Updated: Jun 17
The embodiment of the need for a Personalized approach for optimal Patient Compliance and Health Outcome
Disclaimer: This article is written to serve as a source of perspective based on my view and the existing scientific evidence. On no account should it be used as medical advice. My advice is for everyone to consult their medical doctor to seek the unsurpassed personalized treatment option.
HMG-CoA reductase inhibitors comprise a class of medications that have been around for the last three decades. It is known as “Statins,” which physicians prescribe to lower lipid levels in the blood in layperson terms. LDL (low-density lipoprotein) is a subcategory of cholesterol that is bound to protein. Its reduction by Stain use also reduces illness and mortality in those at high risk of cardiovascular disease.
Some of the commonly prescribed Statins are:
· Atorvastatin (Lipitor),
· Fluvastatin (Lescol, Lescol XL),
· Lovastatin (Mevacor, Altoprev),
· Pravastatin (Pravachol),
· Rosuvastatin (Crestor),
· Simvastatin (Zocor), and.
· Pitavastatin (Livalo).
With a minor variance between each member of the Statin drugs family, their effects and side effects are generally analogous.
Today Statins comprise the most commonly prescribed cholesterol-lowering medications.
Although Statins have a proven record of prolonging lives nonetheless, they come with specific side effects. That is why it is crucial to personalize the treatments with the Statin medications to avoid non-compliance or, at the other end of the spectrum, unnecessary prescribing and overdosing of the Statins.
One of the few yet controversial side effects of statins is their impact on sex hormones!
Based on a report from the Center for Disease Control (CDC), almost 28% of American men and women over age 40 are on some form of Statin regimen. Yet, only 61% of those continued taking the medication after three months, and only 55% remained on the drug after six months.
Let us keep in mind that, even though Statis affect the hormonal component of the sexual performance in men. Nonetheless, according to a study published in the World Journal of Men’s Health, Statins seem to improve erectile function. Since LDL-C is associated with restored endothelial (the blood vessel tissue single layer of cells lining) function, good endothelial function is imperative for the erection. The study suggests, that statins may improve endothelial function through ‘pleiotropic’ properties, including increased nitric oxide availability, which is considered the critical intermediary of penile erection, decreased oxidative stress, and antioxidant effects.
Effect of Statins on Sex Hormones
In layperson terms, in the meantime, HMG-CoA reductase is the central enzyme in cholesterol metabolism, and sex hormones such as estrogen and androgens are the byproduct of some form of cholesterol metabolism, it would be logically expected physiologically lower androgens. Indeed, statins inhibit the local synthesis of androgen (male Hormone) substrate production. The Statins’ pleiotropic effects seem to be somewhat similar yet unrelated to the physiological effects of lowering Testosterone.
A study published in Diabetes Care by the American Diabetes Association in 2009 pointed to the possible correlation between Statins and low blood Testosterone. According to the publication, the high prevalence of hypogonadism in men with type II diabetes who were also taking Statins lead to believe their potential negative effort testosterone levels. Some postulate that they do that by reducing the availability of cholesterol for androgen synthesis. The study also noted that although men with type 2 diabetes are prone to have lower testosterone levels, total testosterone levels were significantly lower in men treated with Statins.
A 2013 meta-analysis reported in BMC medicine suggested Statins may, indeed, partially lower Testosterone in blood.
Endocrinology Adviser suggests total Testosterone in men and other factors; DHEA (dehydroepiandrosterone) and SHBG (sex hormone-binding globulin) in both men and postmenopausal women were all inversely associated with statin use.
Conclusion; Patients receiving statins based on clinical guidelines to lower their blood cholesterol levels and lower total Testosterone also have lower levels of sex hormone-binding globulin (SHBG) and dehydroepiandrosterone (DHEA). Initially published in The Journal of Clinical Endocrinology & Metabolism, the results are supported by other studies published in clinical and translational Endocrinology.
Maybe it is time to Personalize the Statin Therapy!
Numerous clinical trials focusing on mortality and morbidity of cardiovascular (CV) diseases have everlastingly confirmed Statin’s indication as a lipid-lowering agent. But the tests conducted in the past rarely, if ever, considered personal factors, including gender and hormonal imbalance. Furthermore, it is also postulated that even the Statin therapy regimen may differ between men and women.
A study published in Clinical Lipidology suggests a different prescription of these treatments, particularly in the dosage between men and women. Thus, demanding that the Statin dosage appropriate for a male gender may be insufficient in women with cardiovascular disease.
It is essential to realize that most guidelines to treat an individual with a statin medication are merely based on the population health model. That means the treatment criteria to lower blood cholesterol are solely based on similar treatment outcomes in a group of individuals, including distributing such results. Hence, the health outcomes of such groups with the Statin therapy are the determining factor for policymakers in the public and the private sectors. In other words, if treatment with the Statin drugs prevents a cardiovascular event in 80% of the selected group, therefore, it becomes the standard of practice to prescribe Statin to everyone who meets the set criteria.
In the population model, the persons who show any adverse effects from the statins will be considered for therapy revision. But what if such side effects are associated with subtle but significant symptoms, such as sexual dysfunction, fatigue, and loss of energy that in the beginning do not alert the patient to seek help or may attribute to another problem?
Current Healthcare trends affect the Individual outcome of the Statin Regimen.
With increasing patient engagement in their personal medical care cost reduction and a value-based reimbursement system for physicians, population health cannot answer those demands. Generally speaking, Population health is failing to address 21st-century healthcare requirements. That seems to be the upshot of the increased public knowledge base and access to information. Furthermore, the Millennials have the liberty of individual expectations and encouragement of being engaged in their care but are given the care only suitable for the majority that fit a particular profile of social determinants of disease and health.
It’s, indeed, time to accept the bitter reality of superannuated Population Health.
Population health has run reasonably well since its inception in the 1900s. It is inexpensive as long as the subjects attend the One-Size-Fits-All pattern of the scheme. But on the downside, population health inclines to omit the minority crowd and the vulnerable.
The risk-benefit ratio in medical practice is the keystone of clinical judgment, as every physician endlessly weighs the risks against the benefits of a particular treatment or intervention during clinical evaluation.
Therefore, the clinical decision on treating and prescribing Statins may vary from patient to patient with the same diagnosis.
Every medical professional is mindful of establishing realistic expectations with patients concerning the Statin treatment protocol. That includes considering the patient’s perception, knowledge, and priorities and weighing them against the physician’s objective determination. Statin side effects may be harsh nevertheless, under certain (individual) circumstances satisfactory. Such as one of the biggest concerns about sex hormone imbalance is at times suffering from cardiovascular disease may be more severe than the upshots associated with the hormonal imbalance, even though long-term consequences of the hormonal imbalance may be just as harmful.