People who want to sell books, will say whatever they need to in order to sell those books. It’s not a great incentive system to fall back upon for your source of health info.
Also, people are suckers. Writers of books know this.
Finally, people are dumb and I’m not their dad. I’ll give them the best advice I can, and they can take it or leave it.
My experience with statins is not typical, but not as rare as the industry would assert, either: a mild case of rhabdo and painful exercise intolerance for over a year. There are genetic tests for statin intolerance, such as for variants in the gene SLCO1B1, which should be done before prescribing a statin (but rarely are). I can understand that cardiologists are frustrated. Their problem is that statins are the primary arrow in their quiver for reducing LDL, and the side-effects from statins of mild mitochondrial damage and muscle pain are common, causing people to stop taking them. Changes in exercise and diet, on the other hand, are effective for cardiovascular health but difficult to achieve. The result is a tendency by both drug companies and cardiologists to downplay the problems with statins, which has given rise to an entire industry of books and videos on their danger.
Imagine a world in which we prioritize doing something substantive rather than popping a pill.
We have allowed our humanity to be completely captured by the need for instant gratification and relief rather than the slow adaptation that is necessary to build real resilience. This is as apparent in medicine as anything else.
Whenever my wife points out her mother's bad eating habits and how they may affect her heart condition, she says "Why would I change when I just take a little pill and eat what I want?"
Meager effectiveness is not a term I would use for statin therapy. And, you are not correct about statins being worthless for primary prevention. Don't be fooled. Most heart attacks and strokes are caused by soft (hot) plaque rupture, not necessarily calcified plaque / stenosis. Statin therapy has been shown to stabilize soft plaque making it less likely to rupture. In addition, lifestyle alone does not always prevent plaque. If a patient is following a 'healthy lifestyle' but still has increasing LDL and increasing Apolipoprotein B even rosuvastatin at a low dose (as low as 5 mg. every other day) can be effective in preventing plaque as well as beneficial in soft plaque stabilization.
"A growing body of evidence indicates that plaque progression can be suppressed or even reversed by anti-atherosclerotic medications, especially statins."
The claims for plaque stabilization for statins started off as a speculation for why they could protect one against MI after the link to cholesterol level was shown to be fraudulent. I am not aware of any scientific evidence that this is true but would welcome correction on this point.
In my book, The Cholesterol Delusion, I compared the figures from the five major statin trials with those from the British Medical Journal's "Collaborative Overview of Randomized Trials of Anti-Platelet Therapy" published in 1994. Most of those trials used low dose aspirin. Total mortality was 6.6% in the statin group compared to 8.2% in the control for an absolute risk reduction of 1.6%. Total mortality was 6.8% in the anti-platelet therapy group and 7.9% for their controls for an absolute risk reduction of 1.1%. The figures were similar for the other common endpoint---nonfatal MI. I doubt that any of the differences are of any real significance but it does indicate that, if there is an anti-inflammatory effect, statins provide nothing more than low dose aspirin. Of course, one could also argue that the small differences could be due to anti-thrombotic effect as well.
In primary prevention: “138 people treated with statins for five years would prevent one death… 49 people to prevent one cardiovascular disease (CVD) event… And 155 people to prevent one stroke.” NIH.gov
Hardly the wonder drug you and Big Pharma make it out to be.
“After adjusting for important covariates, cholesterol level was not associated with cardiac or all-cause mortality. No relationship between cholesterol level and fatal or nonfatal MI could be demonstrated except for men under age 65. However, in this subgroup the risk of MI was highest for those with low or middle cholesterol levels. The data show that in patients with angiographically determined coronary artery disease, cholesterol level is not a statistically significant risk factor for death or MI over the follow-up period in CASS.”
Lifestyle, Statins, or Both? My answer is Neither. I didn't think I would live long enough to see someone trot out the Lyon Diet Heart study again. Granted it is logistically difficult (or, more likely, impossible) to carry out a scientifically valid study on the effects of diet and practically every other one of the so-called risk factors for cardiovascular disease. But there have been enough long term observational studies that show no benefit from diet and other claimed risk factors in all-cause mortality, heart attack, and stroke. Statin studies have been equally unimpressive---mostly showing tiny differences that are reported as relative risk reductions in order to make them seem significant. So the only difference I see is that the lifestyle modifications are harmless while the statins have the potential of significant harm. It is time to admit that no one knows how to prevent or significantly reduce the progression of atherosclerosis and its complications. We in the medical profession should concentrate our efforts in the diagnosis and treatment of those who suffer these disorders rather than continue to chase the tail of causation. That is not our job.
Ornish/Esselsytn type diet, grape seed extract (20% reduction), high-dose nattokinase (35 to 40% reduction with aspirin), pycnogenal+centalla asiatica (like 5 to 10% reduction if I remember), possibly extreme fasting. There are other things shown to affect plaque I can't remember.
Take any random nutraceutical or lifestyle change and obsess about it like they have with statins and it would be their wonder drug. Except it would have positive side effects. Dosing the body with some form of pleiotropy can be done 100 ways and works somewhat for just about everything. One paper said an apple a day is equivalent to statins.
No problem with anything you listed and I would encourage anyone who thinks a change in a lifestyle factor would help to go with it. I have read a fair amount of the more recent stuff on the biochemistry and microscopic pathology of atherosclerosis and find it interesting but not conclusive. I retired well before the advent of CT coronary angiography, so I have no feel for its reliability in assessing the nature of plaques. Given the difficulty in assessing the pathophysiology of a degenerative disease punctuated by episodes of acute crisis, we may never have a clearcut answer. What I do know is that, thus far, statin drugs show no scientifically valid evidence of benefit. And my default position is to always avoid taking drugs or other measures that alter one's fundamental physiology without conclusive evidence of benefit that far exceeds potential harm. So I will take the apple a day every day and continue to recommend compete avoidance of statin drugs.
I am pretty sure that at least two of the three doctors on this website have endorsed preventive treatment with statins for a significant percentage of the healthy population i.e. those with high risk scores. And this is a very conservative group when it comes to medications and invasive procedures.
Not just one of but THE biggest and most profitable medical hoax ever. Although covid and the endless run of vaccines which will be "offered" in coming years may give it a run for its money (pun intended). You are probably right about the SGLT 1 inhibitors. Originally marketed for a disease whose existence is debatable (Type 2 diabetes/pre-diabetes), it is now sold for a side effect---weight reduction. The template for the successful promotion of these drugs was established with the statins. Just as normal or "acceptable" levels of cholesterol were progressively ratcheted down in order to make "patients" out of nearly half of the normal healthy population, so were desirable blood glucose levels reduced in the same manner.
I have a stent in the widow maker from 2008 and been on low-carb diet ever since. Cardiologist prescribed two different statins (not at the same time), but I got painful cramps in my calf and shin muscles, especially in the right leg. A few years ago, I finally convinced him to give me a non-statin (Nexlizet), and have rarely, maybe only once or twice, had the bad cramps. (I also read Malcolm Kendrick's book, but have not pressed the issue with him). Very recently, I experienced a syncopal episode with elevated troponin. Every test under the sun, including an angiogram, was negative--my arteries are clear and no heart damage observed. My cardiologist said such an episode may never happen again! Will be on a heart monitor for a few days to check things out, though. I just offer this as more anecdotal evidence on statins.
As a clinician, I don't see any dichotomy. I encourage healthy lifestyle as strenuously as I'd recommend someone start a statin. The patient then has the human agency to take the advice and make their own decisions. Some people are very invested in and motivated to have a healthy lifestyle and others find it difficult to change habits - because they are human! As clinicians, we need to review cardiac risk status on every adult and suggest statins to the appropriate patients. Encourage people that don't already have healthy habits to try to establish some basics.
Statins have always been an aspect of medicine that has had controversy - probably due to the sheer number of people taking them (or having been recommended that they take). I've heard many physicians say "everyone should be on.a statin" vs the other end of the spectrum of high suspicion towards statins. All the talk and "controversy" is trying to find the right balance somewhere in the middle.
It takes time to review the specific cardiac risk with each adult, to review their cholesterol levels and use a risk stratification calculator to review their overall risk. It is ironic that in this age of "quality measures" and check boxes (ie, focus being in the wrong place) that we don't generally have more automated calculation of cardiac risk on each patient as they check in for an appointment - arm the patient with the results, and have that score front and center to discuss during the appointment. (Side note on my disdain for "quality measures" and carrot/stick pressures on physicians as accomplishing anything when the focus should be on automating what we can and arming patients with information easily. But that would remove things we could give a "score" on and try to limit payment based on those "scores". But I digress...)
The best way to approach all of this remains a physician or provider who can look at each patient individually and make recommendations tailored to that person.
Loosing sight and just cranking through algorithms doesn't equal "good" medicine. This is where the "art" of medicine comes in and how effective each provider might be in encouraging change in patients.
The most humorous statin recommendation I've seen in awhile was a cardiologist starting my 96 y/o patient on a statin - really?
The controversy comes from big pharma misinformation. Just take the profitability out of it and you'll see the truth come through real clear. Statins work well for a small group of people, at the cost of side effects. The problem is the assumption that we understand the underlying problem that creates the issue. So many people I talk to say, "it's genetic," which for me just indicates that they don't really know -- "genetics" culturally right now being one of those big X marks that people can throw at each other to halt curiosity (the science isn't that far behind in lack of cohesion or anything substantive other than just more inscrutable categories of disease and inheritance, either). When I realized this, I also realized looking further into it that the causal mechanisms behind high cholesterol are actually not that well understood.
Like a lot of things in medicine, there's some progress in the beginning and then things get stymied because people get attached to their explanatory models and the profitability/success/renown attached to them. It's pretty much that simple I'd suggest.
Kudos to the author for informing himself by reading Malhotra and Demasi before weighing in. That said, the dichotomy is real and can be summarized by: "Do you go with lifestyle interventions which will not only lower your cardiac risk but will also improve every aspect of your health and vitality for the rest of your life including lowering your risk of dementia, or pop a pill where it is not clear that the benefits even outweigh the risks and which will be a drag on your overall health for the rest of your life, including possibly increasing your risk of dementia?"
Just an anecdote but a true one: a friend developed joint pain from statins but when he stopped, the pain did not subside. He ended up on prednisone for a year, purely a result of the statins. I don't know the percentage of statin users who develop similar problems but I do know the percentage in those who adopt lifestyle changes: zero. Quite the opposite in fact. That's the dichotomy - positive health benefits all around vs questionable risk/benefit.
“The relative risk reduction for those taking statins compared with those who did not was 9% for deaths, 29% for heart attacks and 14% for strokes. Yet the absolute risk reduction of dying, having a heart attack or stroke was 0.8%, 1.3% and 0.4% respectively.”
That doesn’t look like much of a benefit to me. Especially when you consider that industry funded studies are biased in favor of their product. For instance, wasn’t the highly influential JUPITER study stopped early? If we had a technique for removing the proven industry bias, then what are the benefits? Why should we trust studies when we know they are biased, especially when the alleged benefit is so small?
If the side effects are nocebo, why is it that people experience the same list of side effects for statins, but not other drugs. I would think every drug would have the same problem, with an identical list. Is it something about the name “statin” that causes users to list the same side effects? What are the harms of taking these drugs for 25 years? How could anyone know?
How do we know statins and lifestyle improvements are better than just lifestyle improvements? Is there a randomized study that compares the two? I can see how it’s plausible that statins create a false sense of security that might inhibit someone from taking better care of themselves.
I have heard friends say they're enjoying an extra chocolate chip cookie because they are on a statin and therefore can get away with splurging a bit, so there may be some truth to the "statin gluttony" idea.
But in our obese-ogenic culture, we need all the tools we can get in order to cope with caloric temptations at every turn. The forces of the food-industrial complex are arrayed against us, and many of us simply weren't born with the willpower to resist. So we should not feel guilty if some of us need to take a statin to keep our lipids in check, or Ozempic to keep our weight down.
Yes it would be preferable for everyone to consume a healthy diet at all times, but that's not the world we live in.
Comprehensive diet, lifestyle, environment, and dietary supplement changes are rarely attained. But if they were, I doubt statin literature would have any relevance left. Esselstyn-type diets for example. Or suppose someone has been takign grapeseed extract which a 2-year RCT said shrunk carotid plaque 20%, and improved intermedia thickness and plaque stability. Or 10,000 units nattokinase which shrunk plaque 35 to 40%. I do lump supplements in with diet/environment, as there is ample reason to believe the side effects are lower, and are generally reduced risks of other diseases. Would statins do anything more in such patients? I doubt it. I call this starvation bias or environmental deprivation bias. Coca-cola is healthy, if you are lost in a desert. (Though this may not be the best name here, as ironically starvation appears to reverse atherosclerosis.) So do you want to improve upon poor environmental compliance or poor statin compliance? Or both? In general, when the causes of heart disease are pretty much environmental, I do think there is a right answer.
People who want to sell books, will say whatever they need to in order to sell those books. It’s not a great incentive system to fall back upon for your source of health info.
Also, people are suckers. Writers of books know this.
Finally, people are dumb and I’m not their dad. I’ll give them the best advice I can, and they can take it or leave it.
My experience with statins is not typical, but not as rare as the industry would assert, either: a mild case of rhabdo and painful exercise intolerance for over a year. There are genetic tests for statin intolerance, such as for variants in the gene SLCO1B1, which should be done before prescribing a statin (but rarely are). I can understand that cardiologists are frustrated. Their problem is that statins are the primary arrow in their quiver for reducing LDL, and the side-effects from statins of mild mitochondrial damage and muscle pain are common, causing people to stop taking them. Changes in exercise and diet, on the other hand, are effective for cardiovascular health but difficult to achieve. The result is a tendency by both drug companies and cardiologists to downplay the problems with statins, which has given rise to an entire industry of books and videos on their danger.
Imagine a world in which we prioritize doing something substantive rather than popping a pill.
We have allowed our humanity to be completely captured by the need for instant gratification and relief rather than the slow adaptation that is necessary to build real resilience. This is as apparent in medicine as anything else.
Whenever my wife points out her mother's bad eating habits and how they may affect her heart condition, she says "Why would I change when I just take a little pill and eat what I want?"
The meager effectiveness of statins applies only to people who have suffered an MI, right?
Am I correct that they are worthless for primary prevention?
Meager effectiveness is not a term I would use for statin therapy. And, you are not correct about statins being worthless for primary prevention. Don't be fooled. Most heart attacks and strokes are caused by soft (hot) plaque rupture, not necessarily calcified plaque / stenosis. Statin therapy has been shown to stabilize soft plaque making it less likely to rupture. In addition, lifestyle alone does not always prevent plaque. If a patient is following a 'healthy lifestyle' but still has increasing LDL and increasing Apolipoprotein B even rosuvastatin at a low dose (as low as 5 mg. every other day) can be effective in preventing plaque as well as beneficial in soft plaque stabilization.
"A growing body of evidence indicates that plaque progression can be suppressed or even reversed by anti-atherosclerotic medications, especially statins."
https://pmc.ncbi.nlm.nih.gov/articles/PMC4960066/
Statin therapy is associated with atherosclerotic plaque transformation to higher calcium density, which is associated with slower plaque progression.
https://www.acc.org/Latest-in-Cardiology/Articles/2021/11/10/19/50/The-Effect-of-Statin-Therapy-on-the-Progression-and-Composition-of-Coronary-Atherosclerotic-Plaque
The claims for plaque stabilization for statins started off as a speculation for why they could protect one against MI after the link to cholesterol level was shown to be fraudulent. I am not aware of any scientific evidence that this is true but would welcome correction on this point.
This is largely due to their anti-inflammatory effect, which can be achieved much safer and cheaper with other inflammation-reducing agents.
In my book, The Cholesterol Delusion, I compared the figures from the five major statin trials with those from the British Medical Journal's "Collaborative Overview of Randomized Trials of Anti-Platelet Therapy" published in 1994. Most of those trials used low dose aspirin. Total mortality was 6.6% in the statin group compared to 8.2% in the control for an absolute risk reduction of 1.6%. Total mortality was 6.8% in the anti-platelet therapy group and 7.9% for their controls for an absolute risk reduction of 1.1%. The figures were similar for the other common endpoint---nonfatal MI. I doubt that any of the differences are of any real significance but it does indicate that, if there is an anti-inflammatory effect, statins provide nothing more than low dose aspirin. Of course, one could also argue that the small differences could be due to anti-thrombotic effect as well.
In primary prevention: “138 people treated with statins for five years would prevent one death… 49 people to prevent one cardiovascular disease (CVD) event… And 155 people to prevent one stroke.” NIH.gov
Hardly the wonder drug you and Big Pharma make it out to be.
Furthermore, sir...
“After adjusting for important covariates, cholesterol level was not associated with cardiac or all-cause mortality. No relationship between cholesterol level and fatal or nonfatal MI could be demonstrated except for men under age 65. However, in this subgroup the risk of MI was highest for those with low or middle cholesterol levels. The data show that in patients with angiographically determined coronary artery disease, cholesterol level is not a statistically significant risk factor for death or MI over the follow-up period in CASS.”
https://pubmed.ncbi.nlm.nih.gov/1342254/
Lifestyle, Statins, or Both? My answer is Neither. I didn't think I would live long enough to see someone trot out the Lyon Diet Heart study again. Granted it is logistically difficult (or, more likely, impossible) to carry out a scientifically valid study on the effects of diet and practically every other one of the so-called risk factors for cardiovascular disease. But there have been enough long term observational studies that show no benefit from diet and other claimed risk factors in all-cause mortality, heart attack, and stroke. Statin studies have been equally unimpressive---mostly showing tiny differences that are reported as relative risk reductions in order to make them seem significant. So the only difference I see is that the lifestyle modifications are harmless while the statins have the potential of significant harm. It is time to admit that no one knows how to prevent or significantly reduce the progression of atherosclerosis and its complications. We in the medical profession should concentrate our efforts in the diagnosis and treatment of those who suffer these disorders rather than continue to chase the tail of causation. That is not our job.
Ornish/Esselsytn type diet, grape seed extract (20% reduction), high-dose nattokinase (35 to 40% reduction with aspirin), pycnogenal+centalla asiatica (like 5 to 10% reduction if I remember), possibly extreme fasting. There are other things shown to affect plaque I can't remember.
Take any random nutraceutical or lifestyle change and obsess about it like they have with statins and it would be their wonder drug. Except it would have positive side effects. Dosing the body with some form of pleiotropy can be done 100 ways and works somewhat for just about everything. One paper said an apple a day is equivalent to statins.
No problem with anything you listed and I would encourage anyone who thinks a change in a lifestyle factor would help to go with it. I have read a fair amount of the more recent stuff on the biochemistry and microscopic pathology of atherosclerosis and find it interesting but not conclusive. I retired well before the advent of CT coronary angiography, so I have no feel for its reliability in assessing the nature of plaques. Given the difficulty in assessing the pathophysiology of a degenerative disease punctuated by episodes of acute crisis, we may never have a clearcut answer. What I do know is that, thus far, statin drugs show no scientifically valid evidence of benefit. And my default position is to always avoid taking drugs or other measures that alter one's fundamental physiology without conclusive evidence of benefit that far exceeds potential harm. So I will take the apple a day every day and continue to recommend compete avoidance of statin drugs.
Doctors aren’t pushing statins.
The drug industry is.
Doctors are merely its distributors.
I am pretty sure that at least two of the three doctors on this website have endorsed preventive treatment with statins for a significant percentage of the healthy population i.e. those with high risk scores. And this is a very conservative group when it comes to medications and invasive procedures.
Yes. Its so amazingly effective that we should add it our drinking water supply, right?
Some people actually suggested that. I don't know whether they were being completely serious or not.
They were/are.
Cholesterol as a cause of heart attacks has been one of the biggest, most profitable hoaxes ever perpetrated on the general public.
Next up? SGLT1 inhibitors. They cure every ill, right?
And only $1,000/month. A bargain!
Not just one of but THE biggest and most profitable medical hoax ever. Although covid and the endless run of vaccines which will be "offered" in coming years may give it a run for its money (pun intended). You are probably right about the SGLT 1 inhibitors. Originally marketed for a disease whose existence is debatable (Type 2 diabetes/pre-diabetes), it is now sold for a side effect---weight reduction. The template for the successful promotion of these drugs was established with the statins. Just as normal or "acceptable" levels of cholesterol were progressively ratcheted down in order to make "patients" out of nearly half of the normal healthy population, so were desirable blood glucose levels reduced in the same manner.
Meh, you want to get over a "binary" but then you offer no third or fourth etc. alternatives.
I have a stent in the widow maker from 2008 and been on low-carb diet ever since. Cardiologist prescribed two different statins (not at the same time), but I got painful cramps in my calf and shin muscles, especially in the right leg. A few years ago, I finally convinced him to give me a non-statin (Nexlizet), and have rarely, maybe only once or twice, had the bad cramps. (I also read Malcolm Kendrick's book, but have not pressed the issue with him). Very recently, I experienced a syncopal episode with elevated troponin. Every test under the sun, including an angiogram, was negative--my arteries are clear and no heart damage observed. My cardiologist said such an episode may never happen again! Will be on a heart monitor for a few days to check things out, though. I just offer this as more anecdotal evidence on statins.
As a clinician, I don't see any dichotomy. I encourage healthy lifestyle as strenuously as I'd recommend someone start a statin. The patient then has the human agency to take the advice and make their own decisions. Some people are very invested in and motivated to have a healthy lifestyle and others find it difficult to change habits - because they are human! As clinicians, we need to review cardiac risk status on every adult and suggest statins to the appropriate patients. Encourage people that don't already have healthy habits to try to establish some basics.
Statins have always been an aspect of medicine that has had controversy - probably due to the sheer number of people taking them (or having been recommended that they take). I've heard many physicians say "everyone should be on.a statin" vs the other end of the spectrum of high suspicion towards statins. All the talk and "controversy" is trying to find the right balance somewhere in the middle.
It takes time to review the specific cardiac risk with each adult, to review their cholesterol levels and use a risk stratification calculator to review their overall risk. It is ironic that in this age of "quality measures" and check boxes (ie, focus being in the wrong place) that we don't generally have more automated calculation of cardiac risk on each patient as they check in for an appointment - arm the patient with the results, and have that score front and center to discuss during the appointment. (Side note on my disdain for "quality measures" and carrot/stick pressures on physicians as accomplishing anything when the focus should be on automating what we can and arming patients with information easily. But that would remove things we could give a "score" on and try to limit payment based on those "scores". But I digress...)
The best way to approach all of this remains a physician or provider who can look at each patient individually and make recommendations tailored to that person.
Loosing sight and just cranking through algorithms doesn't equal "good" medicine. This is where the "art" of medicine comes in and how effective each provider might be in encouraging change in patients.
The most humorous statin recommendation I've seen in awhile was a cardiologist starting my 96 y/o patient on a statin - really?
The controversy comes from big pharma misinformation. Just take the profitability out of it and you'll see the truth come through real clear. Statins work well for a small group of people, at the cost of side effects. The problem is the assumption that we understand the underlying problem that creates the issue. So many people I talk to say, "it's genetic," which for me just indicates that they don't really know -- "genetics" culturally right now being one of those big X marks that people can throw at each other to halt curiosity (the science isn't that far behind in lack of cohesion or anything substantive other than just more inscrutable categories of disease and inheritance, either). When I realized this, I also realized looking further into it that the causal mechanisms behind high cholesterol are actually not that well understood.
Like a lot of things in medicine, there's some progress in the beginning and then things get stymied because people get attached to their explanatory models and the profitability/success/renown attached to them. It's pretty much that simple I'd suggest.
Kudos to the author for informing himself by reading Malhotra and Demasi before weighing in. That said, the dichotomy is real and can be summarized by: "Do you go with lifestyle interventions which will not only lower your cardiac risk but will also improve every aspect of your health and vitality for the rest of your life including lowering your risk of dementia, or pop a pill where it is not clear that the benefits even outweigh the risks and which will be a drag on your overall health for the rest of your life, including possibly increasing your risk of dementia?"
Just an anecdote but a true one: a friend developed joint pain from statins but when he stopped, the pain did not subside. He ended up on prednisone for a year, purely a result of the statins. I don't know the percentage of statin users who develop similar problems but I do know the percentage in those who adopt lifestyle changes: zero. Quite the opposite in fact. That's the dichotomy - positive health benefits all around vs questionable risk/benefit.
Is this the benefit?
“The relative risk reduction for those taking statins compared with those who did not was 9% for deaths, 29% for heart attacks and 14% for strokes. Yet the absolute risk reduction of dying, having a heart attack or stroke was 0.8%, 1.3% and 0.4% respectively.”
https://theconversation.com/benefits-of-statins-may-have-been-overstated-new-study-175557?form=MG0AV3
That doesn’t look like much of a benefit to me. Especially when you consider that industry funded studies are biased in favor of their product. For instance, wasn’t the highly influential JUPITER study stopped early? If we had a technique for removing the proven industry bias, then what are the benefits? Why should we trust studies when we know they are biased, especially when the alleged benefit is so small?
https://www.newscientist.com/article/dn3781-research-funded-by-drug-companies-is-biased/?form=MG0AV3
If the side effects are nocebo, why is it that people experience the same list of side effects for statins, but not other drugs. I would think every drug would have the same problem, with an identical list. Is it something about the name “statin” that causes users to list the same side effects? What are the harms of taking these drugs for 25 years? How could anyone know?
How do we know statins and lifestyle improvements are better than just lifestyle improvements? Is there a randomized study that compares the two? I can see how it’s plausible that statins create a false sense of security that might inhibit someone from taking better care of themselves.
What about the proven risks, are they irrelevant?
https://www.bmj.com/content/381/bmj-2022-071727?form=MG0AV3
I have heard friends say they're enjoying an extra chocolate chip cookie because they are on a statin and therefore can get away with splurging a bit, so there may be some truth to the "statin gluttony" idea.
But in our obese-ogenic culture, we need all the tools we can get in order to cope with caloric temptations at every turn. The forces of the food-industrial complex are arrayed against us, and many of us simply weren't born with the willpower to resist. So we should not feel guilty if some of us need to take a statin to keep our lipids in check, or Ozempic to keep our weight down.
Yes it would be preferable for everyone to consume a healthy diet at all times, but that's not the world we live in.
Comprehensive diet, lifestyle, environment, and dietary supplement changes are rarely attained. But if they were, I doubt statin literature would have any relevance left. Esselstyn-type diets for example. Or suppose someone has been takign grapeseed extract which a 2-year RCT said shrunk carotid plaque 20%, and improved intermedia thickness and plaque stability. Or 10,000 units nattokinase which shrunk plaque 35 to 40%. I do lump supplements in with diet/environment, as there is ample reason to believe the side effects are lower, and are generally reduced risks of other diseases. Would statins do anything more in such patients? I doubt it. I call this starvation bias or environmental deprivation bias. Coca-cola is healthy, if you are lost in a desert. (Though this may not be the best name here, as ironically starvation appears to reverse atherosclerosis.) So do you want to improve upon poor environmental compliance or poor statin compliance? Or both? In general, when the causes of heart disease are pretty much environmental, I do think there is a right answer.