Our guest this month is Dr Kenna Stephenson, (left) MD, FAAFP, a US Board-Certified family physician and Clinical Professor at the University of Arizona College of Medicine whose clinical research on healthy aging has received international recognition.
A clinical research scientist in women’s health, cardiovascular pharmacology, healthy aging and preventative medicine, Dr Stephenson often sees patients being over-prescribed medication. Where possible, she adopts an holistic model of patient care, focusing on lifestyle and nutrition interventions.
Here, the published researcher and author discusses statins and an example of a patient who had been using these long-term, unnecessarily - and why this common prescription for adults should be used with care.
Patient case study highlights the power of diet and lifestyle - and advocating for correct, careful prescribing
Dr Stephenson writes:
"I often come across cases of inappropriate prescribing practices that may induce harm in patients aged 75 and older, when health professionals treat patients in a homogenous, uniformed manner.
My philosophy about using medications is that they should be prescribed with care and the risks of medication side effects must be balanced with the potential benefits.
Botanical, plant-derived agents along with diet and lifestyle are my first choice in addressing most health conditions as opposed to quickly prescribing potent synthetic medications.
'Statins can worsen a patient's ability to fight infection'
Statins are amongst the most commonly prescribed medications in the US, UK and New Zealand, but in patients 75 years of age and older, statins prescriptions should be carefully considered.
The reason for avoiding statin use is that some evidence shows that they may increase risk of conditions including muscle changes leading to frailty, Type 2 Diabetes and dementia - and continued use can worsen a patient’s ability to fight a serious infection.
To address cholesterol levels in most patients 75 and older, I recommend the Mediterranean diet, which reduces risks of cardiovascular disease, cancer and dementia. These diet adjustments should be incorporated along with 30 minutes of exercise four to five times weekly such as walking, dancing, or swimming.
One such recent example was a 79-year-old female patient who presented to me to establish care and requested a refill of her statin prescription.
She did not know her previous cholesterol levels and had been taking the statin medication for over 15 years. The patient did not have a history of heart attack or stroke.
She was overweight and did not exercise.
I advised that the statin should be stopped as there was no clear evidence that it was needed.
In consideration of her future health risks, I shared that there is no evidence that the statin would provide significant benefit and there is some evidence that statin use may increase her risk of conditions such as dementia, diabetes, and frailty as well as affect the ability of the body to fight a serious infection.
For this patient, I advised diet and lifestyle changes and incorporating the Mediterranean nutrition approach first.
At our follow-up, the patient had implemented the diet and lifestyle changes, her weight was approaching goal level and her cholesterol profile was in normal range.
In my model of care, each patient is assessed individually based on their unique biological, psychological, and sociological signature, and a personalized prevention and treatment plan are developed. Patients themselves must advocate for this model of care.
Patients must be participants in decision making about statin use and advocate for themselves and I encourage them to ask prescribing clinicians about the benefits and risks of statins for their personal health.
About Dr Stephenson
Kenna Stephenson, MD is a board-certified family medicine physician practicing in Northern Arizona and serves as Associate Professor of Family, Community & Preventive Medicine at The University of Arizona College of Medicine, and as Founding Medical Director of Team-5, a foundation dedicated to providing medical and dental care and education in austere, underserved areas throughout the world.
She has consulted for Paramount Pictures and is a member of The Royal New Zealand College of General Practitioners. Learn more at: www.doctorkenna.com
Dr Stephenson has authored the book The Gospel of Women’s Health: Awakening Athena Again which includes over 60 case studies with specific inclusion of women aged 70 years and older. Dr. Stephenson’s book is now available in print, digital and audio formats on Amazon, Spotify, Nook, Audible, and more.