DEAR DR. ROACH: I have read that there is a correlation between the use of statins and suicide in men over 60, especially if they have suffered chronic depression. Can you tell me if this has been studied more? — K.M.
ANSWER: This concern has been studied extensively.
An older class of cholesterol medication, the fibrates, was associated with a small increased risk of suicide and violent deaths in several large studies. However, a very large study published in 2020 showed no increase in risk of death by suicide among those taking statin drugs. In fact, that study, as well as several others, have shown a decrease in depression risk among statin users. Statins have even been found to be (modestly) effective in treatment of drug-resistant depression.
Men over 60 are certainly at higher risk from death by suicide, but statin drugs do not appear to increase that risk. Anyone with thoughts of hurting themselves should seek care from their doctor, a mental health professional, or the suicide and crisis lifeline at 988 in the U.S. and 833-456-4566 in most Canadian provinces.
DR. ROACH WRITES: In a recent column on glaucoma, I described it as a disease of the retina. Several eye physicians wrote to clarify that it is really a disease of the optic nerve. Eye professionals look in the back of the eye at the optic nerve for “cupping,” which is an increase in the size of the optic cup, related to the loss of nerve cells in the retina. But the site of the damage is in the optic nerve, where there is a difference between the eye pressure and the blood pressure, either from high pressure inside the eye or very low blood pressure. Many people with glaucoma who have normal pressures inside the eye have low blood pressure. Reducing pressure inside the eye remains the preferred treatment. I appreciate the clarifications, especially from Dr. Peter Libre at Columbia University.
DEAR DR. ROACH: I am 74. I have always been described as “small boned.” I am on a statin, but otherwise, I’m healthy. I was recently diagnosed with osteopenia. I do not eat dairy, but I do take vitamin D. I am vegetarian and eat lots of tofu. I am very concerned about taking any additional medicines. Suggestions, please? — F.M.D.
ANSWER: Osteopenia, or low bone density, is analogous to borderline diabetes or elevated blood pressure. It’s not a disease in itself, but puts you in a range between the healthiest condition and one that can put you at risk. In the case of osteopenia, you are at higher risk for developing osteoporosis, which, in turn, puts you at high risk for a fracture, especially one of the spine or the hip. We do not normally treat low bone density with medicine. Lifestyle interventions to help slow loss of bone density include not only the calcium and vitamin D you are taking, but I especially recommend exercise (weight-bearing exercise, muscle strengthening and posture exercises are proven to help). Smokers should quit.
You should have gotten a T-score on your report, which compares your bone density for a given bone (such as the hip or vertebral bone) to a healthy young adult. The worse the T-score, the closer you are to osteoporosis, which is a T score below -2.5.
Depending on how close you are to osteoporosis, the sooner your bone density test should be repeated. People with osteoporosis should be considered for medication. I understand your concern about taking more medicine than you need, but you really don’t want a hip fracture to occur.
