On Tuesday, Nov 12, two of the nations leading heart organizations—the American Heart Association and the American College of Cardiology– released new guidelines on the use of statin drugs for the prevention of heart disease.
The new guidelines—about which more in a moment—are a giant step forward towards the goal of having every American over the age of 40 on a statin drug.
Having co-written a best selling book titled The Great Cholesterol Myth, I’ve been asked by many to comment. And I’d like to start by saying one word…
No, I’m not going to blame the new statin drug guidelines on the President. Rather, I want to illustrate something by doing a kind of thought exercise with you, and I picked a word– Obamacare– about which everyone seems to have a strong opinion.
Now regardless of where you stand on the political spectrum, regardless of your views on the Affordable Care Act, or on President Obama himself, every single person reading this—including Tea Partiers and Occupy Wall Street-ers—should be able to agree on one fact: The truth about Obamacare—or the Iraq war, for that matter, or, for goodness sake, any other hot button issue—depends completely on who you ask.
And– as we’ll see-the same is true about statin drugs.
Ask the Republicans about Obamacare and they’ll say one thing. They’ll emphasize the horrific website roll-out. They’ll point to the people who lost their existing policies, or to the few whose rates went up. They’ll quote studies and surveys that project massive costs to the middle class.
But ask the Democrats, and they’ll point to the millions of people who will now have insurance. They’ll talk about the people who can’t be kicked off their policies because of pre-existing conditions. And they’ll quote studies and surveys that project massive savings to the middle class.
My point here is not to debate the Affordable Care Act. It’s to say that the exact same thing happens all the time in science. Seriously. And to think otherwise is to profoundly misunderstand the nature of science and commerce in modern society.
So the statin promoters have studies to show they “work”. (Are you surprised?) They will use those studies—which my side believes to be deeply flawed– to promote their position. We, on the other hand, will point to studies that show that no lives are saved by using statins. (In fact, in many studies more deaths occur from diabetes or cancer in the statin-treated group than in the placebo group.) And we would point to studies that suggest that statin treatment for people without existing heart disease, for women, for the elderly, and (definitely!) for children has not been shown to be particularly beneficial and may, in some cases, be downright harmful.
Statin Drugs Are Unneccessary for Almost Everyone
(Please notice I said “almost”. I am not anti-statin drug. I am anti- statin OVERUSE.
There’s no doubt that statins have a place in the treatment of middle aged men with existing cardiovascular disease, people with familiar hypercholesterolemia, and that they do a number of “good” things such as thin the blood and act as an anti-inflammatory. But I do not think they are without risks and side effects– many of them serious– and therefore it’s hard to make the case for using them in populations where you get all the risks and very little benefit.)
So here’s my take on statin drugs:
- Statins have not been shown to significantly prevent heart attacks in people without existing heart disease.
- Statins have not been shown to be particularly effective in women. No study shows that a single woman’s life has been saved by lowering cholesterol.
- Statins have not been shown to be protective in the elderly—quite the opposite, in fact. In the Framingham study, those with the highest cholesterol lived the longest.
- Statins are being wildly overprescribed for populations in which they have shown little appreciable benefit (the elderly, women, healthy middle aged men) and in which they may cause irreparable harm (children).
- The new recommendations abandoned the goal of lowering cholesterol to a target number because it never worked in the first place. By making the new focus incredibly broad—statins for everyone!– they effectively doubled the customer base for statin drugs.
I guess, if you’re a dyed-in-the-wool optimist, you could find some good news buried in the new recommendations, which is this: the new recommendations recognize that the old recommendations sucked. “The question is not whether a drug makes your lab tests better, but whether it lowers your risk of heart disease and stroke”, writes Harlan M. Krunholz, MD, in the New York Times.
“Studies over the past several years have shown that improving your lab profile with drugs is not equivalent to lowering your heart risks”.
Which is what we say in “The Great Cholesterol Myth”. Trying to lower the risk of heart disease by lowering cholesterol is like trying to cut calories by taking the lettuce off your Whopper. High cholesterol and heart disease are not the same thing, and cholesterol should not be the primary target of our efforts to reduce heart attacks.
The Drug Companies Hate This New Documentary
This is a great time to suggest that you watch part two of that extraordinary documentary I told you about last week. In case you missed it, the documentary was hosted by Dr. Maryanne Demasi, and aired on the prestigious Australian Broadcasting Company network. The first part is on cholesterol and saturated fat.
But the second part—the program on statins is the one I’d like to direct your attention to.
Worth noting is that this really IS a documentary “they” didn’t want you to see. Major organizations in the medical establishment fought tooth and nail to get ABC not to air this documentary on statin drugs, fearing that people would “throw away their medications” and would die as a result.
Well, I never recommend that people “throw away their meds” without supervision and a frank discussion with trusted health professionals.
But I do have a feeling that if people knew the truth about statin drugs they’d have a whole different feeling about popping them like candy.
Here’s the second part of the ABC documentary on cholesterol and statins. It’s one of the best pieces of reporting I’ve seen in a while, and I urge you to watch it.
As always, let me know what you think!