Retrospective #45: Do You Need to Lower Your Cholesterol?

“We have all been told that ‘high cholesterol’ is bad and that lowering it is good,” Mark Hyman, MD, posted on his website back in 2010. This belief is almost universal. And, a sure-fire way to lower Total Cholesterol and the “bad LDL” (calculated) cholesterol is to take a statin drug:  Crestor, Lipitor, Zocor or their generic equivalents.

“But on what scientific evidence is this advice based?” and “What does the evidence really show?” Dr. Hyman asks. Many health professionals have asked similar questions, but back in 2010 Dr. Hyman offered a comprehensive Summary of Findings in the medical literature that question the rationale and justification for prescribing statins:

·         If you lower bad cholesterol (LDL) but have a low HDL (good cholesterol), there is no benefit to statins.

·         If you lower bad cholesterol (LDL) but don’t reduce inflammation (marked by a test called C-Reactive Protein or hsCRP), there is no benefit to statins.

·         If you are a healthy woman with high cholesterol, there is no proof that taking stains reduces your risk of heart attack or death.

·         If you are a man or a woman over 69 years old with high cholesterol, there is no proof that taking statins reduces your risk of heart attack or death.

·         Aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone but led to more plaque build-up in the arteries and no fewer heart attacks.

·         75% of people who have heart attacks have normal cholesterol

·         Older patients with lower cholesterol (<180) have higher risks of death than those with higher cholesterol.

·         Countries with higher average cholesterol than Americans such as the Swiss or Spanish have less heart disease.

·         Recent evidence shows it is likely statins’ ability to lower inflammation that accounts for the benefits of statins, not their ability to lower cholesterol.

“So, for whom do the statin drugs work anyway?” Dr. Hyman asks. “They work for people who have already had heart attacks to prevent more heart attacks or death. And they work slightly for middle-aged men who have many risk factors for heart disease like high blood pressure, obesity or diabetes. And that data also shows that treatment really only works if you have heart disease already. In those who don’t have…heart disease, there is no benefit.”

“So why did the 2004 National Cholesterol Education Program (NCEP) guidelines expand the previous guidelines to recommend that more people take statins (from 13 million to 40 million) and that people who don’t have heart disease should take them to prevent heart disease? Could it have been that 8 of the 9 experts on the panel who developed these guidelines had financial ties to the drug industry?” he asks rhetorically. “Thirty-four other non-industry experts sent a petition to protest the recommendations to the National Institutes of Health (NIH) saying the evidence was weak.” Dr. Hyman’s summed it up neatly: “It was like having a fox guard the chicken coop.”

Yet, at a cost of over $20 billion a year [in 2012, approaching 1 trillion by 2020] 75% of all statin prescriptions are for exactly this type of unproven primary prevention. “If these medications were without side effects, then you may be able to justify the risk – but they cause muscle damage, sexual dysfunction, liver and nerve damage and other problems in 10-15% of patients who take them. Certainly not a free ride,” says Dr. Hyman.

William Castelli, MD, a Director of the famous Framingham Study said, “In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active.”

And George Mann, ScD, MD, former Co-Director of The Framingham Study, said, “The diet-heart [lipid] hypothesis has been repeatedly shown to be wrong, and yet, for complicated reasons of price, profit and prejudice, the hypothesis continues to be exploited by scientists, fund-raising enterprises [AHA], food companies and even governmental agencies. The public is being deceived by the greatest health scam of the [last+current] century.”

And heart surgeon Michael DeBakey, said, “An analysis of cholesterol values in 1,700 patients with atherosclerotic disease revealed no correlation between serum cholesterol…and the nature and extent of atherosclerotic disease.”

So, if lowering cholesterol is not a great idea, how does one treat heart disease risk? See the next Retrospective.