Are Statin Medications the Best Choice for Preventing Heart Disease?

Within the conventional medical community, statins have been revered as a wonder drug for cardiovascular disease, with some physicians suggesting they should be added to the water supply. The basis for this opinion is rooted in observational research conducted 40-50 years ago that showed a correlation between saturated fat, cholesterol, and heart disease. This was subsequently called the “Diet-Heart Hypothesis” and has informed well-meaning physicians for half a century. Unfortunately, cardiovascular disease is one of the most misdiagnosed and mistreated conditions in medicine. Over the past decade, we’ve learned much about what causes heart disease. However, for some reason, the medical establishment is still operating on outdated science that has either been wholly disproven or vigorously scrutinized to the point of obsolescence by more recent and higher-quality research.  Within the integrative and functional medicine communities, it’s now understood that diets high in saturated fat and cholesterol don’t cause cardiovascular disease.

On the other hand, consuming “heart-healthy” vegetable oils rich in omega-6 fatty acids is linked to heart disease, cancer, inflammation, metabolic disease, and other conditions. For over 50 years, the American people have been the subject of a “fat phobia” experiment based on poorly designed, biased research that never established a causal link between saturated fat, cholesterol, and the incidence of heart disease. We were told to replace healthy animal fats and proteins with refined carbohydrates and industrial seed oils, including hydrogenated oils (margarine). As you might have guessed, this was a disaster. The incidence of cardiovascular disease and dyslipidemia increased while Americans saw significant changes in inflammatory markers, body mass index, blood sugar regulation, metabolic health, and cancer risk.  As a side note, the ancestral human diet consisted of 80-90% animal protein and fat, and modern humans are 99.9% genetically identical to their pre-agricultural ancestors. Hence, we are not genetically designed to thrive on refined carbohydrates, sugar, and highly refined plant oils that comprise over 75% of the Standard American Diet. The increased prevalence of chronic disease in society is the consequence of a maladaptive and unbalanced diet.

Statins are among the most commonly prescribed medications in the United States. Currently, 39 million Americans take a daily statin medication to control cholesterol levels and reduce the risk of cardiovascular events. Statin use typically increases with age, from 17% of adults aged 40–59 to 48% of adults aged 75 and over.  Statin prescriptions are also very lucrative for drug manufacturers. One annual revenue estimate for two commonly prescribed statins is 34 billion dollars.

It might surprise you to know, but statins don’t save lives in people without heart disease. When evaluating the data that researchers and pharmaceutical companies present on the effectiveness of statin medications, it’s important to distinguish between relative and absolute risk reduction. For example, they might say, “In this trial, statins reduced the risk of a heart attack by 30%”. But what they may not tell you is that the actual risk of having a heart attack went from 0.5% to 0.35%. In other words, before you took the drug, you had a 1 in 200 chance of having a heart attack; after taking the drug, you have a 1 in 285 chance of having a heart attack. That’s not nearly as impressive as using the 30% relative risk number, but it provides a more accurate picture of the actual or “absolute” risk reduction.

Statins are typically prescribed to those with pre-existing heart disease and those without pre-existing heart disease. In the medical literature, these groups are called “secondary prevention” and “primary prevention,” respectively.

SECONDARY PREVENTION (THOSE WITH PRE-EXISTING HEART DISEASE)

There’s little doubt that statins are effective in reducing heart attacks and deaths from heart disease in people who already have heart disease. Several large, controlled trials, including 4S, CARE, LIPID, HPS, TNT, MIRACL, PROV-IT, and A to Z, have shown relative risk reductions between 7% on the low end in MIRACL and 32% on the high end in 4S, with an average risk reduction of about 20%.

However, absolute risk reductions are much more modest. They range from 0.8% in MIRACL on the low end to 9% in 4S on the high end, with an average of 3%. Drawing on large meta-analyses of statins, researchers found that among those with pre-existing heart disease who took statins for five years, 96% saw no benefit at all, and only 1.2% (1 in 83) had their lifespan extended (were saved from a fatal heart attack).

PRIMARY PREVENTION (THOSE WITHOUT PRE-EXISTING HEART DISEASE)

Statins do reduce the risk of cardiovascular events in people without pre-existing heart disease. However, this effect is more modest than most people assume. Researchers analyzed the effect of statins given to people with no known heart disease for five years. They concluded that 98% saw no benefit at all, 1.6% (1 in 60) were helped by preventing a heart attack, and 0.4% (1 in 268) were supported by preventing a stroke. These statistics present a more sobering view on the efficacy of statins in people without pre-existing heart disease. They suggest that you’d need to treat 60 people for five years to prevent a single heart attack or 268 people for five years to prevent a single stroke. These somewhat unimpressive benefits must also be weighed against the downsides of therapy, such as side effects and cost. During that hypothetical 5-year period, 1 in 67 patients would have developed diabetes, and 1 in 10 patients would have developed muscle damage, which can be permanent in some cases. While statins do moderately reduce cardiovascular events such as heart attack in people without heart disease, they’ve never been shown to extend lifespan in this population. This is true even when the risk of heart disease is high. In a large meta-analysis of 11 randomized controlled trials published in the Archives of Internal Medicine, statins were not associated with a significant reduction in the risk of death from all causes.

I’m not trying to suggest that statins have no place in treating heart disease but rather to give you the objective information you need to decide (along with your doctor) whether they are appropriate for you. A treatment plan should be holistic in scope and personalized for your specific needs. It should include discussing dietary and lifestyle habits, risk factors, nutritional therapeutics, and stress management.

ADVERSE EFFECTS OF STATINS

Statin use has been associated with a wide range of side effects, including myopathy (muscle pain), liver damage, cataracts, kidney failure, cognitive impairment, impotence, and diabetes.

  1. Muscle Pain and Weakness (Myopathy):
    • Many people experience muscle pain, weakness, or tenderness while taking statins. In some cases, this can progress to a more severe condition called rhabdomyolysis, where muscle tissue breaks down and releases a protein into the bloodstream that can harm the kidneys.
  2. Liver Enzyme Abnormalities:
    • Statins can cause an increase in liver enzymes, although severe liver problems are rare. Routine monitoring of liver function is recommended during statin therapy.
  3. Digestive Issues:
    • Some individuals may experience gastrointestinal symptoms such as nausea, constipation, or diarrhea while taking statins.
  4. Type 2 Diabetes Risk:
    • There is evidence suggesting that statin use may be associated with an increased risk of developing type 2 diabetes. A study by Dr. Naveed Sattar and colleagues published in The Lancet in 2010 examined 13 randomized clinical trials involving over 90,000 patients taking statins. They found that statin use was associated with a 9% increased risk of developing diabetes.
  5. Cognitive Effects:
    • Some studies have explored potential associations between statin use and cognitive effects, such as memory loss or confusion. The evidence in this area is mixed, and more research is needed to understand the relationship between statins and cognitive function fully.
  1. Hormone Levels:
  • It’s essential to remember that all human sex hormones are made from cholesterol. In both men and women, statin medications have been shown to lower testosterone. This could have widespread implications for health and longevity.

PREVENTING AND REVERSING HEART DISEASE NATURALLY

While acting now does not guarantee that you’ll never get heart disease (as age is perhaps the most potent risk factor), it vastly improves your chances of avoiding it or at least delaying it significantly.

  • Transition to a “heart-healthy” diet. Remove refined grain-based carbohydrates, sugar, industrial seed oils, trans-fats, and highly processed foods from your plate. Instead, adopt a low-carbohydrate, whole-food diet rich in vitamins, minerals, healthy fats, plant antioxidants, and fiber. Popular diets like Paleo, ketogenic, or low-carb Mediterranean are great options. If you need help understanding these diets and customizing them to your lifestyle, contact me, and I would be happy to help you.
  • Find an exercise routine you like and engage with it consistently. Exercise has been shown to reduce LDL particle concentration even independently of diet. (43) Regular exercise prevents the development and progression of atherosclerosis, improves lipids, and reduces vascular symptoms in patients with heart disease.
  • Make sure you are getting enough sleep. This is critical! Sleep deprivation has been associated with weight gain, insulin resistance, increased appetite, caloric intake, overconsumption of highly palatable and rewarding food, decreased energy expenditure, and a reduced likelihood of sticking with healthy lifestyle behaviors.
  • Nutritional therapeutics like omega-3 fatty acids from fish, polyphenolic antioxidants from colored fruits and vegetables, soluble fiber, CoQ10, magnesium and potassium, vitamin D, and the amino acid L-carnitine can support healthy heart function.

 

Michael K Chase, MS, NTP
Nutrition Science and Dietetics

 

 

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DISCLAIMER: The information provided in this post is for educational purposes only, and should not be construed as personal medical advice or instruction. No action should be taken based solely on the contents of this information. Individuals should consult appropriate health professionals on any matter relating to their health and well-being. The statements made in this informational document have not been evaluated by the Food and Drug Administration. Any product discussed is not intended to diagnose, treat, cure or prevent any disease.

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