Few Indians use cholesterol-­fighting drugs thanks to ignorance, myths

MUMBAI: Misleading claims about the safety and efficacy of statins, and a lack of awareness about them, have resulted in the underuse of these effective cholesterol-reducing drugs, cardiologists in Mumbai said on World Heart Day on Thursday. Studies have shown that only 5% of Indian heart patients use the drugs, as compared to 66% in high-income countries such as Sweden and Canada.

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Statins are fat-lowering medications that have been found to reduce deaths among high-risk heart patients. In a recent review published in The Lancet, a medical journal, 23 researchers from across the globe discussed the efficacy and safety of statin therapy to help clinicians, patients, and the public to make informed decisions about it and prevent heart attacks and strokes.

Professor Rory Collins from the University of Oxford said, “Evidence from randomised trials shows that statin therapy reduces the risk of major vascular events like coronary deaths, heart attacks, strokes, and bypass surgeries by about 25%, with specific reductions in LDL cholesterol each year once therapy starts.” Low-density lipoprotein (LDL) cholesterol is considered the ‘bad’ cholesterol as it contributes to plaque, a thick, hard deposit that can clog arteries and make them less flexible.

Heart specialists from Mumbai said many patients are averse to choosing statin therapy thanks to myths and a lack of awareness about it. Dr Jamshed Dalal, director of cardiac sciences at Kokilaben Dhirubhai Ambani Hospital, Andheri, said that while an increasing number of parents are being prescribed statin therapy, the lack of awareness among clinicians is the main reason for its underuse. “The major issue is that the drug is not used as a preventive measure for high-risk patients. Secondly, every drug has its share of side-effects, but the benefits of these drugs greatly outweigh their side-effects,” said Dalal.

Dr Ajit Menon, an intervention cardiologist at Wockhardt Hospital, Mumbai Central, said he prescribes statin therapy to young patients with a history of heart disease and other high-risk patients. “Numerous studies have proved that cholesterol is one the main causes of blockages and plaque. Statins are certainly more effective if monitored closely. Side-effects only occur when high doses are prescribed, which is rare. The drugs are also inexpensive; they cost about Rs150 to Rs200 a month,” said Menon.

The side-effects of statins, according to Professor Collins, are myopathy (muscle pain or weakness combined with large increases in the concentration of the enzyme creatine kinase in the blood), diabetes, and an increase in strokes due to bleeding (haemorrhagic strokes).

“Typically, treating 10,000 patients for five years with standard statin regimen would be expected to cause about five cases of myopathy, 50 to 100 cases of diabetes, and 5 to 10 haemorrhagic strokes. The harmful effects of statin therapy can usually be reversed, without any residual effects, by stopping it. On the contrary, harmful effects of heart attacks or strokes can be devastating,” the Oxford researchers said.