Statins are the most prescribed drugs in America. Atorvastatin (Lipitor) alone is taken by nearly 30 million people. If you add simvastatin, rosuvastatin, pravastatin and lovastatin, you get more than 50 million people swallowing statins. And yet heart disease remains the # 1 cause of death in the US. How can that be? Haven’t we been told that statins stopped cholesterol from causing heart attacks?

Why Is Heart Disease Still Killing People?

The National Center for Health Statistics states that there are 702,880 deaths in the U.S. each year because of heart disease. That is roughly “1 in every 5 deaths.” The CDC goes on to report that:

“In the United States, someone has a heart attack every 40 seconds.”

The American Heart Association notes that heart disease has been the leading cause of death in our country for a century. That is despite a lot of drugs to lower cholesterol, help control blood sugar and reduce blood pressure.

Is There Good News About Heart Disease?

The good news is that the trend has been going down since 1950, with a drop of about 60 percent until recently. Unfortunately, in the past few years progress has stalled and the death rate has even begun to climb slightly according to the American Heart Association.

One likely explanation for some of the decline in heart disease mortality is that many fewer Americans are smoking. In the 1950s, nearly 40 percent of adults smoked a pack a day. Now, that figure is “only” about 20 percent.

The CDC states that:

“Smoking is a major cause of cardiovascular disease (CVD) and is responsible for one in every four deaths from CVD.”

No doubt stop-smoking campaigns have had a major impact on smoking behavior in the US. And that in turn has had a major impact on heart disease.

One overview (Heart Views, Oct-Dec, 2022) states:

“Recent studies have shown that smoking cessation provides a 50% reduction in mortality and morbidity and a 65% reduction in the risk of a heart attack in patients with CVD [cardiovascular disease].”

Everyone agrees that stopping smoking makes a big difference in health outcomes, especially cardiovascular disease.

Why Haven’t Statins Stopped Heart Disease?

Many cardiologists would like to credit statins for much of the reduction in heart disease mortality seen in recent decades. These drugs help lower total cholesterol as well as low-density lipoprotein (LDL) cholesterol. These factors, which often rise and fall in concert, have been the primary focus of attention when it comes to preventing heart disease.

The very first prescription statin, lovastatin (Mevacor), entered the market in 1987. Before long, many competitors joined it.

Atorvastatin has been the top-selling drug in the country for several years, with rosuvastatin and simvastatin not far behind. With more than 50 million people taking statins, you might have expected heart disease to have declined steeply. Why haven’t statins stopped heart attacks, or at least reduced them to a trickle instead of the existing flood?

Our Statin Time Machine:

Before Lipitor became available in a generic formulation, the brand name manufacturer paid for magazine ads. In one, the company featured a large headline that emphasized the benefits of this statin-type cholesterol-lowering medication:

“In patients with multiple risk factors for heart disease,

Lipitor

Reduces risk of heart attack

By 36%*

Many readers, including many health professionals, might have assumed that out of 100 people, 36 could avoid a heart if they just took Lipitor.

But…if you noticed the asterisk and then read the much smaller print, you would discover:

“That means in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor.”

Want to see the advertisement for yourself? Here is a link.

In this drug company clinical trial, people who were at high risk for developing heart disease could lower their likelihood of having a heart attack by 1% by taking Lipitor for 5 years.

What sounds more exciting…36% risk reduction or 1%? That’s a no brainer.

The company also paid for an ad touting Lipitor’s ability to prevent stroke:

“In patients with type 2 diabetes, LIPITOR REDUCES RISK OF STROKE BY 48%.* If you also have at least one other risk factor for heart disease….”

And the asterisk states:

“That means, in a large clinical study, 2.8% of patients taking a sugar pill or placebo had a stroke compared to 1.5% of patients taking Lipitor.”

We now know that while aggressive statin therapy does reduce the risk of ischemic (clotting strokes), it can also raise the risk for hemorrhagic (bleeding strokes). Here is an article I wrote about this contradiction.

Why Haven’t Statins Stopped Heart Attacks? Lp(a)?

You have heard a lot about LDL cholesterol. It has been described as the “bad” cholesterol. But one lipid fraction in blood that you have heard relatively little about is Lp(a). Yet it is responsible for a lot of heart attacks and strokes.

The American Heart Association states unequivocally:

“High Lp(a) numbers of 50 mg/dL (125 nmols/L) or higher promote clotting and inflammation, significantly increasing risk of heart attack, stroke, aortic stenosis and peripheral artery disease.”

It is estimated that about 20% of the general population has high Lp(a) levels. One out of four people in India has a high Lp(a) level (Indian Heart Journal, March, 2024).

Here’s the kicker. Statins tend to raise Lp(a) levels. An article published in the European Heart Journal (Jan. 1, 2020) stirred up a hornet’s nest among cardiologists. It was titled:

“Statins and increases in Lp(a): an inconvenient truth that needs attention”

Other Risk Factors for Heart Disease:

Why haven’t we seen more progress in the prevention of heart disease? Perhaps we are overlooking some other risk factors that could be addressed more effectively. We’ve already mentioned smoking and the benefits from having fewer people smoke.

But we have not addressed the problems related to weight gain, particularly insulin resistance and type 2 diabetes. Heavy people are also more prone to hypertension and elevated triglycerides. All of those can contribute to the risk of heart disease.

Another factor that could be increasing our risk is less physical activity. In modern society, relatively few people earn their living with hard physical labor. Consequently, too many of us don’t get the physical activity that our bodies need to keep our cardiovascular systems healthy.

Hostility and Heart Disease:

One elusive risk factor that most health professionals ignore is chronic hostility. A recent study revealed that provoking anger, even briefly, has prolonged negative consequences on the cardiovascular system (Journal of the American Heart Association, May 7, 2024).

The idea that “anger kills” has been around for decades. Despite this, insurance companies rarely cover anger management, mindfulness or other ways to reduce stress. And many cardiologists have a hard time wrapping their heads around factors such as hostility or loneliness. It is much easier to prescribe a statin to lower LDL cholesterol.

We wish that statins stopped heart attacks. It would be great if heart disease were no longer our # 1 killer. And we would love it if doctors prescribed anger management for those suffering with chronic hostility. Even better, we would be happy to see insurance companies paying for such therapy.

Learn More:

You can learn more about many of the risk factors that contribute to heart disease in our eGuide to Cholesterol Control & Heart Health. This online resource can be found under the Health eGuides tab. You will learn much more about Lp(a) and some ways to control this deadly risk factor for cardiovascular disease.

Our increasingly polarized society may also be contributing to the uptick in heart disease deaths in recent years. Finding ways to reduce hostility and increase social support might help make life more pleasant and healthier.