A recent report in Science Daily on a study soon to be published in the Journal of the American College of Cardiology may stir anew the debate over cholesterol-lowering statin drugs.
The studysuggests that the formula commonly used to estimate levels of low-density lipoprotein (LDL) cholesterol is inaccurate (you did know it’s only an estimate, right?). This is thought to be of greatest concern to patients at high-risk for heart disease as it may understate their risk for a heart attack or other cardiovascular event.
This is of obvious concern to such patients. My concern, however, is that its message will find its way down the ladder to moderate and low-risk patients and result in even more over-prescribing of cholesterol-lowering statin drugs.
Currently approved statin drugs in the U.S. include Zocor, Lipitor, Crestor, Pravachol, Selektine, Mevacor and Lescol.
Much has been written about the over-promotion of statins for even those with normal cholesterol levels, including by me (see Our Healthcare Sucks). Of particular note is the estimate – derived from the drug manufacturers’ own disclosures – that only 1 in 100 people taking these drugs for prevention will actually benefit, as discussed further below.
But too little attention is paid, as is true in general of American healthcare, to the other side of the equation.
Risks of Harm With Statins
Were these drugs as safe as many doctors would have you believe, this could boil down to a simple financial decision – but there’s more at stake here than your money.
There’s an ongoing dispute within the medical community about the long-term safety of statin drugs (the “statin wars”), although the bulk of mainstream medicine continues to promote them heavily despite these misgivings by their peers.
Indeed, the name of the game in medicine has become to drive LDL cholesterol levels as low as possible. This, of course, increases demand for these products – explaining the pharmaceutical industry’s research and marketing investments to promote such “treat-to-target” cholesterol levels.
“The (ACCORD) trial demonstrated the folly of assuming that risk factors must have a causal role in disease, says Robert Vogel, a cardiologist at the University of Colorado, Denver. ‘Short people have a higher risk of heart disease,’ he says. ‘But wearing high heels does not lower your risk’.”
Not only might lower cholesterol not be the holy grail it’s become among cardiologists, but statin drugs have been repeatedly found in clinical studies and case reports to be associated with a range of harmful conditions.
The best known of these is muscle pain and weakness – a substantial concern considering your body’s biggest muscle is your heart.
Many patients discontinue statin drugs because of such side effects, which also include insulin resistance, weight gain, type 2 diabetes, hemorrhagic (bleeding) stroke, insomnia, memory and mood disorders, immune dysfunction and more.
Heart Protection or…?
One probable effect that hasn’t been widely reported yet but that seems eminently plausible is heart failure, especially given the drug’s muscle-weakening effects. This, of course, would suggest that a drug prescribed to protect your heart may actually be harming it.
Statin drugs are very effective at lowering cholesterol, but they also lower the CoQ10 enzyme that’s essential for muscle function. As noted, your heart is your body’s largest muscle.
It’s also your only muscle that never rests. Its energy requirements are constant. It’s crucial for heart strength and longevity that it has a steady source of energy to keep it pumping with a steady and unvarying rhythm.
Statin drugs interfere with this process – and may actually lead to heart failure in those with coronary artery disease – through the following progression to disease (click here for more on this association):
An Often Poor Risk-Benefit Ratio
Several clinical reports suggest there’s little return on this risk with statin drugs. One study followed patients with high total cholesterol but low baseline CVD risk over six years of statin use. Those with the lowest LDl cholesterol levels (under 80 mg/dL) had nearly double the death rate of those with higher LDL levels (120-200 mg/dL).
The probability of benefit vs. relative risks of statins is discussed further below, with links to a site that quantifies the probabilities of benefit and harm (number-needed-to-treat, or NNT, for one patient to benefit and number-needed-to-harm for one patient to be harmed).
Cholesterol Quality Trumps Quantity
Despite these unimpressive findings, mainstream medicine remains fixated on driving the quantity of LDL cholesterol as low as possible with aggressive statin drug regimens rather than focusing on the qualityof LDL cholesterol with more aggressive use of fish oil.
The EPA antioxidants in fish oil have been shown – at prescription strength levels (2-4g/day) – to prevent the oxidation of LDL cholesterol (click here for more on oxidized LDL). Since only oxidized LDL is dangerous – it can form plaque in your artery walls – improving your ratio of non-oxidized LDL with fish oil improves your LDL quality, rendering it harmless.
This makes it less toxic and leaves you with more efficient HDL (“good”) cholesterol, since it has a lesser amount of oxidized LDL to remove from your bloodstream. Fish oil works indirectly on LDL particle size by lowering triglycerides, which redistributes the body’s LDL composition toward less small, dense LDL particles that are most likely to form plaque on arterial walls.
This leaves you with more larger and lighter LDL particles that your HDL (“good”) cholesterol is better able to remove from your bloodstream. This more healthful LDL composition helps maintain healthy cell membranes, muscle function, and other essential roles that cholesterol plays in your body.
By reducing your need for statin drugs – either with a lower dose or by eliminating them altogether – it also reduces your risk of diabetes, weight gain and muscle weakness that statins can produce.
An Upgraded Lifestyle’s a Better Answer
Our best focus for long-term disease avoidance is to maintain both a healthy weight and lean muscle mass – both of which become more difficult as we age.
Statins interfere with both of these essential goals, making them even harder to achieve.
This is obviously not what doctors or patients intend in prescribing and taking them, but this is what the evidence suggests is probable for a substantial number of patients taking these current medical favorites.
While there are exceptions where these risks may be outweighed by your greater risk for a cardiovascular “event” – especially of you have a history of cardiovascular disease – it’s important for the heart strength and overall health of those without such a history to avoid taking these drugs if at all possible. And if you do take them, supplementing with CoQ10 and prescription-strength fish oil should be seriously considered.
Your Doctors May Be Wrong
Your physician may object if you have even the slightest elevated cholesterol or even if you have normal cholesterol readings.
That’s because they’re now convinced anyone with elevated cholesterol – based partly on a single reading of a flawed test called CRP (C-reactive protein) – needs to be on a statin drug even with no prior history of heart disease.
Yet only 1 in a 100 will realize any benefit, none will live longer, and 1 in 10 will suffer muscle damage. And the results aren’t much better even for those with heart disease.
For now, the important thing to remember is that cholesterol is often overstated as a risk factor for cardiovascular disease for a large part of the population being prescribed these drugs to lower their cholesterol.
Women and men over 60 – as well as children and adolescents, in particular – should think twice before agreeing to take statin drugs, as the evidence of benefit for these groups is especially weak while their risk of harm is above average.
And these drugs have substantial downsides that go well beyond their potential adverse effects on your heart – diabetes, muscle damage and memory problems being the best recognized at this time. Simply put, their long-term safety hasn’t yet been fully established – so prescribing them for children, as we’re now doing, may produce still-unknown effects after decades of use.
This suggests there’s little reason for most people being prescribed these drugs to be taking them. Elevated cholesterol isn’t nearly the threat it’s come to represent.
In fact, cholesterol is an essential lipid that’s protective except when its composition is distorted by a poor diet – trans fats that are everywhere in our packaged food diets being the primary culprit – that makes it vulnerable to oxidation that can form plaque on your artery walls, as already noted.
The far better answer for those with no history of heart disease is to CHANGE YOUR DIET, not to add dangerous chemicals that disrupt natural bodily processes and functions.
If you’re in the minority who benefit from statin drugs – diabetics with coronary artery disease and elevated CRP, for example, or are at high CVD risk (over 20% 10-year risk) – it may be advisable to take a statin if your doctor recommends it. But it’d be wise to supplement with CoQ10 to offset the loss of CoQ10 the drug will cause. And adding fish oil to the mix could lower your amount of oxidized LDL, allowing a lower dose statin to be considered.
And, of course, consult with your doctor before doing any of this. There may be reasons particular to your medical condition that warrant statin therapy, although it can’t hurt to explore with your doctor ways in which you could increase its effectiveness and lower your risk of adverse side effects as discussed in this article.
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John Lynch: John Lynch was founder and CEO of Medical Diagnostics, Inc. - twice named to Business Week's "Best Small Companies" in America. He's since founded MedSmart Members to publish consumer health education publications.