I had an interesting conversation with a young doctor at a local hospital recently. He was convinced that high cholesterol always indicated higher heart disease risk, despite all the recent research that has failed to support this. I suggested he should do his own research because the message he had received just recently at medical school, was clearly wrong.
If my doctor ever suggested that I should be taking a statin to lower cholesterol, I would need a discussion and probably would refuse. The reasons are many. Here is what I have come to learn about statins and cholesterol.
Statins lower cholesterol, but they have many nasty side effects and a careful analysis of their effectiveness suggests that they are not very effective for the majority of people, particularly older people and women. Statins lower cholesterol by interfering with your body’s cholesterol production process, however other compounds are also made by this process including Co-enzyme Q10 which is very important for heart health. Some people on a statin also take a CoQ10 supplement because of this problem.
Perhaps you don’t need to lower your cholesterol? Apparently the majority of people who are hospitalized by a heart attack have normal or even low cholesterol levels. An analysis of cholesterol levels and all cause mortality in older people, clearly showed that lower cholesterol was linked to a shorter life. Older people who live longer generally have higher cholesterol. If you like to read research reports, see this link: https://bmjopen.bmj.com/content/6/6/e010401/ This is not surprising since cholesterol is an important element of your immune system and is also used in you body to make vitamin D. A too-low level of cholesterol apparently predisposes you to greater deaths from infection and susceptibly to cancers. Cholesterol is critical for your brain and your nervous system, and without it you will die. A Danish study of over 100,000 people over 9 years identified that the optimum level of LDL cholesterol for longest life was 3.6mmol/L (139mg/dL). The current US guidelines are less than 100mg/dL.
Apparently the old message to reduce cholesterol was based on very poor historical research and is now debunked, but many people and organizations’ in the medical profession have not yet transitioned to this understanding, or are “required” to push the lower cholesterol message because of the “standard of care” they operate within. Even if a doctor knows this, they may be reluctant to give more up to date advice because of the fear of censure by the organization for which they work. The largest US study of 140,000 people admitted to hospital with heart attacks in 2009, revealed their average LDL cholesterol level was lower than that of the general population.
Due to the side-effects of statins, many people voluntarily cease taking them. Sometimes after consultation with their doctor, but sometimes without any consultation because they are reluctant to “disagree” with their doctor. A statin survey in USA in 2012 revealed that 62% had stopped taking them primarily due to the side-effects, particularly muscle aches and pains and loss of energy. This level of abandonment could be understated, due to people being reluctant to reveal their decision. One statin advocate has even developed a side-effect calculator that people can use to help establish what, if any, side-effects they will experience.
How is it that a drug like this has such a high level of side-effects? In order to reduce the incidence of reported side-effects, some statin drug trials have a “run-in” period of about 6 weeks at the start of the trial, where anyone who is showing side-effect symptoms, is eliminated. Then the trial starts officially and of-course the result is a much lower incidence of side-effects than would be the case for the general population. This process clearly minimizes the side-effect levels notified to doctors by the drug marketing companies and seems unethical to me.
Many of the potential benefits of medicines are advertised in terms of “relative risk”. If a doctor is not aware of the statistical significance of this, it can seem that a medicine is much more effective than is truly the case. Imagine if you were presented with information suggesting a drug would reduce your risk of a heart attack by over 30%, would this seem compelling. However it may actually only be around 1%. Here is how this works out: Imagine a 5 year drug trial with 100 people as controls and 100 trialing the drug. If 3 people in the control group had a heart attack but only 2 in the trial group, it could be said that 1 person in the trial group was saved from a heart attack, (2 people had heart attacks instead of 3). One view of the statistics would suggest that 1 out of 3 people was saved (33%), this is known as relative risk, whereas in fact only 1 additional person out of 100 was saved, so the actual risk was 1 out of 100 which is 1.0%. This is not so compelling at all. If this drug then also caused unpleasant side effects you may choose not to take it. While this view of the figures is valid statistics, it is horribly misleading and apparently fools many people including doctors. Reducing your risk by 33%, sounds much better than actually reducing your risk by 1.0%. Statins have been advertised this way.
A group of ethical doctors have begun to evaluate drugs in a different way. Their website www.theNNT.com presents the benefits and harms of drugs using a “Number Needed to Treat” formula (NNT). In other words, how many people would need to be treated and for how long, to gain a benefit for 1 person. For example their evaluation for those who took ibuprofen for headache showed:
1 in 14 became headache-associated pain-free at 2 hours, while
1 in 6 reported “very good” or “excellent” scores on a global evaluation scale.
None developed adverse events.
For Statins taken for 5 years
None were helped (life saved),
1 in 104 were helped (preventing heart attack)
1 in 154 were helped (preventing stroke) but
1 in 50 were harmed (develop diabetes)
1 in 10 were harmed (muscle damage)
Unfortunately some people have come to believe that taking a statin somehow protects them from heart disease and because of this, they ignore other advice about looking after their health. One cardiologist even suggested giving out statins with fast food to “neutralize” the cardiovascular risk of unhealthy diet choices.
A very significant influence for me is the lack of transparency of the statin drug test data. Much of the statin drug trials data is locked down under non-disclosure agreements and not available for independent medical review. Even the British Medical Journal (BMJ) has requested this data to be released for independent review. I have to wonder what is being protected by this secrecy. Surely a widely used drug should have its trial data made available for full independent evaluation.
When all of this is digested, if you should decide to proceed with a statin, what is the expected increase in your total days of life. It is estimated that average increase in someone’s life from taking a statin regularly is around a whole 4 days!
Maybe you will now understand why I would never take a statin.
George Elder, Author, “Take back your health”. Ebook and paperback on Amazon
The Great Cholesterol Con, by Dr. Malcolm Kendrick
A Statin Free Life, by Dr. Aseem Malhotra
The Great Cholesterol Lie, by Dr. Dwight Lundell. (this is a free ebook)
The Big Fat Surprise, by Nina Teicholz
Know Your Fats, by Mary G. Enig, PhD