A focused look at the mounting Value of the Risk-Benefit Ratio
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.
Statin is a simplified term used to describe a group of medications to lower low-density lipoprotein (LDL) levels in the blood. In simple terms, LDL is an agent that carries cholesterol that plays a vital role in developing atherosclerosis and coronary heart disease.
Statins, also called HMG-CoA reductase inhibitors, are a widely used family of medications primarily prescribed for cardiovascular disease prevention for high-risk individuals. It is used since the 1990s, supported by the groundbreaking investigation, the Scandinavian Simvastatin Survival Study (also known as the 4S study). The latter was the first-ever multicenter, randomized, double-blind, placebo-controlled clinical trial, which provided the initial data supporting the utility of cholesterol-lowering medication, simvastatin, in moderately raised cholesterol and coronary heart disease (CHD). The study was backed by the pharmaceutical company Merck and enrolled 4,444 people from 94 centers in Scandinavia.
Weighing the Cardiovascular benefits of the Statin drugs against their possible role in long-term Dementia
HMG-CoA reductase inhibitors indeed reduce illness and mortality in those with a high risk of cardiovascular disease. Today, statins comprise the most common cholesterol-lowering drugs. However, since Statin medications integrate into the cardiovascular prevention protocol, there have been concerns about its association with dementia prevalence, emphasizing Alzheimer’s diseases. This hypothesis can be traced back to the early 2000,s when it was speculated that there might be a direct association between high cholesterol levels and Alzheimer’s disease prevalence. However, the results were inconclusive because, even with the ever-increasing utility of statins, cases of Alzheimer’s have been on the rise.
On the other end of the spectrum, in the recent decades, some patients reportedly have been claiming to be experiencing some form of memory loss and cognitive issues while on statin drugs. The FDA has also reported memory loss and confusion with statin use. Nonetheless, these reported incidents seemingly were temporary and straightforward. Those signs and symptoms seem to be frequently associated with one class of Statins comprising the “lipophilic” or fat-soluble structure. That class, by physical nature, helps the medication penetrate the blood-brain barrier (highly selective semipermeable border separating the blood from brain cells) and disappears once the drug is discontinued.
The effect of Statins on dementia risk reduction has been controversial for decades.
No overall Statin effect was detected on Dementia and cognition, according to the ASPREE study. Nor did Statins, whether lipophilic or hydrophilic, appear to influence changes in “cognition” or affect separate domains of mental performance, such as memory, language ability, or executive function, over the trial’s follow-up, which averaged almost five years.
Based on another report, all memory and cognitive incidences for all Statins, except for Fluvastatin, were reduced with variances in individual risk profiles.
An overall 30 observational studies, including 9,162,509 participants (84,101 dementia patients), saw the eligibility criteria amongst whom Statin lowered all-cause dementia risk than those without Statin
The Overall Statin Effect on Dementia and Cognition seems to be leaning towards no effect; however, vigilance about risk and benefit analysis of using Statin medications rests between individual expectations, their needs, and their clinician’s judgment. It is not wise to exclude medicines like Statins that have saved lives from our drug regimen based on a few inconclusive observations.
Just like any other Medical Treatment, the Choice to prescribe Statin Medications needs a Personalized approach
The risk-benefit ratio in medical practice is the cornerstone of clinical judgment as every physician continuously examines the risks against the benefits of a statin treatment during clinical evaluation. The clinical determination may vary from patient to patient, even among those who carry the same risks. That is the standard by which every physician is trained, abides, and practices according to the Hippocratic Oath.
We have made adequate developments in technology and literacy to reintroduce up-to-date, personalized medicine into physician practice.
At the beginning of the 19th-century, population health has been timely and excellent. Nonetheless, it has also created safe havens for the Hippocratic model of medical science lacking utility. That is, primarily, for it has failed to integrate the risks-benefit ratio in all clinical scenarios.
That has historically forced physicians to stick to all-or-nothing law when it comes to prescribing Statins. Meaning, everyone who fits the predetermined guidelines gets the Statin treatment, notwithstanding that Statins are beneficial in most populations with similar risk factors but not all.
Personalized medicine is the antidote to the ever-growing conflict between healthcare delivery, the practice of medicine, patient expectations, and proper medical treatment based on the risk-benefit ratio.
“The risk-benefit ratio in medicine is the cornerstone of clinical judgment but Despite all that, over the last century, the true meaning of risk-benefit ratio has been inevitably influenced by countless determinants that have little to do with the practice of authentic medicine” — Adam Tabriz, MD
“Although the risk-benefit ratio has been pragmatic under the population health, beneath certain circumstances like immunization, preventative medicine or end of life care it has encountered certain obstacles as bureaucratically forces citizenry into accepting what that don’t require” Adam Tabriz, MD