Patient-Centered Health Care Evaluation: “Your Heart Is More Important Than Your Neuropathy”
by Aletha Tippett, MD
This is a statement the cardiologist made to my patient the other day. My patient is a diabetic man with severe neuropathy, resulting in pain and numbness in his feet, as well as difficulty walking. He also has a serious cardiac history with multiple myocardial infarctions. When he first came to me he was, of course, on a statin medication for his heart. One of my tenets for treating neuropathy is to stop statin treatment because it can increase neuropathy 26 fold (1).
Virtually 100% of my patients have reduced pain and increased sensation after they stop their statin. I advised him to hold his statin for a month and see how he felt. Well, he began to improve steadily and after a few weeks had no more pain in his feet. His sensation is returning slowly. However, when he saw his cardiologist for a check-up and told her he was off his statin, she became very concerned and made the following statement: “Your heart is more important than your neuropathy.”
So why do we have this impasse? Does not using a statin mean I don’t think the heart is important? Of course not. What it does mean is that in reviewing the literature, taking a statin reduces your risk of a secondary cardiovascular event to about 9%, but increases your overall death chances by 8%(2, 3). Is this percentage worth the loss of feeling and function due to neuropathy? This is the choice that is given my patients and almost all of them choose to hold the statin, a decision that is further reinforced as they regain sensation and function.
If not using a statin, one can use niacin and fish oil to control cholesterol. One can take B vitamins and aspirin. One can still do everything possible to control blood pressure and diabetes. If you stop the statin, does this mean you will have another heart attack? Taking the statin, you will have less chance of a heart attack, but more chance of pain, neuropathy, and death. So how important is that when looking at the overall picture of your health? While I agree that without your heart you cannot live, living with the pain and numbness that comes with neuropathy is a bleak proposition.
Neuropathy can be a terminal disease, and I have lost patients to neuropathy when all systems finally failed to operate. It is a painful and undignified death. What saddens me is that we try to force positions for or against, rather than look at what is best overall for our patients, allowing them to help decide their course of action.
The issues raised here about statins will be the fodder for future blogs. Stay tuned.
- Gaist, D. Jeppesen, U, Andersen, M, Garcia Rodrigues, L.A., Hallas, J, Sindrup, S.H. Statins and risk of polyneuropathy: A case-control study. Neurology May 14, 2002;58:1321-1322, 1333-1337.
- LaRosa, JC, Grundy, SM, Waters, DD, et al. Intensive Lipid lowering with atorvastatin in patients with stable coronary disease. New England Journal of Medicine 2005; 352(14):1425-1435.
- Pitt, B. Low-density lipoprotein cholesterol in patients with stable coronary heart disease—is it time to shift our goals? New England Journal of Medicine 2005; 352(14):1483-1484.
About the Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.