Are Cholesterol Medications Unhelpful?

Cholesterol-lowering statin medications like Lipitor and Crestor have been the #1 prescribed class of drugs in the United States for years. More than 215 million prescriptions add $14 billion to drug company coffers every year. A recent report from the government's National Center for Health Statistics showed that an astounding 25% of Americans aged 45 and older take statins, compared to only 2% in 1994. (The drugs came on the market in 1987.)

It's not surprising that statins are so popular. Cardiovascular disease (CVD) is the biggest killer of Americans, and "bad" LDL cholesterol is one of the bad guys in this national tragedy, clogging arteries and triggering heart attacks and strokes. Taking an LDL-lowering statin is a science-proven strategy for people with diagnosed heart disease or other blood vessel blockages. You're on that list if you have angina or you've had a heart attack, coronary bypass surgery or an artery-widening angioplasty, or a stroke, or you have peripheral arterial disease (clogging of the arteries in the legs). And possibly if you have diabetes, which damages blood vessels and doubles the risk of heart attack and stroke. In other words, if you already have CVD, an LDL-lowering statin might save your life through what medical experts call secondary prevention.

But most people who take statins haven't been diagnosed with CVD. A blood test simply showed they had high cholesterol, and their doctor prescribed a statin to prevent a heart attack or stroke — a use medical experts call primary prevention. Shockingly, a new scientific review of 14 studies shows that statins aren't very helpful for primary prevention.

Meta-Analysis of Statin Studies

The study was a meta-analysis of scientific literature on primary prevention using statins. A team of UK researchers analyzed data from 14 earlier studies that involved more than 34,000 people. The meta-analysis was published by The Cochrane Collaboration, the most respected scientific review in the world.

Before telling you about the final conclusion of the meta-analysis, it’s important to note that the UK researchers faulted the studies in several areas. There was evidence, they said, of “selective reporting of outcomes” — statin-positive results were emphasized, while statin-negative results were ignored (an unfortunately common practice in drug studies). There was a “failure to report adverse events” — if statins produced side effects, the study authors didn’t mention them (another sadly routine feature of pharmaceutical research). And there was “an inclusion of people with cardiovascular disease” in the studies — a sneaky strategy designed to produce positive results, since statins are proven to work in folks with CVD. (Remember, these were studies on primary prevention for people without CVD, not secondary prevention for people with CVD.)

The Cochrane scientists then reported the overall results of the 14 studies on statins and primary prevention. The results were not exactly overwhelming.

"Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life," they concluded. "Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk."

To put it a little less politely: the millions of people taking statins for primary prevention could be taking a drug they don’t need!

The downside of statins for primary prevention isn’t only that they cost you $1,000 a year and may not do you any good. They can also do you a lot of harm.

Side Effects of Statins

In my newest book Real Cause, Real Cure (published in July by Rodale), I detail the many common side effects of statins. They include muscle pain (myalgia), fatigue, exercise intolerance (muscles too painful and weak to exercise), memory loss, peripheral neuropathy (tingling, numbness or burning pain in the hands, arms, feet or legs), irritability, sleep problems, and sexual dysfunction (such as erectile dysfunction).

I also cite a review of 880 scientific studies on statin side effects in the American Journal of Cardiovascular Drugs. Those side effects include not only the problems in the above list, but also cancer, stroke, diabetes, autoimmune disease, digestive problems, kidney disease, liver problems, lung problems, and weight gain.

How can one drug cause so many different problems? Statins block a cholesterol-creating enzyme that also creates coenzyme Q10. This biochemical sparkplug and antioxidant is found in every cell of the body, where it protects and nourishes mitochondria, tiny structures that produce energy.

Now you might ask yourself: If statins — the #1 prescribed drug in the U.S. — often don't work for primary prevention, how come you didn’t hear about this study on CNN or read about it in the newspapers? Follow the money. The #2 source of advertising money for the media is (you guessed it) prescription medications. You don’t bite the hand that pays you.

I’d also like to mention another recent study on statins — the five-year "Heart Protection Study," involving more than 20,000 people, which appeared recently in Lancet, a leading medical journal. This study showed that people with high levels of C-reactive protein (CRP) — a biomarker for inflammation — do not benefit from taking statins any more than people with low levels of CRP. “These results do not lend support to the suggestion that the beneficial effects of statin therapy are affected by … CRP concentration,” concluded the study researchers. And these results run counter to the widespread practice among physicians of prescribing statins for primary prevention in people with high CRP. This is a kind of epitome of a lot of modern medicine: using a meaningless test to prescribe a ineffective drug!

If you take a statin for secondary prevention, it is a very good idea to also take a coenzyme Q10 supplement, which can help protect you from side effects. I recommend 200 mg daily.

If you develop a side effect from a statin, talk to you doctor right away. Especially if you don’t have known heart disease or CVD, as the statin may not be appropriate for you anyway. Another strategy if you develop a side effect from a statin is to simply lower the dose.

Natural Ways to Protect Your Heart

Fortunately, there are many safe and natural, non-drug approaches to protecting your heart. Vitamin K can shield your arteries from cholesterol buildup. The mineral magnesium is powerfully cardioprotective. Vitamin D is linked to better heart health. And all these nutrients — and many other heart-healthy vitamins and minerals — are found in therapeutic dosages in a good multivitamin powder. In addition, if you want to lower your cholesterol without the statin, consider taking an herbal supplement that supports healthy cholesterol levels.

Several lifestyle factors also play a role in a healthy heart. Exercise regularly. Stop smoking. Spend time with supportive family and friends. That includes your animal friends too — a study showed that owning a cat is almost 25 times more effective in lowering the risk of dying from heart disease than taking a statin! Especially important? A low thyroid, despite normal tests, was associated with a 69% increased risk of heart attack in women. So optimize thyroid function. In men (but not women), low testosterone is also associated with high cholesterol levels. So I recommend tuning up these hormones in people with high cholesterol, and this usually will lower cholesterol as well.

As for what you eat: favor a Mediterranean-style diet that’s rich in fruits, vegetables, whole grains, beans, and healthy polyunsaturated and monounsaturated fats (from olive oil, fatty fish, avocados, walnuts and the like), and minimizes meat, dairy products and processed foods.

You may also want to eat an ounce or so a day of dark chocolate, a delicious food that science shows works for both primary and secondary prevention of CVD — and produces primary smiles in everybody who takes a bite!

References

"Statins for the primary prevention of cardiovascular disease." Cochrane Database Syst Rev. 2011 Jan 19;(1):CD004816.Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, Casas JP, Ebrahim S.

"C-reactive protein concentration and the vascular benefits of statin therapy: an analysis of 20,536 patients in the Heart Protection Study." Lancet. 2011 Feb 5;377(9764):469-76. Epub 2011 Jan 27. Heart Protection Study Collaborative Group, Jonathan Emberson, Derrick Bennett, Emma Link, Sarah Parish, John Danesh, Jane Armitage, Rory Collins.