By Marika Sboros
Cardiologists have said it for years. New Israeli research backs it up: millions of people globally take powerful cholesterol-lowering drugs they don’t need.
Statins are blockbuster drugs to lower cholesterol. They are the world’s most prescribed medicine ever. They make billions for drug companies.
Some doctors say statins are life-saving. They already prescribe the drugs to millions around the world. They want more, otherwise healthy people to take them daily. Other doctors say that’s “statin insanity”. They say guidelines on statin use need radical revision.The Israeli-led multi-centre study published in the JAMA (Journal of the American Medical Association) Internal Medicine supports that view. Here’s why:
Dr Morton Leibowitz, of Clalit Research Institute in Tel Aviv, and scientists from the US and Canada looked at more than 31,000 patients with heart disease. In particular, the researchers looked at levels of so-called low-density lipoprotein cholesterol (LDL-C, aka “bad” cholesterol) in patients.
The researchers noted study limitations of the study, including restricting to patients with pre-existing ischaemic heart disease and “limited generalisability”. They conclude that their results “do not do not support treatment guidelines recommending very low target LDL-C levels for all patients with pre-existing heart disease”.
In other words, the evidence does not provide support for a blanket principle that lowering cholesterol is always a smart move. In particular, that lowering LDL-C is better for all patients in secondary prevention.
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Statins cost medical schemes globally billions of dollars in prescriptions. In the UK, media reports say statins are the most widely prescribed drug with around 7 million users. The cost to the country’s National Health Service is estimated at around £285 million annually.
Doctors routinely prescribe statins for secondary prevention, in patients with stable ischemic heart disease (IHD) because of the increased risk of recurrent “cardiovascular events” . That’s the medical profession’s term for repeat heart attack or stroke. Some doctors say the evidence does not support the push for statins for primary prevention – in patients who have yet to have a heart attack or stroke.
Doctors opposed to increasing use say statins are not a case where more is better. They say there is compelling evidence that drugs make little difference to deaths from heart attack and stroke worldwide. They say the drugs come with a long list of serious side effects that often offset any benefits they may have.
One of the problems is differences among guidelines around the definition of appropriate targets for low-density lipoprotein cholesterol (LDL-C, so-called “bad” cholesterol) levels. The American Heart Association’s guidelines, for example, do not establish target LDL-C levels. The European Society of Cardiology recommends treatment titrated to achieve LDL-C levels below 70 mg/dL.
In a related editor’s note on the Israeli study, JAMA Internal Medicine Editor Dr Rita Redberg, of the University of California, San Francisco, and colleagues write: “The study by Leibowitz et al adds important information to the ongoing discussion of the best statin strategy and LDL-C targets to improve outcomes with minimal harms.”
Another problems is that data on statin benefits comes mostly from industry-funded trials.
South African-born US cardiologist Dr Dennis Goodman, professor of medicine, and director of integrative medicine at New York University, says doctors “would be a whole lot happier if statins were harmless, but they clearly aren’t” .
Many people can’t tolerate statins, Goodman says. Data on statins for secondary prevention “can’t be refuted”. However, he says primary prevention data are “much softer”.
US family physician and “Denver’s Diet Doctor” Dr Jeffry Gerber agrees wholeheartedly. He says statins have been around for nearly 30 years. “They’ve had a good run, but they clearly are not a panacea.”
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French cardiologist and independent researcher Dr Michel de Lorgeril of Grenoble University is quoted as saying that data from the industry-funded trials “cannot be trusted”. He has declared that he would “warn people not to take statins”.
Scottish GP Dr Malcom Kendrick, author of The Great Cholesterol Con , has relentlessly revealed the truth behind the hype. In his book, he demolishes the “diet-heart hypothesis”. H shows that high cholesterol levels don’t cause heart disease; a high-fat diet – saturated or otherwise – does not affect blood cholesterol levels; the protection provided by statins is so small as to be not worth bothering about for most men and all women.
Kendrick says statins have far more side effects than doctors who prescribe it will willingly admit. Statin advocates should be treated with scepticism, he says, because of their links with the drugs’ manufacturers. He regularly criticises the powerful pharmaceutical industry and unquestioning medical profession for perpetuating the madcap concepts of “good” and “bad” cholesterol and cholesterol levels. (You need “good” and “bad” cholesterol in your body because without both, you’d be dead.)
He says the hidden agenda is not so hidden: to convince millions of people to spend billions of pounds on statins, creating an atmosphere of stress and anxiety which is the real cause of fatal heart disease.