statins, pros and cons?

HollyBerry

I tried to search for an old conversation on this, but didn't find one; feel free to redirect me if this has been discussed before.

A few years ago, the provider in Geriatrics put my partner on a statin because her cholesterol was something like 240. The next time she saw her primary, they took her off the statin. I was never completely sure why. Yesterday she saw her new primary (other one retired), cholesterol is up, LDL is quite high, and she would like her back on the statin. 10-year risk of a coronary event is 13%.

I have really mixed feelings about all of this and I'm trying to tease out my own opinions vs what is objectively good medical practice vs. what might be different for someone well along the path of Alzheimers. In the same way we choose whether we want to continue screenings like mammograms, how important is it for someone with a progressive, terminal condition to take yet another prescription drug to avoid something that's a fairly low risk? maybe it doesn't matter, just take the statin along with the handful of stuff she already takes. For CVD, it's probably the only preventive measure she's capable of doing, so how much does it really affect the outcome? I struggled somewhat with similar questions when they wanted to treat her osteoporosis, but in the end decided it (Reclast) was probably a good idea.

Thoughts? would your thoughts be different for someone who has a strong family history of heart disease and has other risk factors, vs someone with no family history and few risk factors? are there other benefits I'm not recognizing to starting a statin in a 76-year-old person diagnosed with Alzheimers 6 years ago? You are welcome to tell me to quit worrying and just fill the prescription, it's cheap and it's just one more small pill among many. thanks!

Timmyd

These are my considerations. It is reasonable that other people have different considerations.

How compliant is DW with taking medication? Is it easy to get DW to take the pill?

What is the cost of the medication? Will it increase our financial burden?

How far along is DW in progression and what do the statistics indicate about life expectancy? Is the pill addressing something which is is a reasonable medical concern given the big picture at this stage of the disease?

RetiredTeacher

My 77 yr old DH is probably late stage 5 VD due to 3 previous strokes. He has 2 abdominal aortic aneurysms a thoracic aneurysm, poor CV health and emphysema. His Dr still wants him on a statin and a low dose aspirin. He's been on these for the last 5 yrs. If we stop the statin his chance for an additional stroke or heart attack increases. If we stop the statin and he has a CV event. It's quite likely he could spend the rest of his days in SNF. He doesn't want that, I don't want that for him and it would financially bankrupt us. If he were late stage 7 would I feel the same??? Perhaps not. For our situation in this moment in time, we will continue the statin. It is a very personal decision and no universal correct answer. We can only do our best and pray God will handle the rest.

SDianeL

what stage is your partner in? If she’s in stage 7 I would consider stopping the statin and all prescriptions except those for comfort or those that would prolong her progression. If she’s in stage 7 you might want a hospice evaluation. They will help you answer these questions. Reclast would be a comfort decision because arthritis is painful.  Potential side effects of statins in older adults can include muscle pain, liver toxicity, and an increased risk of diabetes. You would need to weigh those possible side effects against the cardiovascular benefits of the statin.

Michele P

https://alzconnected.org/discussion/75347/statins-pros-and-cons

Look into Dr. Dean Ornish’s Lifestyle Program. In clinical trials, he reversed heart disease and progression of early stage Alzheimer’s with a plant based diet, exercise, stress management.

harshedbuzz

@HollyBerry

There is no one-size-fits-all answer to your question.

A concern I would have it is that all too often, PCP and specialists don't understand dementia as the terminal condition it is. They focus on best practice preventative care appropriate to someone with decades to live or hyperfocus on one organ system while ignoring the life expectancy of the individual in front of them.

I have this to a degree with routine care as it relates to my almost 90-year-old mom who doesn't have dementia. My mantra is always "what are we going to do with this information?" when it comes to routine screenings like mammography.

The other thing I would consider is the risk/benefit for your LO. The reality is that certain "benign" medications have unpleasant side effects (muscle pain for statins and flu-like symptoms for Reclast) to which I would not choose to subject a LO who could not participate in the decision or reliably report discomfort.

With dad, we took a more palliative approach to his care around stage 6. His new PCP stopped his BP meds, metformin and statin. We did continue his androgen deprivation therapy in the hopes of preventing his prostate recurrence from spreading to his bones.

HB

HollyBerry

Following up on my own message - I was reading someone else's comment elsewhere on this board and something important struck me. The person was telling someone else that it is the provider's responsiblity to put the patient's best interest first. That made me think of conversations we've had over the years at home about our different attitudes toward health care, prevention, intervention, end of life, etc. I think if my partner was making her own decisions 20 or 10 years ago and was asked about restarting the statin, she would say absolutely yes, do whatever medicine can offer. That was always her attitude and in my capacity as (whatever it is…) the person who makes decisions in a manner that's true to her wishes, that's my obligation. It's a tiny example of a much bigger truth, I guess, and that point of view hadn't really occurred to me when I wrote the post.

And I agree with all of you who mentioned the stage and its influence on the decision. She's probably late 5 with some characteristics of 6, so still good about taking the handful of pills and also not compliant with any preventive health behaviors (diet, exercise, etc). Will she live to prove out the effectiveness of the statin in preventing disease? probably not. Does it matter, for a $5 copay? probably not.