Do Statins Decrease Or Increase The Risk Of Parkinson’s Disease?

Written by Dr. Steve Chaney on . Posted in Drugs and Health, Issues

The Fine Print Behind The Misleading Headline

 Author: Dr. Stephen Chaney

 Human NeuronsI hadn’t paid much attention to the headlines saying “Statin Use May Decrease Parkinson’s Risk” until the other day when I happened to glance a couple of lines below the headline and spotted a statement saying “Study Shows That Discontinuation of Statin Therapy Increases Risk of Parkinson’s”.

 I immediately said to myself “That’s bizarre. There is a total disconnect between the headlines and the study.” If you really wanted to determine whether statin use reduced the risk of Parkinson’s, you would compare the incidence of Parkinson’s disease in a group of statin users and a matched group who did not use statins.

It turns out those studies have been done, and they were inconclusive – some studies showed a slight increase in Parkinson’s in statin users, some showed a slight decrease, and most showed no correlation between statin use and Parkinson’s.

In that context, this study could equally well have been interpreted as suggesting that statin use increased the risk of Parkinson’s, but somehow none of the headlines mentioned that possibility.

Are Both Possibilities Plausible?

 Let’s look at each possibility in detail. The reasoning is complex, but let me try to walk you through it.

 Could Statins Decrease The Risk Of Parkinson’s

 Parkinson’s is caused by the progressive degeneration of the brain neurons that produce a chemical messenger called dopamine that controls muscle movement. However, the causes of nerve degeneration in Parkinson’s patients are largely unknown.

Genetics may play a small role. Environmental toxins may play a role. But most experts feel that Parkinson’s patients produce an excess of free radicals, and it is the oxidative damage caused by those free radicals that results in the loss of the ability of neurons to produce dopamine.

But even that is not the whole answer. The brain is normally able to use coenzyme Q10, which is very abundant in brain, and other antioxidants to destroy free radicals before they damage brain neurons. Somehow in Parkinson’s patients free radical production and antioxidant production have gotten out of balance.

Advocates of the theory that statins may decrease the risk of Parkinson’s, point out that statins decrease oxidative damage. So if a person was predisposed to developing Parkinson’s and oxidative damage is a major cause of Parkinson’s, it is theoretically possible that statins could slow the progression to Parkinson’s while they were taking the drug. Of course, once they stopped taking the drug the oxidative damage to dopamine-producing neurons would resume and Parkinson’s would eventually develop.

In this model- Let’s call it Model A:

1)     Oxidative damage of dopamine-producing neurons was caused by some unspecified external agent.

2)     Statins protected the neurons from oxidative damage while they were being used.

3)     Once the statin drugs were discontinued oxidative damage resumed and the risk of developing Parkinson’s increased.

This is the model favored by the authors and repeated in all of the headlines you saw.

Could Statins Increase The Risk Of Parkinson’s?

Statins also interfere with the synthesis of cholesterol and coenzyme Q10, and these are both absolutely essential for brain function. Let’s start with cholesterol:

  •  20% of the body’s membrane cholesterol is found in the myelin sheath that coats the brain’s neurons (You can think of the myelin sheath as analogous to the plastic coating that insulates an electrical wire).
  • Cholesterol can’t cross the blood-brain barrier, which means that the brain cannot utilize cholesterol from the bloodstream . It has to make its own cholesterol.

As for coenzyme Q10:

  • It is not only a powerful antioxidant. It is also absolutely essential for cellular energy production.
  • The brain has tremendous energy requirements. The brain accounts for 20% of the energy utilization of our body. Neurons burn 2 times more energy than other cells in our body.

For both of these reasons, many experts have cautioned that statin drugs have the potential to cause neurodegenerative diseases such as Parkinson’s.  In this model – Lets call it model B:

1)     The statin drugs themselves are damaging the dopamine-producing neurons by inhibiting cholesterol and coenzyme Q10 synthesis in the brain.

2)     The antioxidant effects of the statin drugs were masking the damage caused by the statins while the drugs were being used.

3)     Once the statin drugs were discontinued the underlying damage was unmasked and the patients quickly developed Parkinson’s.

What Did The Study Actually Show?

The study (Lee et al, Neurology, 81: 410-416, 2013) looked at 43,810 statin users on the island of Taiwan. The Taiwanese Health System keeps extensive records of prescription use and health conditions of everyone on the island. It also requires that statin use be discontinued as soon as the patient reach their target of < 100 mg/dL LDL cholesterol, so they had the perfect population base to study what happens when you discontinue statin therapy.

The results were:

  • The patients who discontinued statin therapy were 42% less likely to develop Parkinson’s that those who continued on statin therapy. That result is consistent with both models A & B.
  • The increased risk of developing Parkinson’s when the drug was discontinued was only seen for the statin drugs like simvastatin and atorvastatin that are able to cross the blood brain barrier. That result is actually a bit more consistent with model B (Remember that the brain has to be able to make its own cholesterol and statins block cholesterol production).
  • When the study compared people using statin drugs to those not using statin drugs there was no significant difference in the prevalence of Parkinson’s – even for those statin drugs that cross the blood brain barrier. That means that merely being on a statin drug did not influence the risk of developing Parkinson’s. It was only when patients were on statin drugs for a period of time and were subsequently taken off statins that the risk of developing Parkinson’s was affected – and the effect was to increase risk! In the context of the first two findings, that result is also a bit more consistent with model B.

The Bottom Line:

If I were writing one of those medical blogs, I would have probably have gone with the party line and told you that statins decrease your risk of developing Parkinson’s. And if I were one of those health bloggers who never let the facts get in the way of a good story, I’d probably be scaring you with headlines saying that statins increase your risk of Parkinson’s.

But, I’m a scientist. I actually read the article, and I tell it to you like it is. Here’s your bottom line.

1)     Ignore the headlines. The study they are talking about can’t distinguish between statins increasing or decreasing the risk of Parkinson’s. Don’t let anyone tell you that reducing the risk of Parkinson’s is a side benefit of statin therapy. That simply has not been proven.

2)     The study does clearly show that discontinuing the statin drugs simvastatin and atorvastatin is associated with increased risk of developing Parkinson’s. That’s a big red flag for me, because 53% of patients discontinue statin therapy because of side effects, cost or other reasons.

3)     However, statin drugs do save lives, especially for people who have already had a heart attack, so talk with your doctor about the benefits and risks of statin drugs, and which statin drugs are best for you.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Tags: , , , , , , ,

Trackback from your site.

Comments (8)

  • Angela

    |

    My husband has been on statins for more years than I can remember. His health has deteriorated greatly over the last 5 years and he has just been diagnosed with Parkinsons Disease. He has stopped the statins 3 weeks ago and there has been an improvement in his disposition and mental capacity. he has stopped hallucination/hearing things and and is carrying himself more balanced. He is happier in himself and not the grumpy old man he had become. He is smiling brightly. His slight tremor has now virtually disappeared. He is still very stiff. I believed it was the statins that were making him ill and now am more convinced of it than ever. It was because of what I could see that I looked for evidence on the www. There was certainly no case of ceasing the statins causing the Parkinsons.

    Reply

    • Dr. Steve Chaney

      |

      Dear Angela,
      Sometimes I am too subtle for my own good. I was raising the hypothesis that statins could cause neurological damage that increased the risk of Parkinsons, but that the neurological damage was masked by the anti-inflammatory effects of statins. Of course, once someone has been on the statins long enough it may no longer be possible to mask the symptoms. That is just a hypothesis at this point, but it would explain your husband’s situation.
      Dr. Chaney

      Reply

  • Rene Cote

    |

    After having an operation (2 stents), I received a prescription for Statins (Crestor).

    After 2 days, I started to having pain while working, back pain also, and after 5 days I could hardly walk correctly. My doctor told me I had to excercise more.
    After reading side effects on internet, I talk about it with my neighbor whose a phamacist. She told me to stop the statin treatment immediatly. After 3 days, I was back to normal.

    My father who was taking statins for 5 years was diagnosed Alzeimer. He could hardly move and was confused once in a while.
    My mother and I decided to stop my father’s statin treatment.
    After 2 weeks, my father started suddendly to walk with no help and was much much less confused. After a visit to his doctor, the Alzeimer diagnostic was removed, and replaced with a Parkinson diagnostic, because he was shajing a bit from his right hand.

    My non-scientific observation is that after being attacked by statins, their must be a period for muscles to get completly back to normal.

    I am sorry but I think you don’t follow your own recommandations: where is it proven that “statin drugs do save lives”?

    Oh yes, in studies (made by who?)

    Reply

    • Dr. Steve Chaney

      |

      Dear Rene,

      In clinical studies with patients who have already had one heart attack or otherwise have serious heart disease, statins significantly decrease the risk of a second heart attack. That has been shown in numerous clinical trials. As I pointed out, it has not been possible to prove that statins reduce heart attack risk significantly in people who have not had a heart attack. And the kind of side effects that you have described are real, and can be quite serious. This aspect of statin therapy has often been downplayed in the medical community.

      Dr. Chaney

      Reply

  • Randy Ice PT, CCS

    |

    Since oxidative stress of the dopamine producing brain cells appears to be the most likely cause of Parkinson’s, and since statins can cause or maybe protect against it, it would seem a more logical approach to prevention would be to take CoQ10 and other fat soluble antioxidants like Vitamin E and R-Alpha Lipoic Acid. This offers the best defense along with a good diet and exercise while avoiding a whole host of statin “side effects” aka unwanted direct effects, which are approaching 300 now.

    I am not convinced that statins have cardioprotective effects in secondary prevention. The original 4S study showed a 0.8%/year absolute risk reduction in the simvastatin group relative to placebo and that was in a cherry picked population of 8888 men screened from 21,000 men with prior heart attacks. So why were over 12,000 men rejected from this study.?Why was the study population so large? Because the researchers knew going in that the effects of this drug would be minimal, therefore to achieve “statistical significance” they had to rig the study with large numbers of cherry picked men. There was no difference in strokes nor MI’s in either group. Studies of women with coronary disease have shown no benefit with statins in primary ore secondary prevention.

    The absolute risk reduction in secondary prevention is so ridiculously miniscule that the long term risks of CHF, Type II diabetes, muscle and joint pain, cataracts, peripheral neuropathy, dementia, etc etc that I see in my patients very frequently make the use of these expensive drugs simply unacceptable

    This is a scam of unbelievable proportions maiming and killing millions of people around the world all in the name of “cholesterol reduction” which has no effect on atherosclerosis.

    I have directed a cardiopulmonary rehab program for the last 42 years and I see first hand the damage statins do as well as patients who have been on them for years and have another cardiac event due to progression of disease.. That is also why they have no effect on primary prevention. They Lipid Hypothesis of atherosclerosis has been dis proven and should discarded.

    Unfortunately there are $29 billion reasons why this won’t happen anytime soon.

    Reply

  • Prof A N Agrawal

    |

    I am going to stop Atorvastatin 20 which my wife , a pt of CKD on hemodialysis has been taking for last 10years and also a pt of PD on Levodopa/ carbidopa for last 3 years, and monitor the for 10-20 days whether PD symptoms improve.

    Reply

    • Dr. Steve Chaney

      |

      I always recommend checking with your physician first before going off medications. I report on clinical studies, which describe what happens for most people. However, each of us are unique and only our physicians know the pluses and minuses about changing medications for us as individuals. Tell you physician your concerns about PD and enlist their help in monitoring how your wife responds to going off or reducing Atorvastatin.

      Dr. Chaney

      Reply

Leave a comment

Recent Videos From Dr. Steve Chaney

READ THE ARTICLE
READ THE ARTICLE

Latest Article

High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

UA-43257393-1