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Monday, November 16, 2009

Statins and Gallstones

Will Statins Soon be Added to Municipal Water Supplies?

Yet another benefit has been added to the list related to the use of statins - those medications intended primarily to reduce cholesterol in the blood. Why reduce cholesterol? Because high cholesterol is associated with a host of nasty consequences: narrowing or blockage of blood vessels and subsequent clot formation, heart attacks or strokes among them. Now what else is good about statin use? Turns out long term use of statins results in fewer folks forming gallstones and requiring surgical removal of their gall bladder. That's in the current issue of JAMA: Statin Use and Risk of Gallstone Disease Followed by Cholecystectomy.

Researchers in England, where they are famous for collecting health data on people as part of their national health service and doing studies on it, looked at over 27,000 people who had had their gallbladder removed (a cholecystectomy in medical jargon) and compared them on a number of variables to over 106,000 people who had not. Thousands in both groups had been taking statins.

The conclusion was that people who had taken statins for a couple of years had a reduced risk of forming gallstones that eventually required gallbladder removal. This is good news all around since cholecystectomy, while most often done laparoscopically where only small incisions are required, is still surgery with its consequent risks. From a public health perspective avoiding this operation results in huge savings to our health care system.

The study also accounted for other factors related to the formation of gallstones: female gender, obesity, high-carbohydrate and high-fat diet, and use of estrogen-containing contraceptives among them. Even when these factors were taken into account the benefit of statins remained. And as Rick quipped at the beginning of the podcast, it sure seems like statins have such a multitude of benefits we may one day supplement water supplies with them, much as we do with fluoride to prevent cavities in teeth.

But there are caveats to statin use: some people complain of muscle aches and pains, and a very small percentage will experience a compromise of liver function and need to stop taking them. So for now, taking statins if you have high cholesterol in your blood or if you are about to undergo certain types of surgery may help, but avoiding gallstones should not be your primary objective.

Other topics in this week's podcast include having your blood tested for lipids may not require fasting (!) in this week's JAMA, mood improvement on a low fat diet in Archives of Internal Medicine, and treatment of blockages in the arteries to the kidneys in NEJM. Until next week, y'all live well.

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