Should you be taking a statin-type cholesterol-lowering medication like atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor) or simvastatin (Zocor)? Some patients have been “fired” by their doctors if they won’t take such drugs. Other physicians say the drugs aren’t as effective as everyone seems to believe.
Medicine is Divided on Statins:
American politics are extremely polarized. The candidates are at each other’s throats and voters are deeply divided.
People are not surprised when politicians disagree. After all, that is the nature of politics. But they don’t expect their doctors to take polarized positions on health concerns.
Cholesterol and Heart Disease:
No where is this more apparent than the cholesterol hypothesis of heart disease. It evolved during the early 20th century after a Russian scientist, Nikolai Anichkov, fed rabbits pure cholesterol. When they developed arterial plaque containing cholesterol, he proposed that heart disease was driven by this blood fat.
In the US, Ancel Keys took that insight and applied it to humans. In the mid-20th century he conducted epidemiological research that is now renowned as the Seven Countries Study. This research gained prominence with cardiologists because it seemed to demonstrate that high-fat diets led to high blood cholesterol and atherosclerosis.
The Cholesterol Controversy Heats Up:
Never mind that Dr. Keys was selective about which countries to include in his analysis. Even at the time of his first publication, other scientists were critical of his methods and disagreed with his conclusions. Some suggested that chronic diseases such as heart disease and diabetes should be considered “refined carbohydrate disease.”
Despite the controversy, many doctors embraced the idea that cholesterol was the path to heart disease. They began looking for ways to help people reduce their blood cholesterol and statins became the treatment of choice.
Drugs like atorvastatin (Lipitor), lovastatin (Mevacor), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor) became wildly successful. They are highly effective at lowering cholesterol.
Should All Older People be on Statins?
The American Heart Association recommends that everyone with diabetes and virtually all older people should be taking such drugs. The statin enthusiasts insist that statins save lives and that anyone who questions their value is undermining public health. They consider the side effects to be inconsequential. We have come under direct fire ourselves for even daring to ask questions about statin effectiveness.
On the other side are physicians who question the cholesterol hypothesis. A recent analysis of data from a controlled diet study (1968-1973) run by Ancel Keys and his colleagues revealed that lowering cholesterol through diet did not reduce the risk of dying from heart disease (BMJ April 12, 2016).
Cardiologists Robert DuBroff and Michel de Lorgeril wrote a controversial commentary in the World Journal of Cardiology (July 26, 2015). They noted that, “Although a number of statin trials have reported a mortality benefit, quite a few have not.” They pointed out that serious or fatal reactions to statins are rare, but side effects are not. Many people prescribed statins stop taking their drugs because they do not like the muscle aches or other problems they experience.
DuBroff and de Lorgeril suggested that reducing inflammation might be more important than lowering cholesterol, and pointed out that the Mediterranean diet has anti-inflammatory and anti-atherosclerotic effects. They concluded that:
“Coronary heart disease is an extremely complex malady and the expectation that it could be prevented or eliminated by simply reducing cholesterol appears unfounded.”
Why Patients are Confused:
If cardiologists are clashing over the value of statins, it’s hardly any wonder that patients are confused. No election will resolve this controversy, but hopefully data will.
To learn more about the cholesterol controversy and other ways to reduce the many other contributing factors to heart disease you may want to check out our book, Best Choices from The People’s Pharmacy. Share your own thoughts about this controversy below in the comment section and please vote on this article at the top of the page.
