Cholesterol and statins: The good, the bad, the truth
By Dr. Christopher Nagy
“It is impossible for a man to learn what he thinks he already knows.”
Cholesterol is a substance that we are familiar with as a major risk factor for heart disease, or not? The allegation of cholesterol as an evil, heart attack creating villain has been preached to us on numerous occasions for the past 60 years. The evidence implicating cholesterol as a major cause of heart disease, when critically examined, does not stand up to scrutiny.
This lipid/cholesterol hypothesis is a faulty dictum that has been propagated since the 1950s. Many studies demonstrate no statistically significant correlation between fat and cholesterol intake and heart disease. Despite this, we continue to follow the cholesterol hypothesis and recommend treatment to lower cholesterol levels to prevent heart disease. Yet 50-75 percent of the people who have a heart attack have “normal” cholesterol levels.
The importance of cholesterol in the body should not be ignored. It is a ubiquitous substance that is responsible for many vital functions. A major component of every cell in the body, cholesterol comprises 50-60 percent of the weight of the brain. Cholesterol is required to produce the hormones testosterone, estrogen, progesterone, cortisone, vitamin D and many others. Optimal cholesterol levels support the immune system in the fight against infection and cancer. Cholesterol is the key substance found in the insulating sheaths of our nerves.
Seventy five-80 percent of the cholesterol in our body is made by our body, with only 15-20 percent related to dietary intake. Many studies have failed to directly correlate dietary intake with total cholesterol levels. Some studies demonstrate a lowering of cholesterol levels with increased cholesterol consumption. I’m not recommending eating poorly. I am pointing out that cholesterol levels are not linearly correlated to dietary fat consumption.
The vital functions of cholesterol demonstrate why it is a major component of an optimally functioning body. Artificially lowering cholesterol levels, particularly with statin medications, risks damage to all of these systems. The focus on cholesterol distracts us from fully concentrating on the important causes of heart disease, our lifestyle and dietary choices. Inflammation plays a significant role in heart disease, and conditions such as poor food choices, smoking, diabetes/insulin resistance, inactivity and stress may be bigger factors in heart disease than high cholesterol.
We live in a “one disease, one drug” culture where many of us accept the false belief that health comes in the form of a pill. Forget lifestyle modification; there’s a pill we can take to make up for our wrong choices. This mindset is responsible for many of the illnesses we currently treat.
Statins, successful at lowering cholesterol levels, are standard treatment for the prevention of heart disease. Many of the studies “proving” the benefit of statins rely on statistical manipulation to prove their value. The package insert for the very medicine being used to “prevent” heart disease states that statins do not reduce all cause mortality. This means that statins do not increase lifespan when compared to placebo. Statins may slightly decrease the risk of heart disease, but if, as research shows, their use contributes to the development of another disease, it becomes a zero sum game. Why replace one disease with another when the ultimate final outcome is no different?
If told that patients taking a statin resulted in 2 in 100 having a heart attack over a 3.4-year period and patients not taking a statin resulted in 3 in 100 having a heart attack over a 3.4-year period, those odds wouldn’t impress anyone as favorable. Yet, according to the way the statistics are reported, this represents a 33 percent reduction in cardiac risk (1 divided by 3). A 33 percent risk reduction sounds significant, but what this really means is that only 1 person out of 100 taking a statin over a 3.4 year period was spared a heart attack compared to those taking nothing. That’s not very impressive nor as convincing sounding as stating a 33 percent reduction in cardiac risk.
The main treatment indication for statins is for the treatment of middle-aged men under the age of 65 who have cardiac disease or have had a heart attack. Statins have not been found to be beneficial for prevention of cardiac disease and have demonstrated no benefit in reducing all cause mortality in those without a history of heart disease. The benefit of statin use in women is even more questionable. Extrapolations are made as to the benefit of statin use for primary prevention of heart disease. A recent review by the esteemed Cochrane Collaboration concluded that statin drugs show no benefit for heart disease prevention among those without diagnosed heart disease.
With the touted benefits of cholesterol-lowering medication, one would think there would be substantially more benefit than what the research shows. There have been more than 900 studies demonstrating the risks and adverse effects of statin drugs, yet they are readily prescribed. Statins can lead to diabetes, significant muscle damage and destruction, peripheral neuropathy, liver injury, lowered immune response, increased cancer risk, erectile dysfunction, heart failure, depression and dementia (among others). Many of these symptoms are associated with the aging process and we accept them as such.
Vitamin D and CoQ10 depletion are only two of the deficiencies associated with statin use. CoQ10 is a key nutrient that powers our muscles and keeps them functioning. The organ with the highest concentration of CoQ10 is the heart. It makes no sense taking a drug to “protect” the heart that depletes the very source of energy the heart relies upon for function. The increasing number of congestive heart failure cases often occurs in those who have been on long-term statin treatment.
An elevated cholesterol level is not a disease but often a symptom of metabolic derangement in the body. Blaming cholesterol for heart disease is like blaming a scab for the wound it is covering. Cholesterol is found at the scene of the crime but is not the guilty party. Inflammation, from many sources, is what must be identified; cholesterol is just cleaning up the mess as a biological bandage.
The current cholesterol guidelines are based on the consensus opinion of nine physicians, eight of whom had financial ties with the pharmaceutical industry. Science should be about facts, not consensus. When presented with “scientific evidence” of the benefit of statins, it is worth investigating the funding source of the studies cited. Bias is common in industry funded studies (as opposed to independently funded studies) and, in my opinion, seriously taints the results of these studies. If you are told to lower your cholesterol below 200, you will not find a specific scientific study supporting this recommendation (it’s a consensus statement). Current guidelines make patients out of an estimated 40 million people who, prior to the new recommendations, were considered healthy, yet now require “treatment” for a “disease” they didn’t even know they had.
I realize this information will likely shock and surprise many. Presenting the other side of the story on the data available on this topic is important. I do not ask that you take my word for it, but I also ask that you do not take anyone else’s word either, unless they have done the research and have no vested interest in the current dogma.
Cholesterol research is controversial, and I suggest reading “The Cholesterol Delusion,” by cardiologist Ernest Curtis, MD, or “Ignore the Awkward,” by Uffe Ravsnkov, MD, PhD. Spacedoc.com is a great resource for further research.
The comments in this article are my thoughts and opinions based on my reading of the medical literature. They are not a substitute for consultation with your physician and should in no way be construed as medical advice. The decision to continue or discontinue any drug regimen is a serious one and should be a decision made after careful discussion with your physician.
Christopher M. Nagy, M.D., is the director of Your Personal Wellness Center (www.yourpersonalwellnesscenter.com) and an orthopaedic surgeon with Salisbury Orthopaedic Associates.