The Truth About Statins, Diet And Cholesterol, Cholesterol And Heart Disease.(Blog entry).

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 (http://www.proteinpower.com/drmike/statins/statin-panic/):

What do we find when we read the full 284 page report (which you can get here (http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm))? 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 (http://www.proteinpower.com/drmike/cardiovascular-disease/framingham-follies/) 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 (http://www.proteinpower.com/drmike/statins/a-bad-week-for-statins/). And here's Gary Taubes on What's Cholesterol Got To Do With It? (http://www.nytimes.com/2008/01/27/opinion/27taubes.html?_r=1&ref=health)

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Source Citation:"The Truth About Statins, Diet And Cholesterol, Cholesterol And Heart Disease.(Blog entry)." Amy Alkon/Advice Goddess Blog (Blogs on Demand) (July 23, 2009): NA. Health Reference Center Academic. Gale. Alachua County Library District. 28 Sept. 2009
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