By Dr. Anita Sadaty
Heart Health Month Series Part One:
What we got wrong about Cholesterol and Statins
Most of us in the United States believe that lowering cholesterol is the most important way to prevent or treat heart disease. Doctors and patients alike strongly believe that statin drugs lower your risk of heart attack and death from heart disease (Thank you pharmaceutical industry!) But if we look at the fine print of many prominent television advertisements, and even the lofty conclusions of medical journals that tout a whopping 30-40% reduction in risk of having a heart attack with statin use, we may see a different story.
What do the studies actually mean and how should it affect YOUR decision about whether or not to use these drugs? I read a very eye opening article published by Dr. Mark Hyman a while back and here are some really interesting statistics he compiled about cholesterol and the benefits (or lack thereof) of statin use.
If you lower “bad” cholesterol (LDL), but have a low HDL (good cholesterol) there is no benefit to statins.
➔ I see this OVER and OVER again in my female patients. Great HDL with high LDL. Not a reason (by itself) to go on a statin.
If you lower bad cholesterol (LDL) but don’t reduce inflammation (marked by a test called C-reactive protein), there is no benefit to statins.
➔ This is a VERY significant point. As NOTED by the CAPITALIZATION in my REMARKS. One of the more important root causes of high cholesterol is underlying inflammation. Cholesterol is just letting you know that you’ve got inflammation. It’s not the CAUSE of the problem. Hey…DON’T SHOOT THE MESSENGER!!!
If you are a healthy woman with high cholesterol, there is no proof that taking statins reduces your risk of heart attack or death.
➔ Ummm. Say what??? Yep.
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.
➔ Guess what? As you age, mortality INCREASES with lower levels of cholesterol. Your body, your cells, your BRAIN need cholesterol. Lowering it in older individuals is NOT the way to go. Particularly in anyone with cognitive decline or dementia. Obviously if the reason for dementia is runaway cardiac plaques and strokes related to terrible cardiovascular disease, there is more to the story and I am NOT saying NEVER be on statin. But there needs to be way more compelling evidence to put a woman over 69 on a statin than just a high cholesterol level.
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.
➔ More is not always better. This endless attempt to decimate your blood cholesterol levels is not necessarily getting you what you want.
75% of people who have heart attacks have normal cholesterol.
➔ The point here is that there are far greater causes of heart attacks that get swept under the carpet. Let’s start with the top reasons for heart disease and stroke.
Things you can control:
- Smoking – biggest risk factor
- Diabetes (and the terrible Standard American Diet)
- Hypertension
- Stress is a massive risk factor for EVERYTHING
- Physical inactivity
- Being overweight
Things you can’t control:
- Aging – More than 83% of people who die from coronary heart disease are 65 or older.
- Genetics or family history
- Race – Heart disease risk is higher among African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans compared to Caucasians.
- Male gender – even after menopause, women do not carry the same risk as males.
Some evidence suggests that it is likely statins’ ability to lower inflammation that accounts for their benefit, which is unrelated to their ability to lower cholesterol.
What this tells you is that lowering inflammation is the critical piece. And there are MANY other SAFER ways to lower cholesterol that do not carry the same risks as statin drugs.
Given all of this very interesting data to chew on, who DOES benefit from using statins?
They work for people who have ALREADY had a heart attack. There is evidence that statins DO prevent more heart attacks or death in this group of people. They also show some benefit for middle-aged men with multiple risk factors for heart attack risk like high blood pressure, obesity, or diabetes.
“So why did the 2004 National Cholesterol Education Program 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? Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak. It was like having a fox guard the chicken coop.”
―Dr. Mark Hyman
Stay tuned for Heart Health Month Series Part 2: The Truths and Myths about Cholesterol and Why I’ve ignored my Cholesterol level of 270 for the past 20 years
Well, that won’t be the title actually, but that happens to be true…
Please Share the Health if you liked what you read!!!
For more information about my wellness programs and my practice, check out my website drsadaty.com. Hey Look! You are already here…
Ready for the legal disclaimer? Information offered here is for educational purposes only and does not constitute medical advice. As with any health recommendations, please contact your doctor to be sure any changes you wish to consider are safe for you!
Salient points….Thank you!!!!!
Hi Dr Sadaty – my 86 yo mother is on Zocor – she’s basically in good health w no heart problems – her present cholesterol is 292
HDL 66
LDL 188
Triglycerides 388
hsCRP 3.282
She’s just getting over pneumonia – her lungs are totally clear – Her major complaint is that she is always tired – has been for many years & now she has pain in hands and fingers – her b12 is very high 939, iron is good too – she has leg pain but she’s been through several scans and her legs r fine – no clots etc – she has some arm pain which she got a cortisone shot for which helped -she’s having a nerve test for her arms & hands & fingers next week to see what’s up
She is not active and won’t walk because she says her legs hurt then
I’m wondering if the Zocor may be causing this pain –
Hi Maria, please contact your mother’s doctor to find out if Zocor could be causing these issues.