Statins Don't Save Lives in People without Heart Disease | Chris Kresser

The Diet–Heart Myth: Statins Don’t Save Lives in People without Heart Disease

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A man taking statins
Statins aren’t as effective as conventional medicine makes them out to be. Brand X Pictures/Stockbyte/Thinkstock

To read more about heart disease and cholesterol, check out this eBook on the Diet–Heart Myth.

Cardiovascular disease is one of the most misdiagnosed and mistreated conditions in medicine. In the first article in this series, I explained the evidence suggesting that eating cholesterol and saturated fat does not hurt your heart health or increase the risk of heart disease. In the second article, I explained it’s not the amount of cholesterol in your blood that drives heart disease risk, but the number of LDL particles. In the third article, I discussed the five primary causes of elevated LDL particle number.

In this article, I will debunk the myth that statin drugs save lives in healthy people without heart disease, and discuss some of the little known side effects and risks associated with these drugs.

Myth #3: Statins Save Lives in Healthy People without Heart Disease

Statins have been hailed by many in the conventional medical establishment as wonder drugs, with some physicians going as far as suggesting they should be added to the water supply. (The doctor that made that particular suggestion is named John RecklessI kid you not.) But are statins really the wonder drugs they’ve been made out to be?

Are statins really the miracle drug they’ve been made out to be? Check out this article to find out more about these popular drugs. #healthylifestyle #chriskresser

Before we dive into the statistics on statins, I need to briefly explain the difference between relative and absolute risk reduction. Researchers and pharmaceutical companies often use relative risk statistics to report the results of drug studies. For example, they might say, “In this trial, statins reduced the risk of a heart attack by 30 percent.” But what they may not tell you is that the actual risk of having a heart attack went from 0.5 percent to 0.35 percent. 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 percent relative risk number, but it provides a more accurate picture of what the actual, or “absolute” risk reduction is.

With that in mind, let’s take a closer look at the efficacy of statins in two broad groups of people:

  • Those with pre-existing heart disease
  • Those without pre-existing heart disease

In the medical literature, these groups are referred to as “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 percent on the low end in MIRACL and 32 percent on the high end in 4S, with an average risk reduction of about 20 percent.

However, absolute risk reductions are much more modest. They range from 0.8 percent in MIRACL on the low end to 9 percent in 4S on the high end, with an average of 3 percent.

An analysis by Dr. David Newman in 2010 which drew on large meta-analyses of statins found that among those with pre-existing heart disease that took statins for 5 years: (1)

  • 96 percent saw no benefit at all
  • 1.2 percent (1 in 83) had their lifespan extended (were saved from a fatal heart attack)
  • 2.6 percent (1 in 39) were helped by preventing a repeat heart attack
  • 0.8 percent (1 in 125) were helped by preventing a stroke
  • 0.6 percent (1 in 167) were harmed by developing diabetes
  • 10 percent (1 in 10) were harmed by muscle damage
A heart attack or stroke can have a significant negative impact on quality of life, so any intervention that can decrease the risk of such an event should be given serious consideration. But even in the population for which statins are most effective—those with pre-existing heart disease—83 people have to be treated to extend one life, and 39 people have to be treated to prevent a repeat heart attack.

Moreover, these results do not apply to all populations across the board. Most studies have shown that while statins do reduce cardiovascular disease (CVD) events and deaths from CVD in women, they do not reduce the risk of death from all causes (“total mortality”). (2)

Nor do these results apply to men or women over the age of 80. Statins do reduce the risk of heart attack and other CVD events in men over the age of 80, and especially at this age, these events can have a significant negative impact on quality of life. However, the bulk of the evidence suggests that statins don’t extend life in people over 80 years of age, regardless of whether they have heart disease, and the highest death rates in people over 80 are associated with the lowest cholesterol levels. (3, 4)

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. Dr. Newman also analyzed the effect of statins given to people with no known heart disease for 5 years: (5)

  • 98 percent saw no benefit at all
  • 1.6 percent (1 in 60) were helped by preventing a heart attack
  • 0.4 percent (1 in 268) were helped by preventing a stroke
  • 1.5 percent (1 in 67) were harmed by developing diabetes
  • 10 percent (1 in 10) were harmed by muscle damage

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 5 years to prevent a single heart attack, or 268 people for 5 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, as we’ll see later in this section).

In addition, 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 by Kausik Ray, MD, and colleagues published in the Archives of Internal Medicine, statins were not associated with a significant reduction in the risk of death from all causes. (6)

This trial included 65,000 people without pre-existing heart disease but with intermediate to high risk of heart disease. It was important because it was the first review that only included participants without known heart disease. Previous studies suggesting that statins are effective in reducing death in people without pre-existing heart disease included some people that did have heart disease, which would have skewed the results.

The lack of significant effect on mortality is even more interesting in light of the fact that LDL cholesterol levels did decrease significantly in the statin group; the average LDL level in those taking placebo was 134 mg/dL and the average in the statin-treated patients was 94 mg/dL—roughly 30 percent lower. Yet in spite of this marked reduction in LDL cholesterol in the statin group, there was no difference in lifespan between the two groups. This is yet another line of evidence suggesting that the amount of cholesterol in LDL particles is not the driving factor in heart disease.

A meta-analysis of statin trials in people without heart disease by the prestigious Cochrane Collaboration came to a similar conclusion. (7) They also observed that all but one of the clinical trials providing evidence on this issue were sponsored by the pharmaceutical industry. This is a reason to remain skeptical, because research clearly indicates that industry-sponsored trials are more likely than non-industry-sponsored trials to report favorable results for drugs because of biased reporting, biased interpretation, or both. (8)

Adverse Effects of Statins

If statins were harmless and free, then it wouldn’t matter how many people need to be treated to prevent a heart attack or extend someone’s lifespan. But statins are not free, nor are they harmless. Statin use has been associated with a wide range of side effects, including:

  • Myopathy (muscle pain)
  • Liver damage
  • Cataracts
  • Kidney failure
  • Cognitive impairment
  • Impotence
  • Diabetes

Unfortunately, studies show that physicians are more likely to deny than affirm the possibility of statin side effects, even for symptoms with strong evidence in the scientific literature. (9) Assuming that physicians would likely not report the adverse reaction in these circumstances, it’s probable that the incidence of statin side effects is much higher than the reported rates.

One of the most troubling side effects of statins is their potential to increase the risk of diabetes, especially in women. 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 percent increased risk in developing diabetes. Note that this is a relative risk, so the absolute risk of developing diabetes while taking a statin is very low. That said, observational data from the Women’s Health Initiative found a 48 percent increased risk of diabetes in healthy women taking statins after adjusting for other risk factors. (10)

What’s more, a 2019 study found a 38 percent increased risk of type 2 diabetes in patients who took statins over a 15-year period. (11) The study also showed:

  • Even people on low doses of statins were at increased risk of developing diabetes
  • The increase in risk was significantly higher in those who were overweight or obese
  • Patients’ risk of diabetes climbed higher the longer they took statins

To summarize:

  • The only population that statins extend life in are men under 80 years of age with pre-existing heart disease.
  • In men under 80 without pre-existing heart disease, men over 80 with or without heart disease, and women of any age with or without heart disease, statins have not been shown to extend lifespan.
  • Statins do reduce the risk of cardiovascular events in all populations. A heart attack or stroke can have a significant, negative impact on quality of life—particularly in the elderly—so this benefit should not be discounted.
  • However, the reductions in cardiovascular events are often more modest than most assume; 60 people with high cholesterol but no heart disease would need to be treated for 5 years to prevent a single heart attack, and 268 people would need to be treated for 5 years to prevent a single stroke.
  • Statins have been shown to cause a number of side effects, such as muscle pain and cognitive problems, and they are probably more common than currently estimated due to under-reporting.

My intention here is not to suggest that statins have no place in the treatment of heart disease, but rather to give you the objective information you need to decide (along with your doctor) whether they are appropriate for you. The decision whether to take them should be based on whether you have pre-existing heart disease, what your overall risk of a heart attack is, how healthy your diet and lifestyle are, what other treatments youve already tried, and your own risk tolerance and worldview. Its clear that statins reduce heart disease as well as the risk of death in those that have already had a heart attack, so if you’re in this group and youve already tried diet and lifestyle interventions without much impact on your lipid or inflammatory markers, you are more likely to benefit.

In the next and final article of this series, I’ll discuss three steps to preventing and reversing heart disease naturally, without drugs.

Do you—or does someone you know—take statins? Have you noticed any of the adverse side effects listed above? Comment below and share your experience.

211 Comments

Join the conversation

  1. Thanks so much for all your excellent research and for sharing it! What’s your opinion on taking statins to stabilize arterial plaque?

  2. Chris,

    I’m interested in your opinion of my situation. I have read so much of your research and appreciate all that you do to educate us. I am a 42yo female of normal weight and normal BMI. I exercise 4-5 days per week doing a variety of different cardio and weight combinations. I eat a paleo-ish diet about 75% of the time. My father died at 45yo of a massive MI and his father died young of CVD as well. My mom also has two stents and her father died of a massive heart attack at 60yo. My cholesterol has been gradually creeping up over the last several years. I recently had a NMR lipoprotein profile done and these were the results:
    LDL-P 1697, LDL-C 173, HDL-C 98, Trig 58, Total Chol 283, HDL-P 34.4, Small LDL-P <90, LDL Size 22 (Large, Pattern A)
    I also had a TSH which was normal, but did not check T3 or T4. All other labs, including fasting glucose and insulin levels were normal.
    My doctor has recommended that I start a statin. There is for sure room in my diet for improvement, but I do consider myself a healthy eater. I stay away from sugar for the most part and do not eat a lot of simple carbs. I am otherwise healthy and have no other medical problems. I did have a complete hysterectomy 5 years ago due to endometriosis and am on bioidentical hormone replacement. I take a MVI, probiotic, 2gms of fish oil, Vit D, DHEA, and Magnesium every day.

    Would my numbers and my family history necessitate me taking a statin? Is there a possibility that I can do something to fix this on my own?

  3. The first step in reversing heart disease and reducing cholesterol is to eliminate stress, or at least reduce the amount of stress in your lives.

    Here are some things that are proven to reduce blood pressure and controlling high cholesterol;

    Aroma therapy
    Listen to a spritely tune
    Learn a musical instrument
    Sing in the shower
    Eat peppermint
    Eat healthy, crunchy, foods like nuts. Research shows that crunchy foods raises dopamine levels. The happy hormone.
    Eat a diet rich in whole grains, fruits and vegetables.
    Avoid saturated fats and foods high in cholesterol.
    Use margarine in place of fatty butters
    Avoid all meat
    Avoid eggs which are dangerously high in cholesterol
    Consume dairy sparingly
    Eat salads
    Have a fruit smoothie instead of cola
    Get at least 8 hours of quality sleep
    Pray, meditate or do yoga everyday
    Walk or bicycle instead of using your car. It’s good for you and saves the planet, too
    Have a strong social atmosphere
    Watch positive, informative TV shows like Dr. Oz

  4. I have had a heart attack 3 months ago with bypass surgery and now overall feel fine. Can I take non flushing niacin, Co Q 10 and D ribose and expect similar results compared to Artorvarstatin? I see a statin as having much more side effects than niacin would have and I would use Co Q 10 to replace what the statins removed from body that my heart needs.
    I think my concern should be more on oxidizing oils and too much sugar in my body that can cause harm than what my cholesterol levels are causing if any at all.
    Prior to my heart attack, I was and am still in pretty good shape, ate well with daily exercising. I think now the cause of the heart attack was stress, and never did get an understanding on how to prevent that.
    I do think Dr Ornish is about as responsible as Ancel Keys was for as they both seem to have had phony ideas.

  5. Familial hypercholesterolemia.mmm I ALSO never get an answer. MY son at 34 got quintuple bypass surgery over christmas and medical frat. doesnt touch us with barge poles. Statins will kill us. we get kidney disease within a week so we take fibrates, those who didn’t died (in MY family). Don’t even know why I’m writing here again.

    • Marguerite, I am so sorry to hear of your family’s medical problems. Can I suggest you read a book, “The Truth About Statins: Risks and Alternatives to Cholesterol Lowering Drugs” by Dr Barbara Roberts MD, a Cardiologist of over 30 years. Also there is a FB group http://www.facebook.com/groups/statins which has almost 2500 from all over the world. Including 2 Cardiologists, 3 Chemists and 1 Pharmacist and several RN’s such as myself

  6. Chris, as a suffere of familial hypercholesterlaemia (FH) and after reading your e-book the diet – heart myth, I was wondering why you feel elevated cholesterol in almost everyone (aside from people with existing heart disease) does not need statins, but people with FH do need statins. What makes people like myself need statins if the cholesterol essentially does no harm and the benefits of the statins is dubious at best – not to mention the side effects?
    Thanks in advance, Dave.

  7. Looking for clarification.
    I’m a slender, healthy 54 y/o. Never had any cholesterol issues at all. This month my doc took an ultrasound of my carotid arteries in my neck for a baseline and found that on the left I have a >60% and >52% blockages in two different arteries. Put me on statins right away. Full disclosure this doc treats me for BHRT… so is a second opinion in order, and won’t a heart doctor do the same? I don’t want to be on this medication and I’m looking to educate myself so that I can speak intelligently to my options. Does plaque build up in arteries (with no cholesterol issues) automatically mean I go on statins?

    • I have been on statins for more then 10 years. Two years ago I was diagnosed with colon cancer and during the last chemo round it was noticed that I had heart problems and had 4 blocked arteries with one 72 percent ,so I got a stent.
      After reading about the negative side effects of statins, I want to stop.So what is the alternative?

  8. sorry again Doc. What exactly are the ingredients of COQ10? I have bought it once before but even on the pack it doesn’t really say exactly what it is. I’m worried about allergies and is it true that it’s made of a kind of fungal matter? Before I start taking them…

  9. Okay so here’s the thing. My family carries HeFH. The men all died young. Both my sons have it. Those who took statins (although we can’t take them we take fibrates) lived. In this articles you have to state the exceptions to the rule. Unfortunately there’s NOTHING else for us on the market and we really die without help. Eating right doesn’t do it for us. I am an avid believer in low carbing (actually high KETO), but lately I have been becoming slightly irate with this fraternity. Our kind is a wonderful opportunity for low carbing doctors to prove its worth to the whole world. My numbers came down for the first time since birth and now, I just don’t care any longer because I cannot find a doctor who does the speak. WE scare them. But with all the blooming side effects we have to live with, unfortunately we have to take them. I HAS saved lives in our family.

  10. The link to reference six appears to be broken. Can you please update with a working link, or provide the reference to that study? Thanks!

  11. Can you link me to the article you mention at the end? “In the next and final article of this series, I’ll discuss three steps to preventing and reversing heart disease naturally, without drugs.”

  12. I hear a lot about people talking about using CoQ10 when they are on statins, but I’m not sure it will fix ALL of the health issues. It might help with muscle issues, but the depression, anxiety, suicidal thoughts etc could still be a risk.

    • Wendy, I was not diabetic and did not have heart disease before taking a statin. I now have total heart block and need a pacemaker with defibrillator. I found out too late that statins STOP your liver from producing COQ10. Your heart has the highest concentration of COQ10 of any organ. Without it you will suffer massive heart damage like me. Get your COQ10 levels tested to make sure you are taking enough supplement to keep your heart healthy. I had a complete nutrient panel done in May 2014 and again in August 2015. I used a company called Spectracell.There are probably other local labs that will test specifically for it.

  13. I’m 62, total cholesteral at 175 with 10mg of Lipitor; family history of elevated cholestrol and heart attacks. I’ve been on this for 5years. Weight, diet and BP are good,…HOWEVER, my legs constantlt ache.

    Would Niacin-SR or red yeast rice be a viable alternative?

    • Red rice yeast essentially has the same active component as lovastatin it is just naturally occurring. If you take red rice yeast you are taking a statin.

  14. How do I find a doc that doesn’t jump straight to statins? I’ve had high cholesterol in my mid-30s, and was on a light statin for 10 years. I’ve tried to improve my diet and exercise, trying to reduce LDLs somewhat successfully. My primary care doc still wants me on statins. The little cutie drug rep is in his office every time I go for blood tests….. How do I get a 2nd opinion from a doc who doesn’t just jump on the statin band wagon? (I’m in Ohio….)

    • Ray, What you are looking for may not exist. No medical profession will knock the drugs/companies. Even when presented with valid studies of the dangers they still tow the drug company line. You might consider a Nutritionist. They can give you alternatives. My GP prescribed a statin when my LDL was 163. Apparently 250 is too high to start a stain now it has to be under 100. I stopped taking it when my LDL hit 36 and I had to have my 2nd pacemaker implanted in less than 1 year. More profits for the drug companies.I was not diabetic and did not have heart disease before taking a statin. I now have total heart block and need a pacemaker with defibrillator. I found out too late that statins STOP your liver from producing COQ10. Your heart has the highest concentration of COQ10 of any organ. Without it you will suffer massive heart damage like me. Get your COQ10 levels tested to make sure you are taking enough supplement to keep your heart healthy. I had a complete nutrient panel done in May 2014 and again in August 2015. I used a company called Spectracell. There are probably other local labs that will test specifically for it.

      • I was on a statin for 10+ years, over that time I developed chronic fatigue, chronic aches & pains, migraines, and more. My doctor never told me to take additional CoQ10 to combat the deficiencies statins cause. The type of CoQ10 matters too depending on age.

        Thank you for sharing the part about CoQ10 being made in the liver, I’ll need to look into that more.

        I’m just hoping & praying I stopped the statin before any permanent damage has been done.

  15. My dad is on Statins and he is simply fat and overweight, he has not had heart disease yet, I’m waiting as he has already had cancer, quite a dire situation. Are there references for the info in this article to actually bring and present to a GP?

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