The Truth About Statins, Diet And Cholesterol, Cholesterol And Heart Disease
And that's that the evidence just isn't there. Which doesn't stop your doctor from dosing you with side-effect-rich statins and telling you to twist your diet and life around...a lack of evidence. Whoops -- maybe he only read the executive summary. Dr. Michael Eades clears a few things up, blogging:
What do we find when we read the full 284 page report (which you can get here)?We find that the full report presents a totally biased misrepresentation of the underlying scientific material and seems intent on promoting the use of statin drugs despite any evidence to the contrary. Not the "evidence-based and extensively referenced report that provides the scientific rationale" for statin therapy that the executive report would have us believe.
Before we get into some of the specifics of this full report, let's recall that the Framingham data, the Queen Mother of all dietary cholesterol studies, didn't show a correlation between diet and cholesterol, cholesterol and heart disease, nor diet and heart disease. And we need to remember that, despite all the hoopla about statins and lowering cholesterol levels, that cholesterol is an extremely important molecule. The brain is rich in cholesterol, the sex hormones are made on a cholesterol structure, and even vitamin D is built on cholesterol. Consequently, statin drug use has been associated with decreased cognitive ability and sexual dysfunction. Statins can cause liver damage and the breakdown of muscle tissue, both of which can lead to death. In my opinion, these drugs would have to lead to huge reductions in risk for death from all causes to overcome the risk one accepts by taking them.
...The full report looks at both primary prevention against heart disease in men and women under the age of 65 and over the age of 65. And it looks at secondary prevention for men and women who already have heart disease. (Primary prevention is prevention against the development of heart disease in the first place; secondary prevention is prevention against having a heart attack in someone who already has heart disease.)
Dr. Eades summarizes the findings of the full report:
In men under 65 with no known heart disease but with risk factors, i.e. LDL of 130 mg/dL or greater, the studies cited showed no difference in all cause mortality. For those men under 65 who had very high LDL levels, the evidence showed that these men might have a slight benefit from taking a statin, but nothing to write home about. Certainly nothing that would justify putting a third of the population on statins.In women who are under 65 there is virtually no evidence that statins do squat. In fact, the report doesn't even produce evidence that cholesterol lowering does anything for women. The report states that it bases its rationale for treatment of women on an extrapolation of data from men.
In men and women over 65 the studies cited show no evidence that cholesterol lowering brings about any significant decrease in risk for heart disease. (Remember the 34% of subjects, average age 66.9, in the control group of the PD study mentioned at the start of this post who were on statins. According to the papers cited in this full report, none of those subjects could expect a decreased risk for CHD by taking the statins, but based on this report's false reporting of the conclusions of these papers, a third of these folks are on statins.)
Men of all ages with diagnosed heart disease were the only group that the studies used in this report show receive an actual benefit from taking statins. And even that is slight.
Women who have heart disease and who take statins have a reduced death rate from heart disease but no decrease in all-cause mortality.
So there you have it. The giant report that, thanks to the executive summary, has driven most physicians in America to prescribe statins to practically everyone who walks through the door shows, when the data is examined, that statins are only really indicated in men who already have heart disease. They don't do much for anyone else but put them at risk for a host of other problems while running health care costs through the roof for the rest of us.
Who could possibly benefit from this situation? How about the underwriters of the whole scheme: the drug companies and the 'experts' on their payroll.
We've got a situation where 'experts' paid by the drug companies write an executive summary about a report written by 'experts' paid by the drug companies, a report that misinterprets (purposefully?) the underlying data to make the case that the drugs made by the drug companies paying the 'experts' are under prescribed. Others jump on the bandwagon, making pronouncements, based on this faulty reporting, that almost everyone should be taking these drugs made by the drug companies that underwrote the entire enterprise. One buffoon, cloaked in all the trappings of academia, even made the comment that since statins are so wonderful perhaps they should be added to the drinking water. As a consequence, we're paying billions of dollars for drugs that don't particularly work and that cause a number of pretty bad side effects to prevent a disease that can be prevented by fairly simple lifestyle changes. Pitiful.
And don't forget to read the part about what kind of people get heart attacks. Hint: According to Eades' experience, those who haven't been to Marlboro Country are few and far between. He posts this in the comments:
Dr. Eades: I'm not making the case that no one has ever had a heart attack who never smoked, but the odds are much,much higher for smokers.Here is an interesting comment from a cardiac anesthesiologist on a discussion board for physicians only:
I am a cardiac anesthesiologist. One day, I was doing another bypass (I have done a few thousand bypass operations) and I got to thinking about a common link between the patients. There was only one I could come up with. Smoking. With the rare exception of familial hypercholesterolemia or juvenile onset diabetes, I could not think of one patient I had put to sleep for bypass that was not a smoker. I have, however, put several to sleep with "normal"cholesterol profiles. Also, it is good reading to look at what "normal cholesterol"has been considered over time. Back in the 70's, it needed to be blow 275 or 300. Over the years, it has continually been ratcheted down to where we are today. I would be willing to wager that if smoking is never started, the chance of needing coronary artery interventions would be about 5% of the rate that smokers/reformed smokers have. I don't know how the "second hand smoke" group would weigh in, but I think that they would still be well below the "first hand smoke" rate. This is just my own personal observation, and I don't have formal studies to back it up, so I just throw this out for consideration and discussion.He (or she) seems to have had the same experience as I have. Best--MRE
Oh, and check out this bit from Dr. Eades in the comments:
As to how I recommend treating cholesterol problems...I don't believe in the lipid hypothesis. The lipid hypothesis posits that (Coronary Heart Disease) is caused by elevated cholesterol. Strange as this may sound, there is no evidence that cholesterol causes CHD. The Framingham study doesn't show it. If anything it shows the opposite. There is no conclusive evidence that cholesterol has anything to do with heart disease. So, if cholesterol doesn't cause heart disease, why treat it?If any components of the whole constellation of lipids do end up being involved in the development of heart disease, they will be triglycerides, HDL (the so-called 'good' cholesterol), and small dense LDL particles. Ideally, you want to have a lot of HDL, low triglyceride levels, and low levels of small, dense LDL particles. How does one achieve that? Easy. With a good quality whole-food low-carb diet. Restricting carbs decreases triglyceride levels, increasing fat increases HDL levels, and at least a dozen studies have shown that switching to a low-carb diet reduces the levels of small, dense LDL particles. Kind of makes you wonder why all the mainstream folks still harp on about low-fat diets, doesn't it?
More from Eades on statins here. And here's Gary Taubes on What's Cholesterol Got To Do With It?
Interesting comment about the correlation between smoking and needing coronary bypass. My dad was a heavy smoker at one time; he hasn't smoked in 20 years, but a few years ago he had to have a bypass. There's a history of heart disease in his family, but there's also a history of smoking. So now I'm wondering to what extent genetics really accounts for the tendency towards heart problems in the family. My brother and I have never been smokers, and I have several cousins who have never smoked, so I guess in another twenty years or so, we'll find out.
Cousin Dave at July 23, 2009 6:35 AM
Thank you Amy for this post. I wonder, how many other prescription drugs are being over-prescribed like this, creating annuity like income for the drug companies?
On the positive side, isn't it possible that a portion of the billions in income that big Pharma earned off of statin sales could be used to fund the development of new drugs such as an improved flu vaccine?
belle de ville at July 23, 2009 7:01 AM
Amy Alkon
https://www.advicegoddess.com/archives/2009/07/the-truth-about-5.html#comment-1659564">comment from belle de villeOn the positive side, isn't it possible that a portion of the billions in income that big Pharma earned off of statin sales could be used to fund the development of new drugs such as an improved flu vaccine?
There's a personal cost here -- there are side-effects to taking statins.
Amy Alkon
at July 23, 2009 7:09 AM
My doctor wanted to put me on statins and blood-pressure medication. I refused, and instead lost 25 pounds by eating a little less and exercising a little more. Problems solved!
Jay R at July 23, 2009 7:48 AM
Eades is really great at uncovering the bullshit-based (instead of evidence-based) ways of eating and prescribing medicine. His blog is http://www.proteinpower.com/drmike/ and his Twitter address (to get his Tweets about studies, etc.) is @DrEades
PS Mine, by the way, is @AmyAlkon
Amy Alkon at July 23, 2009 8:26 AM
My doctor put me on Liptor for cholesterol when I was 18 years old (!). I was vegetarian and into dance, karate, and soccer. They told me that since I was already doing everything I would need to do to lower my cholesterol that my only option was Liptor, which cost $40 a month with insurance. I did this for years, but then worked out how much it would cost over my lifetime (or even just 20 years), and stopped taking it. The side effect of dry mouth, which sounds minor, was actually a fairly big inconvenience. You have to use special toothpaste and special gum to try and not get mouth infections that occur when your mouths moisture balance gets out of whack, and waking up every day with sandpaper tongue was something I was happy to get rid of.
Due to other health problems my heart has been thoroughly examined. I have stress tests and echo-cardiograms more often than a normal healthy person, so I figured if anything was happening they'd spot it before anything got to dangerous. I’ve never smoked and never will.
My new doctor wants to put me on it again, I'll make sure to bring this article when I see her next week, thanks.
Stacy at July 23, 2009 3:25 PM
As someone who's been on Lipitor or its generic equivalent for more years than I can remember, I'd love to discover that it's actually useless and I can toss it out. But frankly, this sounds like one of those wacko conspiracy scenarios. Am I really supposed to believe that with all the real medical problems out there, Big Bad Pharma came up with a drug to treat a fake one and bamboozled thousands of doctors into prescribing it?
As for smoking--of course it's a bigger risk factor than cholesterol for heart disease. No doctor would say otherwise. That doesn't mean high cholesterol is harmless.
Rex Little at July 24, 2009 12:22 AM
Amy Alkon
https://www.advicegoddess.com/archives/2009/07/the-truth-about-5.html#comment-1659648">comment from Rex LittleYou don't have to assume -- he provides the links...read away.
After you do, feel free to come back and say, no, plenty of evidence there.
I have learned that a depressing amount of modern medicine is based on marketing, not evidence. The American diet, for one, which is why I keep recommending people read Gary Taubes' book, Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health (Vintage). Read that, too -- it has quite a bit to tell you.
Amy Alkon
at July 24, 2009 1:34 AM
Rex, you can't believe that multibillion dollar corporations are out to make money? If you perhaps noticed what's just happening in the banking/insurance industry, and extrapolate to other industries...
If you're an intelligent person, you can ask questions and expect to understand what you're told. If it doesn't make sense, do your own research. It's not a conspiracy theory, it's just a little white lie on a massive scale.
Chrissy at July 24, 2009 6:23 AM
OK, I read Eades' blog post. I believe that drug companies make a lot of money off statins and that a number of doctors are paid by these companies. But those statements are true of nearly every drug that exists. They do not constitute evidence against a link between cholesterol and heart disease.
The studies he cites do constitute such evidence, but not conclusively. The nature of medicine and the human body is such that different studies of the same issue often produce different results. For every one he points to which shows no link, there may be a dozen which show the opposite, which he doesn't mention. I don't know, and I don't think you do either.
Oh, one small irony: as I type this, I'm looking at an ad at the bottom of the page for. . . a cholesterol-lowering drug.
Rex Little at July 24, 2009 10:39 AM
Rex--
I do know. There are NOT a dozen that show the opposite, at least not any valid ones. Granted, if you read the medical literature, you will find countless citations of studies purporting to confirm that notion that excess cholesterol causes heart disease. When you check these citations, however, you find that the medical papers referred to cite other medical papers to confirm the cholesterol-heart disease link. If you go to these papers, you find the same thing: citations of yet other papers supporting the link. If you follow these all the way back, you find a couple of papers that are iffy at best. Gary Taubes, a respected science journalist with no diet to promote and no agenda other than a search for the truth, has done this very exercise and reports it in his book "Good Calories, Bad Calories". If you want to see how flimsy this link is, read his book. It's a long read and takes a lot more time than simply sniping off the quick sentence - "For every one he points to which shows no link, there may be a dozen which show the opposite, which he doesn't mention" (implying, of course, that I am being less than honest with my reporting) - but the effort will be rewarding. That is, if you really care about the debate.
The majority of the so-called experts have now abandoned the cholesterol-heart disease hypothesis because there really is little proof that the connection exists. It doesn't stop them from promoting and prescribing statin drugs, however.
Michael Eades at July 24, 2009 11:50 AM
I recall reading something a while back about how the number of heart attacks had dropped by a large percentage, something like 25% - 30% in NYC after they banned smoking in restaurants and bars.
JoJo at July 24, 2009 2:04 PM
That's because the number of people IN the bars dropped.
brian at July 24, 2009 2:16 PM
I wasted money on cigarettes for decades and stopping ended up being very hard. I attempted the many quitting tools still not a single thing helped. Then I stumbled on the e cigarette. The e-cigarette uses a nicotine compound which contains simply nicotine. Simply no toxic substances at all. They've basically made all the difference.
Lelah Eskra at August 12, 2010 9:48 AM
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