Medscape Medical News, a medical information newsfeed, sends me daily suggestions for articles to read, and I save the URLs for interesting items. In the batch I received on September 18, 2023, is a report regarding the risk profile of statin drugs, by Megan Brooks. The report advises us that “A newly published scientific statement from the American Heart Association (AHA) focuses on the impact of aggressive low-density lipoprotein cholesterol (LDL-C) lowering on the risk for dementia and hemorrhagic stroke.”
You can access Ms. Brooks’ report by clicking on the link, or at https://www.medscape.com/viewarticle/996569?ecd=mkm_ret_230923_mscpmrk_neuro_brain-diet_etid5882072&uac=235227EV&impID=5882072, via your browser.
The article, on the safety of Statins
The article, entitled “AHA Reviews Impact of Aggressive LDL Lowering on the Brain, by Larry B. Goldstein, et al. was published on 14 Sep 2023 in the journal “Arteriosclerosis, Thrombosis, and Vascular Biology”. You can access it via https://doi.org/10.1161/ATV.0000000000000164 .
The authors concluded that lowering LDL-cholesterol, with Statins, reduces the risk of atherosclerosis without significant risk of strokes or of adverse effects on cognition. This is a well-written paper and the conclusion drawn by the authors, that physicians should continue the practice of lowering LDL by means of Statin therapy, is reasonable.
However as often happens, the “elephant in the room” has not been noticed by the authors: they gave no consideration to metabolic causes of elevated cholesterol and made no mention of the effect of correction or elimination of such causes.
The Elephant in the Room
(A) A significant sequel of hypothyroidism, whether “true”, or “intracellular”, is impaired glucose and cholesterol metabolism, resulting in atherosclerosis, weight gain and sometimes, a high A1C.
(B) Correction of hypothyroidism frequently eliminates the deviations from normal glucose and cholesterol management, for which Statin medications are prescribed.
(C) It is therefore prudent, whenever hypercholesterolemia is discovered, to investigate thyroid hormone metabolism with a view to diagnosis of either true hypothyroidism, or intracellular hypothyroidism, or both.
Very necessary, but frequently omitted, tests
Metabolic/Functional Medicine physicians agree that every patient with hypercholesterolemia should have a “thyroid profile”, including TSH, Free T4, Free T3 and Reverse T3. The thyroid profile results allow the physician to calculate the T3/rT3 ratio and determine whether true hypothyroidism, or intracellular hypothyroidism, are etiologic agents in the individual’s deranged cholesterol metabolism.
If either condition is found, correction of true hypothyroidism with T4, or intracellular hypothyroidism with T3, will improve the patient’s glucose and cholesterol management, often to the point where a statin prescription is not needed.
The Bottom Line
(1) A “thyroid profile” should be performed as part of routine “checkup” testing. If a thyroid profile has not been ordered, any aberrant glucose and/or cholesterol test results should trigger a request for it.
(2) True Hypothyroidism, or Intracellular Hypothyroidism, if found, should be corrected prior to deciding whether the patient needs a Statin prescription, or not.