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Discusses Women's Health

If you have ever experienced severe abdominal pain, especially up high towards your right breast, and it was accompanied by nausea or vomiting (I have patients describe it as upper abdominal labor!) you probably ended up in your doctor’s office or the emergency room. The differential diagnosis (or DD as we doctors like to use in our alphabetical code) would be gallbladder disease due to gallstones, pacreatitis, food poisoning, ulcer, intestinal malfunction (inflammation, obstruction or just irritable) and let’s not forget, especially in women, heart attack! A work up would most likely include ultrasound and blood tests as well as cardiac testing. If gallstones were found and they were sizable, or the stones were causing enough pain to make you miserable (and your doctor worried) you would likely be referred to the nearest surgeon for removal of that stone ridden organ with a procedure called a cholecystectomy.

We are all at risk for gallstones; indeed this is the leading cause of gastrointestinal illness requiring hospital admission in western countries. There are more than 700,000 cholecystectomies performed every year in the United States. That’s the bad surgical news….the good news is that most of them can now be performed via laparoscopic surgery rather than the open incisions that were the norm (and the extended healing time) 2 decades ago.

Why do so many individuals produce and suffer the consequences of these stones? We synthesize cholesterol in our liver; some is excreted in the bile that is then collected in the gallbladder before it makes its way out to the intestine. Over 80% of gallstones are made of cholesterol. And the more cholesterol that is “sent out” though the bile duct, the more likely stones will be formed. Certain factors and conditions create an environment of supersaturated bile. These include age (the older we get the greater our propensity to synthesize cholesterols in our liver), female sex (sorry about this), obesity, high–fat and even high carbohydrate diets. Then we also find a predisposition to stone formation in women who take estrogen-containing birth control pills and postmenopausal estrogen therapy. The estrogen, especially if taken orally can cause higher bile cholesterol excretion.

So it would stand to reason that anything that lowered the cholesterol production in the liver and hence the concentration of this fatty substance in the bile would also help prevent gall bladder stone formation. A study just published in the Journal of the American Medical Association (JAMA) has partially substantiated this theory. The study showed that statins (which do lower cholesterol) help diminish the risk of gallstone disease if taken for more than a year.

The study was based on the UK General Practice Research Database. The authors analyzed records from 27,035 patients who underwent cholecystectomy between 1994 and 2008 and 106,531 matched controls that did not. (They tried to match each person who had the surgery with 4 controls who were matched for gender, age and were seen by general practitioners at approximately the same time.) Of these, 2396 gall bladder sufferers and 8868 controls were taking statins. The study population was comprised of 76% women and the mean age was 53.4 years. (Sorry to give you all these numbers, but these are what made the study relevant.) The statisticians also adjusted the findings so they would not be skewed by high body mass index (i.e. overweight, obese or really obese).

So here is the short analysis…The lowest odds ratio or chance of having gallstone disease followed by a cholecystectomy was in patients who used statins for at least 1 to 1.5 years or more. Their odds of the disorder and need for surgery was approximately 0.6 or 40% lower than “statinless folk” (my words). This low odds ratio also existed when long term statin users were compared to those who had used it for a short time (less than 1 to 1.5 years of treatment). That means that the statin’s affect on gallstone formation may have been somewhat independent of a recent presence of high cholesterol levels. (My interpretation of this last finding is that it may take a while to make gallstones.)

Considering the evidence that statins are protective against heart attack and stroke, even in high risk men AND women whose cholesterol values fall within the normal range, some cardiologists would like to have “statinization” of in our water supply (or at least those expensive but tasty vitamin drinks). But let’s remember that statins are prescription drugs with specific indications and yes, very infrequent but potentially serious side effects.

I have to admit that my cholesterol levels, albeit within normal range, started to rise a year ago. I thought I might just try statin therapy. Well, you doubtless have heard those incessant ads on TV… you know the ones that admonish you that if you have muscle pain or extreme fatigue you should consult your doctor immediately. Well I did (have the pain, so consulted myself). I stopped and brought my lipid levels down with diet and more exercise. I may try another statin in the future. I still don’t encourage the “everyone- should-be-on-a-statin” therapy. But for those who are taking it, or may need it….your gallbladder may appreciate the added benefit.

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