A friend, at age 60, had cardiovascular plaque problems. His father died of a heart attack at age 51. Good thing, he slowed down his plaque progression, reversed it, and hardened it. As he felt in good shape at that time, he stopped taking his statin. In less than a year off the statin, his plaque softened again and started growing.
So, stopping statins, is it safe? Some studies say it’s safe; some say it isn’t. We look at various studies in favor and against stopping statins and cite reasons patients are stopping their statin.
Study #1: Rory Collins and The Lancet
There’s been a debate going on for about 6 years between the British Medical Journal and Lancet, the two major medical journals in England. It started when the British Medical Journal published things stating that statins are dangerous. Rory Collins and his group from The Lancet refuted those claims.
Collins’ group did a meta-analysis that was published in The Lancet, titled “Interpretation of the Evidence for the Efficacy and Safety of Statin Therapy” (Collins et al., 2016). They observed statin use of 10,000 people who stopped taking statins post-stroke (subjects are either low-risk or high-risk). They followed these people for 5 years.
Here is a snapshot from one of my YouTube video, briefly summarizing the outcomes of continuing statins vs. stopping stains based on Collins’ meta-analysis.
- For subjects who continued their statins, there were a few reported cases of myopathy. You’ll also see increasing insulin resistance, listed as “new-onset diabetes.” There are also a few cases of hemorrhagic stroke. But as you can see, such bad outcomes only top 100 in numbers for every 10,000 people.
- On the other side, that same ten thousand people would suffer 500 heart attacks or strokes if they stop taking their stains. That’s only for a low-risk group; if this was a high-risk group, the number could be in a thousand.
What Collin’s group is saying is that, while statins are dangerous, things aren’t as bad as going statin-free.
Study #2: JAHA article on Taiwanese stroke patients
Here’s another study that’s published in the Journal of the American Heart Association (JAHA) in August 2017. It’s titled “Utilization of Statins Beyond the Initial Period After Stroke and 1-Year Risk of Recurrent Stroke” (Lee et al., 2017).
Among the 45,151 ischemic stroke patients observed during the day-90 to day-180 period,
- 74.5% (33,623 patients) maintained moderate or high‐intensity statin therapy;
- 7% (3,185 patients) were on reduced therapy;
- 18.5% (8,353 patients) were not on any statin therapy.
Researchers found that stopping statins 3 to 6 months after an ischemic stroke was connected with a 42% increased hazard of recurrent stroke and a 37% increase in mortality within 6-18 months after discharge. On the other hand, the reduction of statin therapy between 3 to 6 months after an ischemic stroke does not affect recurrent stroke or mortality rates.
The problems of the JAHA article
But such “conclusions” aren’t as simple as they look. While researchers showed a dip in recurrent stroke and ischemic stroke with continued statin use, one of the study’s issues is that the study didn’t clearly define the differences among recurrent, ischemic, and secondary ischemic strokes. Researchers just showed that a patient is more likely to have a stroke after statin discontinuation.
Exclusions are another issue. This JAHA study was from a Taiwanese registry for strokes, and it was a retrospective study. This means researchers tabulated and took information from strokes that had already occurred.
The snapshot above is from the JAHA paper. Let’s look at some exclusion criteria.
- The first one is 32,611 patients were excluded due to having a recurrent stroke within 180 days after discharge; that may be part of the study. Often, people get one stroke after another in rapid succession, so that’s why the researchers ruled that group out.
- 3,900 patients were excluded due to hemodialysis. Unlike the previous exclusion, it’s unclear why researchers would do that as hemodialysis is a major destabilizer.
- 66,636 excluded for not having antiplatelet or anticoagulant within 180 days, and 119,620 excluded for not having statin or a low-dose statin within 90 days after the discharge. These seem reasonable exclusions, as it’s more likely to be the reason for having a recurrent stroke.
Whether an exclusion is reasonable, researchers didn’t discuss it, and that’s where problems get into such studies. As members of the scientific medical community start debating the quality of research and the quality of the logic, expect them to bring out such issues. Still, give the authors the credit that they knew what they were doing. Though they had sound logic behind the study, we’re not hearing it.
Study #3: Statins’ side effects and stopping statins
Why do people stop taking their statins? There are a lot of reasons, like:
- Side effects. Such side effects include fatigue, muscle soreness, malaise, increasing blood glucose, dizziness, brain fog, etc.
- Need to switch to another statin. For example, patients on Lipitor (atorvastatin) may have realized they’re insulin resistant, and their current statin isn’t giving any anti-inflammatory impact.
- The “dangers” of statins. Some people might have stopped statins after watching YouTube videos or read articles about the dangers of statins.
- Other reasons, like cost or fear. In some cases, “baby boomer” patients just don’t want to take statins or any medications, preferring to be healthy naturally.
In 2017, CNN Health covered an article on stopping statins, titled “Statins: What happens to patients who stop taking them after side effects?” The article covered a cohort study done by researchers in Massachusetts. Researchers looked at 28,266 patients, and they found that 3 in 10 stopped their statins because of side effects, probably the top reason people stop taking statins.
The cohort study is titled “Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study” (Zhang et al., 2017). Here are the findings:
- 8.5% of those that stopped taking statin went on to have a heart attack or stroke or a cardiovascular event. 7.6% of those who stayed on statins had a heart attack or stroke.
- 6.6% of those who stopped statins died of all causes as compared to 5.4% of those who stayed on statins.
Some people, though, may interpret that “slight” difference as not an excellent trade-off for statin’s side effects. But again, the difference is significant, given the fact that there were 28,266 subjects.
Study #4: The TNT (Treating to New Target) Study
Now, here’s a study that says something different. Back in 2004, Dr. Mary McGowan did a separate study that was nested into the TNT (Treating to New Target) study.
What’s the TNT study? The TNT study titled “Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease” was published in the New England Journal (LaRosa et al., 2005). TNT researchers looked at two doses of a statin, Lipitor (atorvastatin). That time, the target was to get somebody’s LDL below 100. Because of this TNT study, LDL target was lowered to below 70, and that made this study a big deal.
As you see, the TNT study changed the standards for LDL lowering. But to arrive at that change, researchers had to take some people off of statins for at least 6 weeks. That’s what Dr. McGowan did in her study. She studied those people that had to be taken off of their statins then found that there was no increase in event risk.
In a nutshell, it appears that taking people off statins is safe.
But is it really safe to stop statins? Let’s go back to the early 2000s. There were already valid studies coming out about the withdrawal of statins increasing event rates in patients with acute coronary syndrome.
Why are there conflicting results?
So, why do we see conflicting studies? Some say it’s okay to stop statin, while some say it’s not. I think these studies and their results are reasonable, compatible, and expected. The studies proving the safety of stopping statins are done on stable patients. Studies showing hazard of stopping statins were with patients that had a recent stroke, heart attack, and other cardiovascular events.
Here’s my take on this issue: plaque instability is systemic. There’s no such thing as a single vulnerable plaque where there’s one unstable plaque. In reality, there’s an entire arterial tree full of unstable plaques. Likewise, if your plaques are stable, then they will remain that way. Check out my video about the “vulnerable plaque” theory, where I went full depth into this topic.
So in a study of people that are stable and healthy, it’s okay to stop statins for a short time. However, if you’re unstable already, and you’ve got evidence of a “hot” plaque, you already have plaques in there that are waiting to do damage again.
Again, plaque instability is a systemic issue, not a local issue. If you’re stable, you may go off of statins for a while. Now, can you go off of statins forever? Well, you may, but be wary of the safety issues. Nevertheless, consult your doctor first on the stopping statins guidelines.