Statins: There’s no free lunch, yet users still chow down

Statin users in the U.S. may think they can have their cake and eat it, too. A study published online April 24 in JAMA Internal Medicine found that fat and caloric intake increased in statin users but not significantly in nonusers over time.

The use of statin treatment to lower low-density lipoprotein (LDL) cholesterol has grown over the past 25 years in the U.S. Some analyses have concluded that recommendations for reducing the risk of atherosclerotic disease in 2013 American Heart Association/American College of Cardiology guidelines could increase the ranks of Americans who would begin statin therapy much more.

The 2013 guidelines, similar to previous recommendations, also emphasized a healthy diet and exercise. Takehiro Sugiyama, MD, MSHS, of the University of Tokyo, and colleagues designed a cross-sectional study using 1999-2010 data from the National Health and Nutrition Evaluation Study (NHANES) to look at the relationship between statin use and food intake in the U.S.

The researchers divided a sample of 27,886 participants into two groups: those taking statins and those not taking statins, and extracted dietary recall data to measure caloric and fat intake.

The proportion of participants using statins almost doubled between 1999 and 2010, from 7.5 percent to 16.5 percent. Body mass index (BMI) increased 1.3 in statin users and 0.5 in nonusers between 1999-2000 and 2009-2010.

Caloric intake was lower in statin users in 1999-2000 compared with nonstatin users, but there was no difference by 2005-2006. Statin users’ caloric intake was 9.6 percent greater in 2009-2010 compared with statin users in 1999-2000 while there was no significant increase in time for nonusers.

Fat intake initially was lower in statin users compared with nonusers. Statin users’ fat intake increased 14.4 percent over the two time periods. In nonstatin users, fat intake initially increased and then decreased over time.

“Since the guideline recommends that patients should prevent weight gain, the observed increase in caloric intake and more rapid increase in BMI among statin users are of concern,” they wrote. “According to the guidelines, people who receive statin therapy also should take steps to reduce fat intake, but we did not observe a pattern of combining statin use with dietary control.”

They suggested that some patients may put more stock in statin therapy than in diet control, or may have lost motivation to follow a healthy diet as they saw their LDL cholesterol levels drop with statins. Physicians may be culpable, too, if they focused their discussions with patients on medication adherence and not diet modification.

“[W]e need to consider if it is an acceptable public health strategy to encourage statin use without also taking measures to decrease the likelihood that its use will be associated with increased caloric and fat intake as well as weight gain,” they concluded. “We believe that the goal of statin treatment, as with any pharmacotherapy, should be to allow patients to decrease risks that cannot be decreased without medication, not to empower them to put butter on their steaks.”