetes, and decrease inflammation--maybe it's time more people knew about it--and received the right education, coaching, & support to do something about it.
It's interesting that one prominent cardiologist recently said it was a lot cheaper to prescribe low-cost statins than it was to coach patients in diet & exercise! He's right.
Excerpt from Topol's, "Diabetes Dilemma for Statin Users"
"We’re overdosing on cholesterol-lowering statins, and the consequence could be a sharp increase in the incidence of type-2 diabetes. Statins have been available since the 1980s but their risk of inducing diabetes did not surface for nearly 20 years.
For those statins [Zocor, Lipitor, & Crestor], the higher the dose, the more diabetes, though we don’t have enough data yet to say with precision at which dose excess diabetes showed up for each drug. What we do know is that diabetes showed up.
More than 20 million Americans take statins. That would equate to 100,000 new statin-induced diabetics. Not a good thing for the public health and certainly not good for the individual affected with a new serious chronic illness.
The announcement, medication label change and health advisory by the F.D.A. were long overdue, and have brought this important public health issue to light.
The information that we have does not support that this is a “small” problem unless one considers more than 100,000 new diabetics insignificant. The problem of statin-induced diabetes cannot be underplayed while the country is being overdosed." (NYT March 4, 2012)
-Dr. Eric J. Topol is a cardiologist at the Scripps Clinic, a professor of genomics at the Scripps Research Institute and the author of “The Creative Destruction of Medicine”-
Excerpt from Parker-Pope's "A Heart Helper May Come at a Price"
“Thinking and remembering became so laborious that I could not even recall my three-digit telephone extension or computer password at work,” said [Steve] Colburn, 62, a sales representative and product developer [from Portland, Oregon].
“All day, every day, I felt like my brain was mush.”
His doctor suggested a “drug vacation,” and when Mr. Colburn stopped taking the statin for six weeks, the problems disappeared. Then he tried a different statin at a high dose, but the cognitive difficulties returned. His doctor has since lowered his dose by more than half, and while the memory lapses have not disappeared, he has learned to cope.
Bill Moseley of Towson, Md., tried taking statins to lower his cholesterol; he also began taking medications for hypertension and high blood sugar. He found the drugs to be mind-numbing.
Against his doctor’s advice, Mr. Moseley in 2006 stopped all of the drugs and began focusing on healthful eating and exercise, meeting regularly with a personal trainer and lifting weights. Four months later, the cognitive problems disappeared. Today, he is 69, his cholesterol has dropped from 225 to about 125, and his blood pressure and blood sugar are under control.
-Tara Parker-Pope, "A Heart Helper May Come at a Price"-
Here's the HeartWire Press Release on Statin Label Warnings
February 28, 2012 Reed Miller
Silver Spring, MD - Taking a statin can raise blood sugar and glycosylated hemoglobin HbA1c levels, according to a new labeling change approved by the Food and Drug Administration (FDA) today for the entire drug class. [Read the FDA warning here]
As reported by heartwire, recent studies of popular statins showed a significant increase in the risk of diabetes mellitus associated with high-dose statin therapy.
The labeling changes approved by the FDA also include new information on the potential for usually minor and reversible cognitive side effects. Also, the label for lovastatin has been significantly updated to provide information on contraindications and dose limitations for the drug in patients taking other medicines that may increase the risk for muscle injury.
The agency is advising healthcare professionals to perform liver-enzyme tests before initiating statin therapy in patients and as clinically indicated thereafter (and not necessarily on a routine basis). Statin therapy should be interrupted if the patient shows signs of serious liver injury, hyperbilirubinemia, or jaundice. The statin therapy should not be restarted if the drugs cannot be ruled out as a cause of the problems, the labeling will now state.
Sorting Out the Statin & Diabetes Connection
Excerpts from My Previous Posts about Diabetes-Statin Research
Over the past two years, at least three articles have been published in major medical journal linking statins to increases in diabetes: Lancet, JAMA, & now the Archives of Internal Medicine. These studies have been based on analyzing data from large long-running studies, including the Women's Health Initiative.
"The results — a nearly 50% increase in diabetes among longtime statin users (compared to those not taking a statin) — should throw cold water on the idea of prescribing these drugs to healthy people, which some have recommended as a way to prevent disease," says Archives of Internal Medicine co-author JoAnn Manson, a professor of medicine at Harvard Medical School.
All three studies controlled for confounding variables, to ascertain if the diabetes was medication driven.
"Since individuals using statins may have different underlying conditions that could put them at elevated risk for [diabetes], we conducted several subgroup analyses to control confounding by indication." All studies have limitations & the researchers can't be sure if different statins might have different effects given the time frame of the study--and the drugs that were used at the time.
The recent Archives of Internal Medicine study noted that women, the elderly, & Asians are at a higher risk of diabetes from statin use. One thing is certain--statin use won't prevent diabetes--diet, weight-loss, & exercise (especially, when it includes weight-training) will help.
Excerpts from the Lancet & JAMA studies: The Higher the Dose of Statins, the Higher the Risk of Diabetes--The Reasons are Unclear
"Last year, Lancet published an analysis of major statin trials involving 90,000 patients that showed statin users had a 9 percent higher risk of developing diabetes than those who didn’t take statins. But questions remained about whether the effect was real or something that may have just been due to chance." NYT June 21, 2011
Now, "a just-published meta-analysis of some of the more high-profile statin trials testing the effectiveness of high-dose therapy has revealed a significant increase in the risk of diabetes mellitus associated with statin use in high doses.
Compared with moderate-dose therapy across five statin trials, investigators report that treatment with high-dose statins increased the risk of diabetes by 12%, which translates to a 20 percent overall increased risk of diabetes for high-dose statin users, compared to those who don’t take the drugs, according to the study’s senior author.
Senior investigator Dr Kausik Ray (St George's University of London, UK) said that while there might be consequences from the raised blood glucose levels, researchers do not yet know what these long-term effects mean.
The net benefit of high-dose statin therapy "is definitely in favor" of using the drugs, he said.
'One thing we do know is that there does appear to be a dose effect with statin therapy, with the risk of diabetes mellitus increasing with higher doses,' Ray told Heartwire.
'Statins have multiple effects and cause a number of changes. What we're seeing is probably an off-target effect, and right now we have no obvious mechanisms.
However, lowering LDL-cholesterol levels is probably more important than the increase in blood-sugar levels.'" Excerpted from HeartWire June 21, 2011. Ray, KK, "Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis," JAMA 2011 Jun 22;305(24):2556-64.
So, I'm wondering...
The researchers have no clear explanation for why statins raise the risk of diabetes as the doses go up.
Is it possible that statins aren't to blame for the rise in diabetes risk?
Could it be as simple as the eating & lifestyle habits of high-dose statin-takers.
Do statins make people worry less about what they eat, or how much they exercise--knowing that the statins will easily take care of their cholesterol for them?
Do they think statins will protect them from the negative effects of weight gain, food indulgences, or lack of exercise? Could that account for the increased risk in diabetes as statin doses rise?
A one NYT's commenter confessed: "Perhaps the reason people who take statins are at a slightly higher diabetes risk is because the statin - which has clearly demonstrated its effectiveness in lowering cholesterol levels- may provide one with the mirage of safety when it comes to deciding whether to avoid a food of questionable nutritional value.
I take statins and I know I eat more red meat than I would if I didn't take statins. I might also cheat a bit more on the sugar-based foods as well. Perhaps I should take my head out of the sand!"
What The Experts Say About The Side Effects Of Statins. What Are They? What Causes Them? Who Is Most At Risk? How Are They Treated?
(originally posted on HHLL on June 27, 2009)
"Muscle problems are the best known of statin drugs' adverse side effects. But cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported."
Dr. Beatrice Golomb, MD, PhD, Director of the UC San Diego Statin Study Group, Dr. Marcella A. Evans, UCSD School of Medicine
Am J Cardiovasc Drug 2008;8(6):373-418
Ann Intern Med 2009 June 16;150(12)858-868
"Those of us who care for patients who cannot tolerate lipid-lowering therapy are often confronted by anecdotes that contradict the findings of well-designed trials. We still do not know whether statins directly induce muscle atrophy or whether lowering lipid levels by any means in patients with vulnerable muscles causes myotoxicity."
Ann Intern Med 2009 Jun 16;150(12):885-6
There's no doubt about it. Statins provide a tremendous benefit by lowering cholesterol and inflammation and decreasing the incidence of cardiovascular disease.
But...our bodies are all different. Even the statins, drugs hailed to have a high safety profile, also have the potential for causing adverse effects in some of us--dependent on the dosage, drug interactions, co-existing medical conditions, age, genetics, activity level, gender and other factors.
If you've had questions about the side effects of statins, these four recent articles will definitely give you a better understanding of who experiences statin problems, what might cause the problems, and how to deal with them.
Many of these side effects could be easily dismissed or assumed to be related to something else. Better to be forewarned. According to Dr. Beatrice Golomb, the expert on adverse effects, "physician awareness for adverse effects is reportedly low, even for those most widely reported by patients."
What Are Drs. Beatrice Golomb, Marcella Evans, Paul Phillips, Tisha Joy & Robert Hegele Saying About Statin Side Effects?
Golomb and Evans' "Statin Adverse Effects. A Review of the Literature and Evidence for a Mitochondrial Mechanism"
- Golomb is one of the top experts on the adverse effects of statins. She has previously conducted a "randomized controlled trial" of persons living in San Diego, examining effects of low dose statins on thinking, mood, behavior, and quality of life. Additionally, she runs one of the largest observational studies on adverse effects of statins--providing a database for people all over the world to self-report any side effect to statins that they have experienced. Read more about her work at UCSD here.
- Her paper is the first comprehensive review of the subject, covering almost 900 studies on the adverse effects of statins. It's an exhaustive analysis of the research, including the most highly regarded of studies, the randomized controlled trial.1. Top statin complaint: Muscle pain, fatigue & weakness. These also include rhabdomyolysis (rare but life-threatening), new difficulty walking, exercise limitations, muscle inflammation, shoulder stiffness and more.
2. Second most common statin complaint: Cognitive problems: memory, thinking & concentration, problems finding the right word, experiencing "holes in one's memory". Since most people are older when starting on statins, this is often difficult to distinguish from age-related memory loss, but Golomb says many have reported that their thinking & memory improves when they stop statins, or lower the dose. Read "Do Statins Make You Stupid? Asks Wall Street Journal and the New York Times" for more on Golomb's research.
3. Less common statin complaints: Depression and irritability, non-muscular pain, cancer, liver problems, hemorrhagic stroke, blood glucose impairments, reduction in sleep quality, peripheral neuropathy, sexual dysfunction, male endocrine disorders, aggression, renal problems, neuro-degenerative disorders like Parkinson Disease & ALS and more.
4. What's causing the problems? According to Golomb, statin-induced injury to the body's "energy-producing cells"--the mitochondria, is the root cause of many of statin's adverse effects. When the mitochondria are impaired the body produces less energy and we end up with more damaging "free radicals". Additionally, statins lower the body's production of co-enzyme Q10, a key component in the mitochondria that is necessary to produce energy & destroy "harmful free radicals". To make matters even worse, there is a real Catch-22: Statins not only lower our CoQ10 levels, but they also reduce our blood cholesterol which is the way CoQ10 and other fat-soluble antioxidants are transported throughout the body. So, not only do we end up with low CoQ10, when our cholesterol is lowered, the CoQ10 has difficulty moving through the body.
**According to Golomb, there is evidence that this mitochondrial/CoQ10 connection relates to both muscle & brain pathology.
5. Age and adverse effects. Now throw in the fact that as we age our mitochondria (the energy powerhouses) naturally weaken, and we produce less CoQ10--adding statins to the mix may not always be wise. According to Golomb, "The risk of adverse effects goes up as age goes up, and this (the mitochondrial/CoQ10 connection) helps explain why statins' benefits have not been found to exceed their risks in those over 70 or 75 years old, even 'for' those with heart disease."
High blood pressure and diabetes are also linked to higher rates of mitochondrial problems--which in turn ups the risk of statin complications for people with these conditions.
"Because statins may cause more mitochondrial problems over time--and as these energy powerhouses tend to weaken with age--new adverse effects can also develop the longer a patient takes statin drugs." The risks go up as we age, as the dosage increases, and with certain genetic conditions that put one at a greater risk for developing side effects.
Joy & Hegele's "Narrative Review: Statin-Related Myopathy"
- This is the quintessential "cookbook" article on statin myopathy. Believe me--this gets very complicated. The authors thoroughly explain what statin-caused muscle pain is. Who is at risk. What causes it. What doses, which statins & circumstances increase the chances of risk. And most importantly, how to make muscle pain go away.
- 10% of statin users experience muscle pain, but those numbers increase with excessive physical activity (which explains why most athletes avoid statins); when the statin dose increases; the older you get; in women; those with small body frames; with grapefruit juice consumption; in those with a family history of statin myopathy; in certain genetic profiles; with hypothyroidism; and in patients taking certain drugs--just to name a few.
- Muscle pain is usually in the thighs, calves or both, but 25% experience generalized muscle pain. The myopathy is described as heaviness, stiffness, or cramping, and is sometimes associated with weakness during exercise. 25% have tendon-associated pain.
- Professional athletes with familial high cholesterol rarely tolerate statin treatment because of muscular problems. J Clin Pharmacol 2004;57:525-8
- Strategies to combat myopathy. Switch statins, particularly to fluvastatin (Lescol); try alternate-day use of certain statins like atorvastatin (Lipitor) or rosuvastatin (Crestor) because they are longer-acting; use of older generation non-statin drugs that work by inhibiting the absorption of cholesterol in the intestine, like ezetimibe and bile-acid-binding resins; and/or supplementing with CoEnzyme Q10.
Phillips' Editorial, "Balancing Randomized Trials With Anecdote"Click here and here for information on a non-drug approach to treating heart disease, cholesterol & inflammation.
- Phillips is just the right physician to comment on both the Becker/Gordon red yeast rice article and the Joy/Hegele statin-myopathy "cookbook" review. He runs a statin myopathy clinic, which now exceeds 600 patients, at the Scripps Mercy Hospital in San Diego, CA. He knows statin-myopathy well--what works--what doesn't.
- According to Phillips, treating statin-myopathy is more of an art--and the clinical trials don't always tell the whole story, or provide clinicians with the best therapies. "Those of us who care for patients who cannot tolerate lipid-lowering therapy are often confronted by anecdotes that contradict the findings of well-designed trials."
- Outside of the clinical trials, Phillips' clinic has discovered that vitamin D deficiency explains many mild cases of statin-induced aching.
- He's also discovered that absorbable forms of CoEnzyme Q10, which may be depleted by statins, seem to help some patients with muscle pain---but most formulations sold over the counter may be inactive. I'm wondering which formulation he would recommend.
- Although clinical trials have convinced many physicians to switch patients with muscle pain over to ezetimibe (bile-acid-binding resins), there are many individual reports that suggest that ezetimbe might not be safe for patients who can't tolerate statins. The reason for this--many of these patients have an abnormal lipid metabolism--rendering both drugs unacceptable.
- In spite of the positive results of the Becker/Gordon study, Phillips' experience makes him reluctant to use red yeast rice to lower cholesterol & prevent muscle pain. Why? Red yeast rice is not regulated or dose-standardized and since it contains the natural form of a lovastatin, it could have the potential for causing serious side effects. In his clinic he "sees many patients in whom red yeast rice use has repeatedly caused recurrence of muscle toxicity symptoms, occasionally with increased creatine kinase (CPK) levels."
- The red yeast rice study only measured muscle pain. Phillips wants to know--what about the malaise, fatigue, and weakness that he sees in his patients who use red yeast rice?
- The FDA continues to warn against inconsistent and possibly toxic formulations of red yeast rice. Phillips advises physicians not to prescribe it until it has been standardized and tested further.Two other articles to check out:
Siddiqi, SA, Thompson, PD. How do you treat patients with myalgia who take statins? Curr Atheroscler Rep. 2009;11:9-14.
Jacobson, TA. Toward "pain-free" statin prescribing: clinical algorithm for diagnosis and management of myalgia. Mayo Clin Proc. 2008;83:687-700.
From Becker/Gordon. Ann Intern Med 2009 June 16;150(12)858-868
Approach to Patients With a History of Statin-Associated Myalgias (based on the Siddiqui & Jacobson articles--see full Becker/Gordon article to follow up on the references below)
1. Initiate or intensify therapeutic lifestyle changes (National Cholesterol Education Program Adult Treatment Panel III Guidelines) (18)
2. Decrease statin dose
3. Discontinue statin and rechallenge at a later date
4. Reduce dose of statin and add ezetimibe (19)
5. Use a different statin or statin-like supplement
a. Fluvastatin, 80 mg/d (20)
b. Rosuvastatin at a low dosage (5 or 10 mg/d) (21)
c. Rosuvastatin once weekly (22), twice weekly (23), or every other day (24)
d. Atorvastatin, 10–40 mg, 3 times weekly (25)
e. Red yeast rice, 1800 mg, twice daily
6. Pulse statin therapy (16)
7. Switch class of lipid-lowering agent
a. Use ezetimibe alone (19)
b. Combine ezetimibe and colesevelam (26)
8. Check vitamin D levels and replenish if low (27)
9. Low-density lipoprotein cholesterol apheresis in qualified patients (16)
10. Add coenzyme Q10 (ubiquinone), 200 mg/d, to statin therapy (28)
I've never been prescribed, nor taken statins. I know many who take them without a problem. I know others who have experienced side effects that they never considered to be statin-related, but found they went away when they stopped taking statins. I would always recommend discussing this with one's physician, and sharing any of these articles with them, as well. You won't know what questions to ask, if you don't do the research.
Remember, there's always Option 2: Switch to a plant-based diet, and don't worry about side effects.
Do Statins Make You Stupid?(originally posted on HHLL February 15, 2008)
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, 2008 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."
Dr. Etingin 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 lowering cholesterol with a drug, artificially, is different from lowering cholesterol naturally, with diet & exercise? Could statns somehow be blocking the brain's natural production of necessary cholesterol?
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.
For the NYT article and the interesting list of comments, including mine (#25) click here.
So there you have it. Looks to me like there are plenty of good reasons to give serious consideration to a plant-based oil-free diet & exercise to lower cholesterol & prevent heart disease or stroke! But, that's just my opinion.