The question of statins

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Illustration: C R Sasikumar Illustration: C R Sasikumar
SummaryRecent American guidelines recommend statins to prevent heart attacks without monitoring lipid levels. However, doctors have urged caution due to the many side effects of these drugs.

of people here,” Dr Upendra Kaul, director of cardiology at Fortis Escorts Hospital in Delhi, said.

He said the entire controversy has stemmed around the last group. “If you are a high-risk individual with a history of cardiac episodes, doctors would recommend statins anyway, as they do have a proven role in reducing the risk of further episodes by 30 to 40 per cent. But if you have moderate levels of LDL and are asymptomatic, I don’t think these drugs should be prescribed at all, definitely not in such sweeping doses,” Dr Kaul said.

He said the guidelines sought to make things easier for cardiologists by advising a “one size fits all” kind of solution, adding that it was “too soon to adopt such easy steps for all patients”. The new guidelines advise against any initial monitoring of levels of LDL, Dr Kaul said.

For people with low and moderate risk of cardiac diseases, Dr Kaul said, “It is still advisable to go by the old thumb rule of monitoring lipid levels since the guidelines are basically asking us to give statins to several people who may not have needed them according to the old guidelines and do it blindly. I think for the moment, we should still be monitoring lipid levels for these people. We have to wait and see how the Europeans, the Canadians and even in the US itself, the guidelines are implemented first.”

Doctors also say that some caution is also advisable because several side effects of statins may be more aggravated in the Indian population.

Dr J S Sawhney, head of cardiology at Sir Ganga Ram Hospital, said, “Indians have very high levels of Vitamin D deficiency. A common side effect of statins in moderate to high doses is acute muscle pain. With such high levels of deficiency of Vitamin D, this pain may be compounded.”

Dr Sawhney said the guidelines only talk about preventive measures on people above the age of 40, which may be a problem for our country.

“In South Asian countries, it has generally been seen that diseases strike people 5-10 years earlier than they do elsewhere in the world. I have patients as young as 28-30 years who have heart attacks. Diabetes, which has been identified as a risk factor, also strikes very young people in India quite often. So if I have such patients, will I not prescribe them statins? Of

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