Are Cholesterol Lowering Drugs Right For You?

Written by Dr. Steve Chaney on . Posted in Drugs and Health, Issues

Do Statins Really Work?

Author: Dr. Stephen Chaney

Do statins really work?Statins – those ubiquitous drugs used to lower cholesterol levels – are big business!

Over 20 million Americans are currently being treated with statin drugs at a cost that runs into billions of dollars every year. And cardiologists have just recommended that another 20 million Americans consider using cholesterol lowering drugs. 44% of the men and 22% of the women in this country are now being told that they should be using statin drugs.

Some of my cardiologist friends are so convinced that statin drugs prevent death from heart attacks that they have said, only half-joking, that we should just add statins to the water supply.

Are Cholesterol-Lowering Drugs Right For You?

Is the faith of doctors in the power of statin drugs to prevent death from heart disease justified? To answer that question in full we need to look at people who have already survived a heart attack and people who have never had a heart attack separately.

If you’ve already had a heart attack the evidence is clear cut.

  • If you have had a heart attack, there is good evidence that statins will reduce your risk of dying from a second heart attack.
  • In the technical jargon of the scientific world that is referred to as secondary prevention.

But what about those millions of Americans who are being prescribed statin drugs who have never had a heart attack? This is something we scientists refer to as primary prevention.

What Do The Studies Actually Say About Statins And Primary Prevention?

Here the evidence is not clear at all. Two major reports have cast doubt on the assumption that statins actually do prevent heart attacks in people who have not already had a first heart attack.

In the first study, Dr. Kausik Ray and colleagues from Cambridge University in England performed a meta-analyis of 11 clinical studies involving over 65,000 participants (Ray et al, Arch. Int. Med., 170: 1024-1031, 2010). They focused on those participants in the studies who had not previously had a heart attack (primary prevention).

  • They found that the use of statins over an average of 3.7 years had no statistically significant effect on mortality. In short, statins had no effect on the risk of dying from heart disease or any other cause.
  • Dr. Sreenivasa Sechasai, one of the doctors involved in the study, said “We didn’t find a significant reduction in death despite having such a huge sample size. This is the totality of evidence in primary prevention. So if we can’t show a reduction with this data, it is unlikely to be there.”

The second study was a Cochrane Systemic Review of statins published January 19th, 2011.  It stated that there was not enough scientific evidence to recommend the use of statins in people with no previous history of heart disease with some caveats (see below).

To help you understand the significance of that conclusion, let me give you a bit of background:

  • First you need to understand that the Cochrane Collaboration is an independent, non-profit organization that carefully reviews the scientific evidence behind medical treatments and proposed medical treatments.
  • Cochrane Reviews are considered the “Holy Grail” of evidence-based medicine (ie. medicine based on the best scientific evidence rather than what the pharmaceutical companies would have you believe).
  • So when a Cochrane Review concludes that there isn’t enough evidence to recommend use of statins in patients with no prior history of heart disease that is pretty big news in the medical world.

How Should These Studies Be Interpreted?

Please don’t misinterpret what I am saying. The Cochrane Review said that statin drugs are overprescribed, but it did not say that everyone who has not had a heart attack will not benefit from statins. It said that there are a number of risk factors that need to be considered in evaluating individual patients for statin use.

  • Simply put, that means that it is not as simple as saying that everyone with no previous history of heart disease should not be on statin drugs.
  • If you are currently taking statin drugs and you have no previous history of heart disease, you may want to discuss with your physician whether the Cochrane Review of statin drugs changes their opinion of whether se of those drugs is still warranted for you.
  • But the bottom line is that only your physician is trained to take into account all of the factors that increase your risk of heart disease and the best therapeutic approach for reducing your risk of heart attack.

There Is A Double Standard In The Medical Community

More importantly, these studies highlight the difficulty in showing that anything works when you start out with a healthy group of adults with no prior evidence of disease (primary prevention).

And, the way that doctors have responded to primary prevention studies shows that there is a double standard in how primary prevention trials are interpreted in the medical community. For example:

  • There is no good evidence that statins prevent fatal heart attacks in healthy people.
  • However, because statins do work in high risk patients, most doctors recommend their use by millions of Americans who have never had a heart attack.
  • There is also no good evidence that nutrients like vitamin E and omega-3 fatty acids prevent fatal heart attacks in healthy people.
  • However, there is evidence that both vitamin E and omega-3 fatty acids prevent heart attacks in high risk patients, yet most doctors will tell you they are a waste of money.

It is food for thought.

The Bottom Line

1)    Statin drugs clearly save lives when used by people who have already had a heart attack.

2)    On the other hand, there is no proof that statin drugs prevent heart attacks in people who have not previously had a heart attack

3)    Statin drugs do have side effects. Increased risk of diabetes, liver damage, muscle damage and kidney failure are the best documented, although memory loss has also been reported.

4)    I am not recommending that you stop using statin drugs without consulting your doctor. I am suggesting that you discuss the benefits and risks of statin drug use with your doctor.

5)    Perhaps the most important poin tto come out of these studies is that it almost impossible to prove the benefit of any intervention in a primary prevention trial. If you can’t prove that statins work in healthy people, it is not surprising that it is difficult to prove that other interventions work.

6)   Finally, the way that these studies have been interpreted shows that there is a clear double standard in how the medical community evaluates primary intervention trials.

  • Statin drugs don’t show any benefit in a primary prevention setting, yet most doctors still recommend them.
  • Vitamin E and omega-3 fatty acids don’t show any benefit in a primary prevention setting, and most doctors recommend against them.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (14)

  • Lyle Yoder

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    Thank you for the thoughtful article; I am a layman and student of healthy living, a Shaklee user for over forty years. In that pursuit I came across a certain Dr. Russell Blaylock a 30 year veteran brain surgeon; who is diametally opposed to the use of any type of statin drugs. He claims tha cholesterol build up in the arteries comes from inflammation and not from excess cholesterol. He further states that cholesterol amounts now recommended are far to low and is very dangerous to our brain which approximately eighty-five percent cholesterol the lack of iwhich may well contribute to early dimensia and other electrical parts of our annatoamy.

    Lyle Yoder

    FOOD FOR THOUGHT.

    Reply

  • Sharon Hill

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    Very timely and important article, Steve. I appreciate it very much.

    Reply

  • Karen

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    Great article!! Interesting yet not really surprising about the double standard. Medical community has their own agenda. Money! What would you tell someone whose father died very young from a heart attack? I don’t really know if its a history of genetics or the lifestyle of smoking and drinking that was the culprit but the history is there. I would much rather see the natural supplementation route but there is a lot of fear in NOT taking the statins placed by the physician. Hard to go up against the one with all credentials.

    Reply

    • Dr. Steve Chaney

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      Dear Karen,
      I just came across an interesting article on the subject by Joe & Terry Graedon (You may be familiar with their “People’s Pharmacy talk show on NPR and their web site http://www.PeoplesPharmacy.com). They referenced a recent study that concluded: “A healthy Mediterranean-style diet could be as effective as statins without the side effects” (JAMA Internal Medicine, Oct. 28, 2013).
      Dr. Chaney

      Reply

  • David Norby

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    Great article. I have a question regarding blood cholesterol levels. High levels are supposed to be a risk factor for heart attacks, so statins are given to lower those levels, which they usually do. So, are the studies implying that cholesterol levels are not a risk factor for heart disease? Or the recommended levels are incorrect, as implied by Blaylock? There are two issues, I think – statins and heart disease plus cholesterol and heart disease. This has probably already been written about.

    Reply

    • Dr. Steve Chaney

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      Dear David,

      Great question, but there is not a simple answer. Elevated cholesterol is one risk factor. Inflammation, LDL/HDL ratio, particle size, triglycerides, high blood pressure, and diabetes are also all important risk factors. Statins are favored by many cardiologists because they lower both cholesterol and inflammation.

      My point was not to say that statins were ineffective in people at risk of heart disease. They might well be. My point was that it was impossible to prove that they were effective for people who have not yet had a heart attack. And, if you can’t prove that stains prevent heart attacks in healthy people, why should it surprise anyone that it is difficult to prove that vitamin E, B vitamins or omega-3 fatty acids prevent heart attacks in healthy people.

      Dr. Chaney

      Reply

  • Shirley

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    I, too, have read and heard about the statin controversy. I have diabetes and heart disease in my family history. I have tried all different statins with serious side effects. Crestor doesn’t seem to cause any problems. Before starting medication, my chloresterol was 363, now it’s under 200. I am reluctant to stop taking the drug.

    Reply

    • Dr. Steve Chaney

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      Dear Shirley,

      Most experts agree that someone with a cholesterol level of 363 should be taking a statin if they can tolerate it. The new guidelines include many people with cholesterol levels in the 200 range or less. It is this recommendation that has stirred controversy among the experts.

      D Chaney

      Reply

  • JoAn

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    Dr. Chaney, please comment on red yeast rice for reducing cholesterol ratio, inflammation, etc. Are there two kinds: One made in China (don’t take because it is like a statin) and one in the USA? What about 5-HTP?

    Reply

    • Dr. Steve Chaney

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      Dear JoAn,
      The active ingredient in red yeast is a natural statin. It can have the same effectiveness and the same potential side effects as the synthetic statin drugs. But, you put your finger on the most important concern. Red yeast rice is sold as a food supplement, and most food supplement companies don’t perform the same quality control tests that the drug companies employ. If you are using a red yeast rice supplement, make sure you are getting it from a reputable company that employs rigorous quality control tests.
      Dr. Chaney

      Reply

  • Carol E.

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    I have taken all the statins for different periods of time and then stopped because they cause muscle problems in my arms in particular.

    My nephrologist/internist gets very angry with me because I stop. He says “ok you will get a heart attack or stroke and die”. I cannot help it that my muslces hurt….BUT he doesn’t listen to me.

    Reply

    • Dr. Steve Chaney

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      Dear Bunny,
      You probably already know that there is no magic “ab cruncher” that gets rid of body fat. But a well designed exercise program couple with a high protein diet (with moderate amounts of healthy carbs & fats) will slowly get rid of that belly fat. It won’t happen overnight, bur it also didn’t develop overnight.
      Dr. Chaney

      Reply

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Latest Article

High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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