The truth about statin drugs

June 6, 2008 in Heart Disease, Myths & Truths | 23 comments

pills and bills Statins have been almost universally hailed as “wonder drugs” by medical authorities around the world. The market for statins was $26 billion in 2005, and sales for Lipitor alone reached $14 billion in 2006. Merck and Bristol Myers-Squib are actively seeking “over-the-counter” (OTC) status for their statin drugs. Statins are prescribed to men and women, children and the elderly, people with heart disease and people without heart disease.

In fact, these drugs have a reputation for being so safe and effective that one UK physician, John Reckless (I’m not kidding – that’s actually his name!) has suggested that we put statins in the water supply.

That’s a bold suggestion, of course, and it begs the question: are statins really as safe and cost effective as mainstream medical authorities claim? The unequivocal answer is no.

Statins don’t increase survival in healthy people

Statins have never been shown to be effective in reducing the risk of death in people with no history of heart disease. No study of statins on this “primary prevention population” has ever shown reduced mortality in healthy men and women with only an elevated serum cholesterol level and no known coronary heart disease. (CMAJ. 2005 Nov 8;173(10):1207; author reply 1210.) In fact, an analysis of large, controlled trials prior to 2000 found that long-term use of statins for primary prevention of CHD produced a 1% greater risk of death over 10 years compared to placebo

Statins don’t increase survival in women

Despite the fact that around half of the millions of statin prescriptions written each year are handed to female patients, these drugs show no overall mortality benefit regardless of whether they are used for primary prevention (women with no history of heart disease) or secondary prevention (women with pre-existing heart disease). In women without coronary heart disease (CHD), statins fail to lower both CHD and overall mortality, while in women with CHD, statins do lower CHD mortality but increase the risk of death from other causes, leaving overall mortality unchanged. (JAMA study)

Statins don’t increase survival in the elderly

The only statin study dealing exclusively with seniors, the PROSPER trial, found that pravastatin did reduce the incidence of coronary mortality (death from heart disease). However, this decrease was almost entirely negated by a corresponding increase in cancer deaths. As a result, overall mortality between the pravastatin and placebo groups after 3.2 years was nearly identical.

This is a highly significant finding since the rate of heart disease in 65-year old men is ten times higher than it is in 45-year old men. The vast majority of people who die from heart disease are over 65, and there is no evidence that statins are effective in this population.

Do statins work for anyone?

Among people with CHD or considered to be at high risk for CHD, the effect of statins on the incidence of CHD mortality ranges from virtually none (in the ALLHAT trial) to forty-six percent (the LIPS trial). The reduction in total mortality from all causes ranges from none (the ALLHAT trial) to twenty-nine percent (the 4S trial).

However, the use of statins in this population is not without considerable risk. Statins frequently produce muscle weakness, lethargy, liver dysfunction and cognitive disturbances ranging from confusion to transient amnesia. They have produced severe rhabdomyolysis that can lead to life-threatening kidney failure.

Aspirin just as effective as statins (and 20x cheaper!)

Perhaps the final nail in the coffin for statins is that a recent study in the British Medical Journal showed that aspirin is just as effective as statins for treating heart disease in secondary prevention populations – and 20 times more cost effective! Aspirin is also far safer than statins are, with fewer adverse effects, risks and complications.

The bottom line

  1. Statin drugs do not reduce the risk of death in 95% of the population, including healthy men with no pre-existing heart disease, women of any age, and the elderly.
  2. Statin drugs do reduce mortality for young and middle-aged men with pre-existing heart disease, but the benefit is small and not without significant adverse effects, risks and costs.
  3. Aspirin works just as well as statins do for preventing heart disease, and is 20 times more cost effective.

So what if you are at risk for heart disease and you’d prefer not to take a statin? Other than aspirin, there are many clinically proven ways to prevent heart disease involving simple adjustments to diet and lifestyle. In fact, the recent INTERHEART study which looked at the incidence of heart disease in 52 countries revealed that over 90% of heart disease is preventable by diet and lifestyle modifications.

I’ll discuss these natural methods of preventing heart disease in my next post. Stay tuned!

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Chris Kresser

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{ 13 comments… read them below or add one }

Matt June 6, 2008 at 3:57 pm
Marc Marshall, D.C. July 12, 2008 at 9:39 pm

We should also keep in mind that statins interfere with co-enzyme Q10 production. CoQ10 is extremely important for mitochondrial energy production and is especially important for heart function. It is also a powerful antioxidant which may prevent arteriosclerosis by preventing the accumulation of oxidized fats. It has been shown in clinical studies to modulate high blood pressure, regulate heart rhythm, and increase exercise tolerance in cases of angina and congestive heart failure.

Reply

Chris July 12, 2008 at 9:53 pm

Hi Marc,

Welcome to The Healthy Skeptic and thanks for your comment.

Yes, that’s exactly right. Statins powerfully inhibit CoQ10 production and that is very likely one reason are not effective for more than 95% of the population and actually increase total mortality in many cases – in spite of their anti-inflammatory effect.

This is one of the many “untold stories” of statin drugs. Thanks for bringing it to our attention!

Chris

Reply

Micki Jacobs August 23, 2009 at 11:34 am

Aspirin is a vitamin K antagonist. This means that the low dose aspirin that is so often recommended is preventing vitamin K from ensuring strong, flexible arteries with little to no calcium deposition – which is probably what REALLY causes CVD. Not to mention that aspirin ups the risk of bleeding out.
Aspirin on a daily basis is ill-conceived and is based on the paradigm of CVD occurring as a result platelets sticking together and then hanging up on build-up in arteries. Instead, it appears that calcium build-up is the first action of problems which occurs throughout life from early on – due to insufficient K2 and insufficiency of other calcium metabolism co-factors – and then the build up causes cholesterol to try to repair this problem and then docs think they need to “thin” blood and reduce cholesterol carrier proteins (LDL and VLDL) and they block the vitamin K action of making calcium go to the teeth and bones by hampering the carrier protein of vitamin K (yep, LDL and VLDL are the carrier proteins of vitamin K and beta carotene, among other beneficial proteins) via statins and aspirin. Hence, we have the wrong paradigm, the wrong treatments, and we need less aberrant forms of calcium, more calcium metabolism co-factors and fewer docs prescribing.

Reply

Mike, RPh September 22, 2009 at 10:19 pm

The comment by Micki Jacobs is incorrect.

Aspirin is NOT in any way a vitamin K antagonist.  Aspirin is not an anticoagulant like warfarin.  Aspirin is an antiplatelet drug.  It is an irreversible inhibitor of cyclooxygenase, which is an ezyme involved in the production of prostaglandins and, important for this topic, thromboxane.

Thromboxane causes platelets to clump together.  This clumping together to repair damage blood vessels is often what leads to heart attacks and strokes.  Therefore, Aspirin works to reduce the incidence of stroke and heart attack by blocking the ability of platelets to clump together.

That’s not to say that low-dose Aspirin does not have it’s own potential adverse effects.  Even low doses of Aspirin can greatly increase one’s risk for gastrointestinal ulcers.  However, everything the aforementioned comment mentioned about it’s effect on Vitamin K is completely false.

Aspirin has absolutely no effect on Vitamin K.

Reply

abolderwoman November 13, 2009 at 1:23 pm

Thanks for this post and comments regarding CoQ10, which most physicians seem to ignore. There’s a very good book related to this discussion — “Drug-Induced Nutrient Depletion Handbook.”  It’s not as up-to-date as some of us would like, but it’s still helpful for anyone wondering about how specific drugs can affect our health.   (fyi, I have no connection to this book or its authors — just find it useful and thought others might, too.)

Reply

admin November 15, 2009 at 8:40 am

Thanks for the heads-up on that book, abolderwoman.  Actually I just received an email a couple of days ago from a woman who suffered from muscle damage as a result of taking statins.  She was wondering what she can do to address the persistent weakness she’s experiencing – even though she is no longer taking the drugs.  I’ll forward this to her.

Reply

Anonymous April 16, 2011 at 5:27 pm

Here are my numbers:
49 year old female
overweight
normal bp
normal sugar readings
0verall chol: 281
hdl 73
ldl 193
triglycerides 152
crp 7.2

My doctor has been bugging me for the past 2 years about going on statins. The main concern is my ldl and crp readings(which he admits are not always accurate). I’ve had these readings for many years, no matter what weight I am at or exercise level.
Took pravastatin 2 years ago for a feww months and stopped after memory issues and muscle pain.
I’d really appreciate input.

Reply

Anonymous April 16, 2011 at 5:27 pm

Here are my numbers:
49 year old female
overweight
normal bp
normal sugar readings
0verall chol: 281
hdl 73
ldl 193
triglycerides 152
crp 7.2

My doctor has been bugging me for the past 2 years about going on statins. The main concern is my ldl and crp readings(which he admits are not always accurate). I’ve had these readings for many years, no matter what weight I am at or exercise level.
Took pravastatin 2 years ago for a feww months and stopped after memory issues and muscle pain.
I’d really appreciate input.

Reply

Kumar December 23, 2011 at 10:51 am

Chris,

Above, you state: “Statins have never been shown to be effective in reducing the risk of death in people with no history of heart disease.”

This is what I had thought as this is basically what has been promoted in the popular media outlets.

I’d be interested in your thoughts on the following article published in the NEJM:
“Long-Term Follow-up of the West of Scotland Coronary Prevention Study”
http://www.nejm.org/doi/full/10.1056/NEJMoa065994#Background=&t=abstract

This shows a reduction in (total) mortality in healthy patients (elevated cholesterol as well as no previous MI). I wonder why this hasn’t been cited more in popular media?

Reply

Kumar December 23, 2011 at 10:52 am

Chris,

Above, you state: “Statins have never been shown to be effective in reducing the risk of death in people with no history of heart disease.”

This is what I had thought as this is basically what has been promoted in the popular media outlets.

I’d be interested in your thoughts on the following article published in the NEJM:
“Long-Term Follow-up of the West of Scotland Coronary Prevention Study”
http://www.nejm.org/doi/full/10.1056/NEJMoa065994#Background=&t=abstract

Are you familiar with this study?

This shows a reduction in (total) mortality in healthy patients (elevated cholesterol as well as no previous MI). I wonder why this hasn’t been cited more in popular media?

Reply

Dave January 6, 2012 at 2:31 pm

Last May (2011) my NEW doctor started me on a statin drug after cholesterol came back at 262. HDL (60′s)and Triglycerides (80′s). LDL 170′s. I asked nurse about side effects and was told not to worry about it. I said what the heck and started taking them. 6 weeks later cholesterol numbers fine. continued on statin. couple months later found my hips hurting so bad couldnt sleep. Then found i couldnt run without massive joint and muscle pain. I decided to do research of side effects and found the statin drugs to be the cause. Stopped them and was fine within a short time. My doctor said I HAD to take them. I asked about diet and exercise and she said a man my age (54) couldnt control my cholesterol without drugs.
Well I refused to take the statins again and started educating myself. Through my reading I discovered the importance of Omega 3 (EPA DHA) in our diet and how Omega 6 causes inflammation. Taking 2+ grams a day of Omega 3 (EPA DHA), also take Niacin, 1 gram a day.. 4 months later, without Statins, my total cholesterol is 217, HDL is 67, Triglycerides 71 and LDL 136. Combined with this started eating way better, avoiding the simple carbs, vegetable oil etc etc etc. I have lost 10 lbs without trying ( I am 6′ tall and did weigh about 194)
The biggest thing is I FEEL GREAT!!!!!!
I tell people to read your articles all the time, changed my life. Thank you!!!

P. S. I am looking for a new doctor.

Dave

Reply

Chris Kresser January 6, 2012 at 3:14 pm

Your welcome, Dave! So happy to hear I’ve made a difference for you.

Reply

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