Statins and Cholesterol: Truth and Fiction

I’ve been arguing against the universal use of statin drugs for several years now, but I’ve felt like the kid at the parade who kept saying the emperor was naked even as all the “grown-ups” continued to admire the emperor’s sartorial elegance.

The arguments I- and many of my esteemed colleagues- have made include these (pay particular attention to number 4):

1)    Cholesterol doesn’t cause heart disease

2)    Half the people with normal cholesterol have heart attacks and half of those with no heart disease have high cholesterol

3)    Any possible benefit you may get from statin drugs  is because they are mildly anti-inflammatory, not because they lower cholesterol, and..

4)    There has never been a single piece of convincing evidence that lowering cholesterol in women prevents a single death.

Well, it’s probably too early to be jumping with glee, but there are signs- small ones, admittedly, but signs nonetheless- that these ideas are beginning to creep over into the mainstream media.

The latest good news is an article in Time Magazine by Catherine Elton which says, among other things:  ”….there is little evidence that (statins) prevent heart disease in women”  and goes on to ask the question, “If statins do not help prolong women’s lives, why are so many women taking them?”

Good question.

One answer is that most doctors in America have about 7 minutes to spend with a patient and practice medicine by formula. “High cholesterol? Prescribe a statin”. Next patient, please.

I suspect that most docs don’t even know that the old division between “good” and “bad” cholesterol is woefully out-of-date. We now know that there are at least 5 different types of LDL (so called “bad” cholesterol”). LDL that looks like big puffy cotton balls is harmless. LDL that looks like little hard bb-pellets is atherogenic. Nonetheless most docs simply look at “LDL” as if it is all the same– which it’s not.

Another reason so many women are put on statins is what Time magazine called “The Prescription Gender Gap”. Gender-based medicine takes into account the differences between men and women in the diagnosis and treatment of disease, but, as Elton points out, it has been slow to catch on, especially in the pharmaceutical industry. “Before the 1990’s, women were largely excluded from clinical drug trials- an attempt to protect pregnant women from harm and avoid the potentially confounding effects of women’s hormone fluctuations” she writes. “Since then, as studies have actively recruited women, gender-based research has begun to reveal crucial information about how the development of diseases— such as heart disease, lung cancer and autoimmune disorders—may affect women in markedly different ways from men”.

Alarms  get raised about saturated fat raising cholesterol but these alarms are  misguided. Saturated fat often does raise cholesterol- but it raises HDL (“good”) cholesterol, and tends to increase the big fluffy cotton ball type of LDL and decrease the little bb-pellet type. So theoretically your overall cholesterol could go up but you could actually be a lot less likely to have a heart attack. I’d much rather have a high LDL (where most of the LDL was “big fluffy cotton ball type”) than a lower LDL (where most of the LDL was the atherogenic “bb-pellets type”)

In my recent interview on the website Big Think,  I was asked to suggest some strategies for the prevention of heart disease. My first suggestion- one which I admitted was bound to piss off a lot of conventional docs- was to stop worrying about cholesterol.

By focusing exclusively on this one misunderstood molecule- one which you absolutely need for health, by the way- we have collectively missed paying attention to the far more important risk factors for disease: smoking, high triglycerides, inflammation, and being overweight and sedentary.

Of course the fact that the two main medicines for bringing down cholesterol- Zocor and Lipitor- bring in over 17 billion dollars a year for their manufacturers might have something to do with our obsession with cholesterol numbers.

After all, as the great American writer Upton Sinclair once said:

“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”

P.S> One of the best arguments for rethinking statin drugs, heart disease and cholesterol in general can be found in the book by cardiac surgeon Dwight Lundell, MD, called “The Great Cholesterol Lie”. I highly recommend it!