Statins are the most studied drugs in all of medicine. Hundreds of thousands of patients have been randomized in statin trials. Yet many disagree on their role in preventing heart disease
Overall this essay agrees with what I've read about statins and heart disease in the past two years (and I've read a lot.) Like many I was on statins (and some other preventions) until I started asking questions and found out for myself how nearly worthless these are for primary prevention of heart disease.
I highly recommend the (4) books of Dr. Malcolm Kendrick. I'm sure there are many other worthy authors too. Or, if you're cheap, read a lot of the same stuff for free at his web site, although not highly organized.
None of the following are my original ideas but I didn’t see them mentioned in the essay and I believe they are highly relevant:
(1) The medical-industrial complex is motivated mainly by profit. Drugs and other treatments cost enormous amounts of money and time to research. Therefore, it should be obvious that strong incentives exist for Pharma and others to get their product to market and to the widest number of patients possible. Alas, that means there will inevitably be the risk of various ethical lapses, corners being cut, standards sidestepped and outright criminal fraud or other violations of law.
(2) The problem is not only greed. Medicine, as with many disciplines, is hidebound. New discoveries that may invalidate established dogma, often with deeply entrenched career and investment conflicts of interest, always face a difficult battle of being accepted. Some, I suspect remain suppressed and never see the light of day.
(3) Many researchers and doctors who are aware of the limitations or even outright dangers of existing, permitted treatments and/or who might be willing to try newer, cutting-edge treatments, must often decide between toeing the party line and keeping their careers or risk losing all if they dare voice distrust of current treatments or try a newer treatment.
You should give some thought to the known or likely motivations of various entitles you interact with. Of course, one shouldn’t go overboard. In fairness medicine can and does provide treatments and cures for many diseases. Nor do I begrudge Pharma and other industries from making a fair profit. But I’m under no illusion that these all exist solely for the goal of delivering the patient the best health care possible.
What happens when a case of hypertension is cured? Nothing. Nobody cares. Hypertension is an incurable disease. Cured is not medically defined for hypertension. Just like the "there is no cure for the common cold," "there is no cure for hypertension." We know how to cure the common cold and most cases are cured. We know how to cure hypertension, and few cases are cured. Cutes have been documented, but cannot be proven for lack of a definition. Medically, there is no cure. Why not? Because the cure is not an approved medicine, it's an improvement in healthiness.
I feel compelled to comment about “a healthy diet” since practically every post mentions diet and exercise as a preferred treatment. I wholeheartedly agree but for the average reader looking for real tangible help it’s not enough. The real question is what is considered a healthy diet? Our medical societies and our government pushes a diet that is not healthy at all, and keeps us exposed to the harms found in our food supply. Then pharmaceuticals come to the rescue to try to heal the damage. The only winners are big ag, the food industry, and pharmaceuticals. Meanwhile our quality of life is awful. I am a walking miracle today after changing my way of eating has literally saved my life. Doctors always encourage a healthy diet, and for decades I followed their definition of what that was: the Standard American Diet (SAD) as lauded by nutritionists everywhere, universities, and our government agencies. To say I was always sick following their advice is an understatement. Our food supply today is riddled with horrible things that are not healthy for the human body to process nor taken into account with these medical studies. I just read a study last week where a sugar substitute they were trying to prove was bad for our hearts was given to the subjects in cookies, sodas, and other prepackaged foods rather than given along with whole foods instead. There was no way to determine if the results could have been caused by the other chemicals and ingredients found in the packaged foods. The SAD favors the financial interests of the food industry and later pharma. Once I started to really learn about food and about everything that you will find in ingredients listings, it was like the Matrix and I started to wake up. 30 years on the medically recommended healthy diet left me as a stroke risk, pre-diabetic, having three tumors, riddled with depression and anxiety, obese at 203lbs (I’m 5-2”) and I developed severe advanced osteoporosis at a severity only ever seen in someone 25-30 years older than me. Medications also led to this development as both diet and meds robbed my bones of calcium. I also developed muscular problems and neurological pain. On top of that I carried the worst case of acne my entire adult life (I’m only 58.) 5 years ago I was diagnosed with high cholesterol too. Now I know my cholesterol wasn’t really that high at all, but I passed some pharmaceutical-developed boundary where their statins should be prescribed. By 2021 I was sick as a dog and had been following the standard “healthy diet” religiously. It was not healthy at all and caused me to continue to decline. Here I sit two years later with better health than ever before and the energy of a 20 year old and clearer skin than a new born baby the entire time. My cholesterol levels are enviable. How? I learned the truth about what’s in our food both in the stores and in restaurants. I have not had a single boxed, prepackaged food in two years, nor any sugar whatsoever or any other over processed, over refined ingredient. I learned to cook again from scratch even making my own condiments and other homemade ingredients where I can control everything that’s in my food. I don’t eat out much anymore but when I do I opt for a grilled steak or fish, and a salad, since I know it can’t be adulterated by our food supply. A healthy diet is using all whole foods and ingredients without any chemicals or lab created ingredients. It’s using butter instead of the recommended margarine. I lost 55 lbs and last week for the first time since I was in my 20s I was doing sprints in the gym. Anyone who saw me up to two years ago would not recognize me. My husband lost all his visceral fat on his belly and outpaces all the young men he works with when doing physical labor. Both of our blood tests over these two years show such a remarkable improvement that our doctors are perking up and finally listening to us. The single change we made that improved our health was to stop trusting our current food supply and anything processed or premade, and to stop following the current nutritional food pyramid. So if you are here wondering about statins and read that what works better is a healthy diet, I agree and disagree. It IS better, but it has to be the right diet, not the nationally and medically prescribed diets of today. If you really want to get healthier, do the hard work of staying away from easy and convenient when making meals, and learn the miracle and convenience of fasting. It can help you afford a truly healthier diet in both time and money.
High cholesterol levels indicate inflammation. They are signs the body is trying to deal with it, LDL, HDL, fluffy, hard whatever the latest goalpost shifting nonsense increasingly spouted is, what is important is the cause or causes, address them (often diet and lifestyle, meds too), lower that inflammation and the levels will fall / drop naturally. Sadly medicine has now become one dimensional in execution and understanding to the degree that now even a primary child could see the failings, the gaps in logic and understanding. Do physicians still actually study biochemistry anymore?? Serious question.
Thank you. Interesting timing as I recently spent 2 days reading studies to see if Atorvastatin 10mg is the right choice for a family member with high Lp(a). I found small studies that statins might actually be increasing this genetic risk factor. It seems even in higher risk and older people addressing high LDL-C with diets supplements and exercise would be the fist attempt at treatment. Thank you for all of your work. I am hoping your video about your research and experience re being fired (a horrible story particularly since you had to deal with the sickening covid pharma lies soon after) will help my family member as many folks can’t process the data alone.
Yesterday I received a letter from my professor at the royal Brompton hospital London
Saying my LDL levels have spiked high FOLLOWING SARS2 blood test confirmation in 2020 and he wishes to now put me on high dose statins .
I’m having problems with heart rhythm 🙄
And taking 100mg beta blockers.
I think I’ll be sticking to a healthy keto diet, fasting and my cardio miracle, DMG recommendations from Judy mikovits 🙏and a bit of dr zelenco and his zelenco protocol (RIP) god bless and leave the rest in gods hands 🙏
I am the sole survivor of the professor sir magdi Yacoub procedure replacement of the aorta 🫀 re suspended aortic valve and repaired mitral valve.
Thankyou for this article this morning 🌅 I take it as gods sigh to me 🙏
I was on statins from the mid-1990s until about 2008. Within a year of being on Lipitor, I had very sore knees that my doctor dismissed as being from statin side effects. The issue never went away, and I just put up with it. I changed brands a couple times after that point and ended up on simvastatin first. That one gave me sore calves and shoulders so my doctor switched me to pravastatin, which I was on for about four to six years. It got so I was so sore all over my body, not just the knees and calves, so I decided to go off statins completely at that point and have refused to go on them since.
I can't help but wonder if I had gotten side effects from the time I was on Lipitor, as I had suspected, and if my doctor had taken me off it, if things would have been different if I had quit then instead of staying on. It seems that my soreness increased the longer I was on the statins, and nowadays, even being off, the soreness remains. I wish I had never ever gone on a statin. The fancy graph that purports to show the benefit of pravastatin should have an overlaying graph showing the cumulative side effects from it as well.
I agree with 1 aspect of this article in its criticism of Dr. Mandrola’s position. As JMM says, the data suggest that the younger you start primary prevention statin, the higher likelihood of more people who stand to reap huge gains (vs fewer people who make more modest gains by starting later). But the current author rightly points out that the “average benefit” of statin in primary prevention, in absolute terms, remains small. So by starting more people younger, the cost of getting more people to reap huge gains is to expose WAY MORE people to minimal benefit, while everyone has the same cost of pill burden and potential long term complications. And of course, we have no idea which category our patient in the office falls into. I disagree with Dr. Mandrola’s emphasis only on the “lucky few”.
OTOH, I disagree with the current author’s criticism of the Mendelian randomization data. The issue seems to be about people who had gene deletion having had the benefit of survivor bias to have made it long enough to enrol into the studies in question. This is true…but is true of any adult participant of any study. Anyone who was included in Jupiter (for example) did not die in childhood. It’s the same survivor bias that applies to absolutely any study of anybody. I don’t see why it should only discount a Mendelian randomization cohort that results in a low LDL.
In the end, I don’t think the answer is for statin in primary prevention in everyone, nor in no one. We already have validated tools to try to better understand risk (and no CAC for me, thanks). And as Dr. Mandrola mentioned in that behavioural study, different people will have different values and preferences that emphasize different things…even when presented with the same data. IMO, our job is to present the info in as plain language as is necessary, then to be fairly indifferent about what the pt chooses based on that information. Some will say sign me up; others will say no thanks. And either is fine by me.
I had the honor and pleasure of being interviewed by Maryanne Demasi for her documentary "The Heart of the Matter" which ran on Australian television about ten years ago. It was practically the only production that raised questions about the cholesterol theory. But it also was a lesson in power politics. The Australian version of the American College of Cardiology threw a complete hissy fit and got it banned from further broadcast and removed from the internet. In the process they slandered me and the other interviewees who appeared in the show. I wrote letters of protest to most of the Australian newspapers that reported on it but got no acknowledgement or reply.
Interesting. I'm 70 with significantly raised BP and Cholesterol, but no family history of heart disease. I drink, but quit smoking 4 years ago. I'm not a fan of meds, eat a healthy diet, and am watching this space.
Highly recommend Dr Malcolm Kendrick’s book “The Clot Thickens” where he dissects the cholesterol theory and not in the favor of statins. Everyone must do their due diligence and don’t let doctors dictate - your body, your choice … at least for the moment we still live in a free country.
Thanks to the authors for presenting differing viewpoints!
All drugs are bad. The Amish bypass pharma altogether and their children are healthy!
Overall this essay agrees with what I've read about statins and heart disease in the past two years (and I've read a lot.) Like many I was on statins (and some other preventions) until I started asking questions and found out for myself how nearly worthless these are for primary prevention of heart disease.
I highly recommend the (4) books of Dr. Malcolm Kendrick. I'm sure there are many other worthy authors too. Or, if you're cheap, read a lot of the same stuff for free at his web site, although not highly organized.
None of the following are my original ideas but I didn’t see them mentioned in the essay and I believe they are highly relevant:
(1) The medical-industrial complex is motivated mainly by profit. Drugs and other treatments cost enormous amounts of money and time to research. Therefore, it should be obvious that strong incentives exist for Pharma and others to get their product to market and to the widest number of patients possible. Alas, that means there will inevitably be the risk of various ethical lapses, corners being cut, standards sidestepped and outright criminal fraud or other violations of law.
(2) The problem is not only greed. Medicine, as with many disciplines, is hidebound. New discoveries that may invalidate established dogma, often with deeply entrenched career and investment conflicts of interest, always face a difficult battle of being accepted. Some, I suspect remain suppressed and never see the light of day.
(3) Many researchers and doctors who are aware of the limitations or even outright dangers of existing, permitted treatments and/or who might be willing to try newer, cutting-edge treatments, must often decide between toeing the party line and keeping their careers or risk losing all if they dare voice distrust of current treatments or try a newer treatment.
You should give some thought to the known or likely motivations of various entitles you interact with. Of course, one shouldn’t go overboard. In fairness medicine can and does provide treatments and cures for many diseases. Nor do I begrudge Pharma and other industries from making a fair profit. But I’m under no illusion that these all exist solely for the goal of delivering the patient the best health care possible.
What happens when a case of hypertension is cured? Nothing. Nobody cares. Hypertension is an incurable disease. Cured is not medically defined for hypertension. Just like the "there is no cure for the common cold," "there is no cure for hypertension." We know how to cure the common cold and most cases are cured. We know how to cure hypertension, and few cases are cured. Cutes have been documented, but cannot be proven for lack of a definition. Medically, there is no cure. Why not? Because the cure is not an approved medicine, it's an improvement in healthiness.
To your health, tracy
No no no
In practice I can share that it takes only three weeks to drop the LDL levels by using two servings per day of resistant starch in the diet.
Cholesterol levels in particular triglycerides and glucose ratio is a useful surrogate marker for insulin resistance.
In my practice diet and nutritional supplements have been enough to see benefit reducing need for statins.
I feel compelled to comment about “a healthy diet” since practically every post mentions diet and exercise as a preferred treatment. I wholeheartedly agree but for the average reader looking for real tangible help it’s not enough. The real question is what is considered a healthy diet? Our medical societies and our government pushes a diet that is not healthy at all, and keeps us exposed to the harms found in our food supply. Then pharmaceuticals come to the rescue to try to heal the damage. The only winners are big ag, the food industry, and pharmaceuticals. Meanwhile our quality of life is awful. I am a walking miracle today after changing my way of eating has literally saved my life. Doctors always encourage a healthy diet, and for decades I followed their definition of what that was: the Standard American Diet (SAD) as lauded by nutritionists everywhere, universities, and our government agencies. To say I was always sick following their advice is an understatement. Our food supply today is riddled with horrible things that are not healthy for the human body to process nor taken into account with these medical studies. I just read a study last week where a sugar substitute they were trying to prove was bad for our hearts was given to the subjects in cookies, sodas, and other prepackaged foods rather than given along with whole foods instead. There was no way to determine if the results could have been caused by the other chemicals and ingredients found in the packaged foods. The SAD favors the financial interests of the food industry and later pharma. Once I started to really learn about food and about everything that you will find in ingredients listings, it was like the Matrix and I started to wake up. 30 years on the medically recommended healthy diet left me as a stroke risk, pre-diabetic, having three tumors, riddled with depression and anxiety, obese at 203lbs (I’m 5-2”) and I developed severe advanced osteoporosis at a severity only ever seen in someone 25-30 years older than me. Medications also led to this development as both diet and meds robbed my bones of calcium. I also developed muscular problems and neurological pain. On top of that I carried the worst case of acne my entire adult life (I’m only 58.) 5 years ago I was diagnosed with high cholesterol too. Now I know my cholesterol wasn’t really that high at all, but I passed some pharmaceutical-developed boundary where their statins should be prescribed. By 2021 I was sick as a dog and had been following the standard “healthy diet” religiously. It was not healthy at all and caused me to continue to decline. Here I sit two years later with better health than ever before and the energy of a 20 year old and clearer skin than a new born baby the entire time. My cholesterol levels are enviable. How? I learned the truth about what’s in our food both in the stores and in restaurants. I have not had a single boxed, prepackaged food in two years, nor any sugar whatsoever or any other over processed, over refined ingredient. I learned to cook again from scratch even making my own condiments and other homemade ingredients where I can control everything that’s in my food. I don’t eat out much anymore but when I do I opt for a grilled steak or fish, and a salad, since I know it can’t be adulterated by our food supply. A healthy diet is using all whole foods and ingredients without any chemicals or lab created ingredients. It’s using butter instead of the recommended margarine. I lost 55 lbs and last week for the first time since I was in my 20s I was doing sprints in the gym. Anyone who saw me up to two years ago would not recognize me. My husband lost all his visceral fat on his belly and outpaces all the young men he works with when doing physical labor. Both of our blood tests over these two years show such a remarkable improvement that our doctors are perking up and finally listening to us. The single change we made that improved our health was to stop trusting our current food supply and anything processed or premade, and to stop following the current nutritional food pyramid. So if you are here wondering about statins and read that what works better is a healthy diet, I agree and disagree. It IS better, but it has to be the right diet, not the nationally and medically prescribed diets of today. If you really want to get healthier, do the hard work of staying away from easy and convenient when making meals, and learn the miracle and convenience of fasting. It can help you afford a truly healthier diet in both time and money.
High cholesterol levels indicate inflammation. They are signs the body is trying to deal with it, LDL, HDL, fluffy, hard whatever the latest goalpost shifting nonsense increasingly spouted is, what is important is the cause or causes, address them (often diet and lifestyle, meds too), lower that inflammation and the levels will fall / drop naturally. Sadly medicine has now become one dimensional in execution and understanding to the degree that now even a primary child could see the failings, the gaps in logic and understanding. Do physicians still actually study biochemistry anymore?? Serious question.
Well-put and compelling argument!
Thank you. Interesting timing as I recently spent 2 days reading studies to see if Atorvastatin 10mg is the right choice for a family member with high Lp(a). I found small studies that statins might actually be increasing this genetic risk factor. It seems even in higher risk and older people addressing high LDL-C with diets supplements and exercise would be the fist attempt at treatment. Thank you for all of your work. I am hoping your video about your research and experience re being fired (a horrible story particularly since you had to deal with the sickening covid pharma lies soon after) will help my family member as many folks can’t process the data alone.
Thankyou
Yesterday I received a letter from my professor at the royal Brompton hospital London
Saying my LDL levels have spiked high FOLLOWING SARS2 blood test confirmation in 2020 and he wishes to now put me on high dose statins .
I’m having problems with heart rhythm 🙄
And taking 100mg beta blockers.
I think I’ll be sticking to a healthy keto diet, fasting and my cardio miracle, DMG recommendations from Judy mikovits 🙏and a bit of dr zelenco and his zelenco protocol (RIP) god bless and leave the rest in gods hands 🙏
I am the sole survivor of the professor sir magdi Yacoub procedure replacement of the aorta 🫀 re suspended aortic valve and repaired mitral valve.
Thankyou for this article this morning 🌅 I take it as gods sigh to me 🙏
I was on statins from the mid-1990s until about 2008. Within a year of being on Lipitor, I had very sore knees that my doctor dismissed as being from statin side effects. The issue never went away, and I just put up with it. I changed brands a couple times after that point and ended up on simvastatin first. That one gave me sore calves and shoulders so my doctor switched me to pravastatin, which I was on for about four to six years. It got so I was so sore all over my body, not just the knees and calves, so I decided to go off statins completely at that point and have refused to go on them since.
I can't help but wonder if I had gotten side effects from the time I was on Lipitor, as I had suspected, and if my doctor had taken me off it, if things would have been different if I had quit then instead of staying on. It seems that my soreness increased the longer I was on the statins, and nowadays, even being off, the soreness remains. I wish I had never ever gone on a statin. The fancy graph that purports to show the benefit of pravastatin should have an overlaying graph showing the cumulative side effects from it as well.
Good article.
My approach is the following:
1/ Stratify all risk factors, and correct the correctable ones (primarily exercise, which is rarely considered by treating physicians).
2/ Check lipid subfractions rather than relying on total cholesterol, total LDL and HDL.
3/ For those whose risk of coronary artery disease is higher, offer coronary artery calcium score CT.
It is quite amazing how many patients who may have been on statins for decades have a very low coronary artery calcium score.
To me it is simply a matter of a right brain "gestalt" approach versus the modern medicine left brain flowchart approach.
I agree with 1 aspect of this article in its criticism of Dr. Mandrola’s position. As JMM says, the data suggest that the younger you start primary prevention statin, the higher likelihood of more people who stand to reap huge gains (vs fewer people who make more modest gains by starting later). But the current author rightly points out that the “average benefit” of statin in primary prevention, in absolute terms, remains small. So by starting more people younger, the cost of getting more people to reap huge gains is to expose WAY MORE people to minimal benefit, while everyone has the same cost of pill burden and potential long term complications. And of course, we have no idea which category our patient in the office falls into. I disagree with Dr. Mandrola’s emphasis only on the “lucky few”.
OTOH, I disagree with the current author’s criticism of the Mendelian randomization data. The issue seems to be about people who had gene deletion having had the benefit of survivor bias to have made it long enough to enrol into the studies in question. This is true…but is true of any adult participant of any study. Anyone who was included in Jupiter (for example) did not die in childhood. It’s the same survivor bias that applies to absolutely any study of anybody. I don’t see why it should only discount a Mendelian randomization cohort that results in a low LDL.
In the end, I don’t think the answer is for statin in primary prevention in everyone, nor in no one. We already have validated tools to try to better understand risk (and no CAC for me, thanks). And as Dr. Mandrola mentioned in that behavioural study, different people will have different values and preferences that emphasize different things…even when presented with the same data. IMO, our job is to present the info in as plain language as is necessary, then to be fairly indifferent about what the pt chooses based on that information. Some will say sign me up; others will say no thanks. And either is fine by me.
I had the honor and pleasure of being interviewed by Maryanne Demasi for her documentary "The Heart of the Matter" which ran on Australian television about ten years ago. It was practically the only production that raised questions about the cholesterol theory. But it also was a lesson in power politics. The Australian version of the American College of Cardiology threw a complete hissy fit and got it banned from further broadcast and removed from the internet. In the process they slandered me and the other interviewees who appeared in the show. I wrote letters of protest to most of the Australian newspapers that reported on it but got no acknowledgement or reply.
Interesting. I'm 70 with significantly raised BP and Cholesterol, but no family history of heart disease. I drink, but quit smoking 4 years ago. I'm not a fan of meds, eat a healthy diet, and am watching this space.
Highly recommend Dr Malcolm Kendrick’s book “The Clot Thickens” where he dissects the cholesterol theory and not in the favor of statins. Everyone must do their due diligence and don’t let doctors dictate - your body, your choice … at least for the moment we still live in a free country.
Thanks to the authors for presenting differing viewpoints!