Statins Don't Save Lives in People without Heart Disease | Chris Kresser
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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. Great article! This is just what I needed to send to some friends on family on the topic. Sadly, many I know would rather take a pill the doctor says is great than change their eating patterns.

  2. I’ve been following this series of articles particularly closely since last July at age 54 my husband had a NSTEMI and subsequent PTCA w/ stent placement (total of 4). He was discharged from the hospital on 80 mg. atorvastatin in addition to a beta blocker, clopidogrel, and aspirin therapy. He then went on a serious lifestyle transformation; now eats “real” foods (mostly paleo), exercises, lost 35 pounds, and is supplementing his diet appropriately. Prior to his heart attack his TC was 247, LDL 115 (calcluated), HDL 40, TG 347, so while certainly not great definitely not horrendous either. He also has mild/moderate hypertension and a family history of heart disease. With the aforementioned lifestyle changes and statin therapy, in a matter of 2.5 months his TC was reduced to 96, LDL 44 (calculated), HDL 36, and TG 80. We were really worried about that extremely low number. I felt it was dangerous and worried about the other health consequences, although his cardiologist was thrilled with that LDL number! He’s had to argue to get his statin dosage reduced several times and is now down to 20 mg. a day with a goal of eventually being able to go off it completely. His most recent lipid panel showed TC 115 (still too low), LDL 55, HDL 53, TG way down to 30! I understand that the literature indicates that he would benefit from being on a statin for the rest of his life (he’s been told he’ll have to take aspirin for the rest of his life). However, from what I’ve read, the benefit of statins for post MI – beyond the cholesterol numbers, which clearly aren’t a problem in his case – is from the anti-inflammatory affect that statins have and how that slows the progression or atherosclerosis. This seems to be why they are being considered as possible therapies for other diseases including prostate cancer, among others. He currently eats an anti-inflammatory, low carb, diet, with variety of fresh vegetables, fruits, healthy oils and nuts, natural meats and no sugar or processed foods. He takes several supplements such as Ubiquinol, magnesium, fish oil, resveratrol, aged garlic, and B complex to name a few. We both hope that he can get off the atorvastatin completely. He’s currently off the beta blocker (too many serious side effects), but is now on an ARB for the hypertension and has a few more months to go with the clopidogrel (1 year after stenting). The sad thing is that his primary care doctor never really counselled him on lifestyle changes and instead just wanted to put him on meds (lovastatin). Prior to his heart attack he started taking RYR and his lipid panel improved a little but he didn’t make any lifestyle changes or effectively manage his stress. I think he would consider trying RYR again in lieu of statins, especially if there are possible other health benefits from using such a supplement. Do you know of any good studies that show that RYR has the same beneficial anti-inflammatory effects? Is there is a company/brand that you recommend for high quality, standardized formulation? Would be interested on your thoughts since he would likely benefit.

    • I believe those cholesterol numbers are WAY too low and dangerous. There are actually many studies that show people with high cholesterol liver longer than those with low cholesterol. Not that high cholesterol is healthy, but many studies show it is healthier than low cholesterol. I can give you some references if you want.

      The idea that aspirin is somehow healthy and a good way to prevent a heart attack is insanity. It would be much better to thin the blood with healthy omega 3 oils (preferrably from wild caught fish or krill oil or fermented fish oil). Aspirin is a potent cox-1 inhibitor which damages epithelial cell structure. This leads to gut lining damage and to intestinal bleeding, which can be deadly. As a cox-1 inhibitor, aspirin also damages blood vessels by disrupting the epithelial cells that line the vessel walls and can lead to blindness for example because the vessels in the eyes become leaky leading to advanced wet age-related macular degeneration – leading to blindness. Taking aspirin daily to prevent a heart attack is utterly ridiculous and serves only to line the pockets of pharmaceutical companies and deteriorate your health. Most doctors are just so ignorant it is the only thing they can offer. This article (http://articles.mercola.com/sites/articles/archive/2012/06/17/is-low-dose-aspirin-causing-an-epidemic-of-intestinal-injury-and-bleeding.aspx) further explains why aspirin should not be used for heart attack prevention.

      Offering my non professional lay person’s opinion, nutrition and lifestyle changes are the answer. Find a good naturopathic doctor and stay away from conventional doctors unless it is an emergency. Here is list of the most important things for cardio health: ubiquinol, magnesium, silica, iodine, chromium, selenium, sodium/potassium balance, B vitamins, gut flora balance (i.e. fermented foods and probiotics), omega 3’s and balancing intake of omega 6 to omega 3 oils, optimal vitamin D levels (at least 50 ng/ml), optimal exercise (not too much, not too little), thyroid health (highly important), enzymes (e.g. nattokinase is excellent), antioxidants, botanical vitamin C (e.g. amla berry or camu camu berry), tocotrienols, support methylation, and dental hygiene. D-Ribose and Acetyl L Carnitine are also beneficial. Avoiding sugar and heated, damaged, rancid fats is also very important.

      Dr. David Brownstein has an excellent book on thyroid health and its importance for cardiovascular health – which does not seem to be widely known. Your husband may have subclinical thyroid problems that are at the “heart” of the problems.

      Herbs that are helpful: salvia root, aged garlic, rhodiola, and astragalus
      Fats that are helpful: virgin coconut oil, virgin olive oil.
      Foods that helpful: raw cacao, noni, and pomegranate and high arginine foods (make sure to balance with lysine)

      And the list can go on and on – in other words there is so much that nutrition has to offer and when used skillfully it will be much more effective and safer and healthier than drugs will ever be. It is so sad the only recourse 90+% of doctors have is a drug. When the body is sick it is not deficient in a drug as doctors seem to act like. Most drugs dont heal root causes, they suppress the warning system of the body by suppressing symptoms which is highly deceptive and misleading and destroying the lives of so many people.

      Good luck and best wishes!!

    • Karen, I’m in a similar boat as your husband. I am 56 and recently suffered a near fatal MI. I have made many of the same changes (diet, supplements, etc) and feel pretty confident I can reverse the CHF, unclog my arteries (All three coronary arteries were completely blocked and they put three stents in one which saved my life) and get my ejection fracture back to normal range (at 30% right now). My focus right now is on detox (oral chelation), mind-body/biofeedback (HeartMath EmWave) and will be starting a cardiac rehab doing high intensity interval training which is far superior to what they prescribe in typical cardiac rehab exercise protocols. I’ve also discovered some promising new technologies that improve cardiovascular health as well such as the Zona Plus tool. So there is a lot of hope! It requires a lot of research, commitment, expert guidance if you can find it, and money! Eating all organic foods, high-quality oils, grass-fed meats and wild fish, etc certainly increases your food budget, along with all of the supplements and detox tools but the cost is nothing compared to what prescription drugs and medical care costs. My hospital bill was close to $200K. Best of luck to you both.

  3. Chris:

    It’s been about 20 years since our paths last crossed…

    Regarding the side effects of statins, in the studies you’ve read, is tiredness during the daytime one of them? What causes tiredness when taking a statin?

    Keep up the great work.

    Dean

  4. Chris, I remember watching a Video by Dr. Dall and I believe she used statins in some cases, but it was to primarily drive down LDL-P. Are there classes of statins that can modulate LDL-P? This would seem to be a good use if there are not too many side effects or other treatment options. Thanks, Dave

  5. What if you never have had heart issues, yet have Diabetes and Rheumatoid Arthritis? Age 62 – LDL of 119 , HDL 60, TG – 79, TC 197. my GP and endo doc want me on a light dosage statin. Doing Paleo – hba1c coming down all the time – down to 5.8 at the moment. On Enbrel and small dose methotrexate – no diabetes drugs. CRP of .03, C-Peptide of 1.4.

    • I don’t understand the logic behind a statin in this case. Your TC is below the cutoff, your TGs are good (though they could be better) and your LDL is only very slightly elevated. Your CRP is excellent and your A1c is improving. I’m not sure why a statin would be indicated here, but this is of course a decision you need to make with your doctor.

      • What’s interesting is that my TG used to be around 49, and my TC around 160 and my HDL around 35. Could eating paleo (and eating lots of fats like coconut,avocado,macadamia nuts) be raising some of those numbers?

        Thanks for your input Chris!

      • Chris,
        The diabetes guidelines recommend an LDL of <100 and 40 which has shown to have benefits in reducing risk of CVD (statins have data on increasing HDL). The trials supporting these numbers are referenced in the guidelines. I believe this is where the recommendation stemmed from. I would not argue with recommendation if the patient has failed LSM in the past.

  6. Clarification: Second sentence in the last paragraph of the secondary prevention of Statins reads, “Statins do reduce the risk of heart attack and other CVD events in men over the age of 80,…”

    Shouldn’t it read, “Statins do not reduce….”?

  7. Hi Chris,

    I noticed that you have Choleast in your web store, and I wonder what your thoughts are on the appropriate use of red yeast rice (RYR). I know all about the RYR controversies regarding safety and efficacy (monacolin content, citrinin, etc.), so that’s not really where my question is coming from. But assuming that you have a good product (Choleast and others have been shown to have significant amounts of monacolins and insignificant citrinin levels), at what point would you use the RYR as an intervention?

    There have been quite a few RYR studies showing benefit, and some (e.g. http://www.ncbi.nlm.nih.gov/pubmed/18549841) even claim to significantly reduce all-cause mortality. Several of the RYR researchers surmise that the other components in RYR (other monacolins and phytochemicals besides the monacolin K) are working together synergistically to reduce risk in a way that isolated monacolin K cannot do, even though the actual LDL number is not reduced as much compared to a statin drug.

    What do you think?

    • I reviewed pretty much every study on RYR I could find prior to writing the High Cholesterol Action Plan. My conclusion was similar to yours: that it can be effective when the right brand is used (that contains negligible citrinin levels and consistent levels of monacolins), and that the side effects are typically less than full-dose statins (which makes sense, because RYR is essentially equivalent to taking a low-dose statin).

      RYR may make sense for people that are otherwise candidates for statin therapy, but would like to try a lower-dose, more “holistic” alternative. Some studies have shown that RYR in conjunction with other therapies (e.g. tocotrienols, pantethine, etc.) have a similar effect to full-dose statins.

  8. What is your response to the notion that cholesterol is produced to repair endothelial damage caused by inflammation caused by poor diet? Some are of the opinion that without inflammation LDL particles would flow freely through blood vessels without causing damage and that when they do become lodged in the endothelium it is the body’s attempt to heal. I understand you saying this is more of a random gradient driven process rather than LDL particles specifically “patching” inflamed areas. Am I understanding you correctly? Are these two views at odds or do they work together?

    • At least a couple of studies have shown that LDL-P is still a risk factor even when oxidized LDL levels are normal. This would suggest that a high LDL-P number even without oxidation/inflammation may be problematic.

      That said, there’s little doubt (in my mind, at least) that inflammation plus high LDL-P is worse than high LDL-P alone. And ox-LDL is only one marker of oxidation/inflammation. It’s possible that those with normal ox-LDL in the studies above were inflamed, but it wasn’t showing up in the ox-LDL marker.

    • Linus Pauling had the idea that Vitamin C deficiency caused unhealthy arteries and cholesterol was the body’s temporary fix, thus giving your body the vitamins it needs will be the permanent ‘fix’.

  9. Chris, thanks for following these issues and enlightening enlightening us. Coukd you please answera stupid question? How do these studies know that a statin prevented a heart attack or stroke?

    • A randomized trial separates participants into two groups. One group receives statins, the other receives a placebo. They follow the groups for a while and record cardiovascular events in each group. If the statin group has fewer events (like heart attack), and other factors that could have influenced the outcome were adequately controlled for, then the assumption is that the statin reduced the incidence of the event.

  10. I was wondering if hyper-responders to saturated fat and folks with heterozygous Familial Hypercholesterolemia might be exceptions to statin’s general like of efficacy? I have 2835 LDL particles on a Paleo diet and am now resuming a low fat regimen to see if that helps. Thank you for your commitment to both outstanding research and communication! I believe you are a life saver.

    • I usually put my patients with FH on what I call a “Mediterranean Paleo” diet. i.e. Paleo with a higher intake of carbs and lower intake of saturated fat. It is generally effective in reducing LDL-P.

      • Hi Doc, I have it full on! Without meds my family has numbers of 12 and 13. I embarked on ketogenic diet in 2012 and astounded my doctors. It came down to 6 (total cholesterol). Lowest since birth. None in my family can tolerate statins (we WILL die of kidney failure and quickly too). I can’t get my sons to go onto keto dieting but for me I feel it’s the saturated fat, eggs, coconut oil etc, which brought it down. I feel our ilk have been done in when it comes to research. We’re given a pack of statins and a shrug by the cardiologist. No-one has looked deeply into our plight. I wish I knew how to start a fund and get some scientists on board to really study it. My son, at 34, over this Christmas got QUINTUPLE bypass surgery. My heart is solidly broken by this, yet the females live to over 80. He too cannot use statins for even 2 days. NONE of the statins. I feel a little angry too and helpless.

      • I would appreciate some guidelines for that. Took your whole High Cholesterol Action Plan, expecting to get them. 90% sure I have FH. One more test to get back. I know increasing safe starches and reducing saturated fat and cholesterol are key (my cholesterol was kept in check as a vegetarian but shot through the roof on paleo). I need numbers. 1 egg/day or 3eggs per week? How often is red meat OK? 2x per week or month? Eliminate raw dairy completely? Really baffled about the specifics. BTW my LDL-c is 2541! I appreciate all the info I did get and the other specifics but thought that section could be be detailed.

  11. What about persons under 80 who had a heart attack (say > 10 years ago) but:
    have a good blood lipid profile
    are in good shape physically (stress EKG results excellent)
    have no significant atherosclerosis (sonogram)

    Is the prior heart attack the only decision criterium?

    • No. There is rarely (if ever) a single criterium that guides a treatment decision, especially with a condition as complex and multifactorial as CVD. I think it would depend on what this person’s diet and lifestyle was leading up to the heart attack, as well as their willingness to make other lifestyle changes (like stress management) that may have a more significant impact on risk reduction than taking a statin.

  12. Instead of relative or absolute risk these studies should have to use some kind of expected life extension amount. What I mean is that no medical treatment can prevent death, only delay it. I think this would give a more easy to understand benefit. Malcolm Kendrick has used something like it in his books. If 100 people have a heart attack in 5 years on placebo they should see how long it takes for 100 people to have a heart attack in the statin group. From this you could calculate the expected life extension in the experimental group. I don’t remember the exact numbers but I think in Kendricks book his calculations were that in some cases a 30% reduction in relative risk only worked out to an average of 60 days or so expected life extension in the statin group. Then the question becomes would you risk all the side effects to extend your life for 60 days?

    • Yes, that’s another way of looking at it—especially because statins don’t prevent death. At best, they only delay it. So from this perspective, the real meaning of 1 in 200 lives will be saved is that if one man at high risk of heart disease took a statin for one year, he would expect to gain an additional two days of life. So if we put this another way, if a 50-year-old male at very high risk of heart disease took statins for 30 years, he could expect to live an additional two months on average.

      Rather sobering, isn’t it?

  13. In my opinion, there are no groups of people who should be taking statins – and I am surprised you are advising certain groups to take statins because they may be “likely to benefit”. Where do favorable studies on statins come from? I believe they are essentially all funded by those who financially gain from positive outcomes, e.g. big pharma. This conflict of interest immediately calls into question the real validity of these studies. I believe it is not clear at all that “statins reduce heart disease as well as the risk of death in those that have already had a heart attack” as you say or as these “studies” say. Here is why…

    Statins work by suppressing an enzyme in the liver that interferes with cholesterol production. However, this enzyme, HMG Coenzyme-A reductase, is not only needed for cholesterol production, it is also needed for several other fundamental biological processes, including production of one of the most essential nutrients that the body needs, which is Coenzyme Q10, an incredibly important nutrient especially for cell energy and heart health. HMG Coenzyme-A reductase is also needed for producing selenoproteins that are the backbone antioxidant system of defense for every cell in the human body, required for healthy immune function, and primary activators of thyroid hormone. The cholesterol pathway that HMG Coenzyme-A reductase is needed for is also linked to the production of vitamin D, adrenal hormones, and sex hormones. It also makes many gene-signaling molecules in the isoprenoid family that are required for healthy cell function and the prevention of cellular mutation (cancer). All of these processes are indiscriminately interfered with by statins, which is potentially devastating to human health. The risks can increase along with the dosage.

    So, statins deplete CoQ10 and thus cause cardiovascular problems (the very condition they are supposed to be helping). They cause fat to be dumped all over the body in places it should not be. Statin use is also associated with copper, zinc, vitamin E and severe selenium depletion. Statins have been linked to intense and debilitating muscle pain, kidney failure, liver dysfunction, and cataracts. Some people have reported severe memory loss (as cholesterol is very important for brain function). Britain’s Medicines and Healthcare products Regulatory Agency even warned recently that some statin users suffer from sexual problems, sleep loss, and depression. There is also clear evidence that statins cause high blood sugar, which is sometimes mistaken for type 2 diabetes. Statins are also associated with an increased risk of developing type 2 diabetes. In fact, a recent study (http://www.wellnessresources.com/studies/statins_increase_risk_of_type_2_diabetes) shows that post-menopausal women who consistently take their statins, as their doctors so happily instruct them to do, have a massive 71% increased risk of developing type 2 diabetes. Sadly, type 2 diabetes is almost always a sign of insulin and/or leptin resistance, which can also cause high cholesterol – implying statins can make the underlying cause of high cholesterol even worse. This implies statin drugs which are meant to lower heart disease risk, can actually massively increase heart disease risk. In fact, statins have been found (http://www.greenmedinfo.com/blog/statin-drugs-found-accelerate-arterial-calcification) to accelerate arterial calcification further harming cardiovascular health. Forcefully lowering cholesterol can also cause major hormonal imbalances (cholesterol is a precursor to ALL sex hormones) which then causes a long list of health problems.

    Furthermore, one main reason cells make cholesterol is to repair themselves. This is especially important for nerve cells, which do not split and divide like other cells in the body and therefore must repair themselves in order to survive. The receptors on nerve cells enable them to receive neurotransmitters, thereby enabling a person to have cognitive function and memory. These nerve cell receptors require cholesterol as part of their proper three-dimensional structure. Statins interfere with this process as an undesirable side effect, inducing slow and progressive memory loss the longer they are used – a form of slow poisoning of your brain. If asked about memory loss after being on statins for a few years doctors will just blow it off as aging. Most doctors do not understand what they are doing to people.

    Nutrition and lifestyle changes are ALWAYS better than statins. Statins do NOT EVER address root causes, they mislead a person into thinking they are ok because of a better number, but in reality the underlying cause is never addressed and sometimes made worse — very very deceptive as are most drugs.

    I really wish chris that you would have taken a much harsher stance against statins than what is written in this article, but at least you are somewhat negative about them and I know you cant please everyone :). I just hope people aren’t misled into taking statins. I believe within a few more years statins will be off of the market and no longer sold once it is realized the catastrophic damage they are doing to people – just my opinion.

    • I would have to agree with this. For me, when I hear the word statin, it’s like I see in front of me a killer of coQ10. I consider Ubiquinol to be in the top-3 supplements today, and possibly the no1 key to the road to optimal (even if still eating a fish-rich paleo diet and supplementing with D3 and magnesium).

      • Thanks for helping me makeup my mind. I am quitting stations after 7 years of daily dose in which I acquired diabetes, cataract and a heart attack. It never brought my cholesterol levels down. 40 days ago had an angioplasty then researched and found out about vegan diet, saw forks over knives and now in 35 days total cholesterol is 150 and LDL is 69.

    • I would suggest you do a better job at researching this issue. There are some very good reasons why certain individuals with existing conditions like congestive heart failure and advanced coronary disease should be taking a low does statin, and the reason is NOT to lower cholesterol. Stephen Sinatra, MD, James C. Robets, MD along with other pioneering integrative cardiologists have proven protocols and very wise recommendations on when low dose statin therapy is important. I thought I would never take a statin and after suffering a near fatal MI followed by congestive heart failure I am following their protocol which also includes coQ10, Carnitine, Arginine, Taurine, Omega three, D3, magnesium, and many other vitamins, minerals and herbs. I also have radically changed my diet and lifestyle, and now after 3 weeks from being discharged, after a week in the hospital, I feel like a totally different human being. I could barely walk for 2 minutes the first day I was home and now I can comfortably walk for 60 minutes and that’s with an ejection fracture of 30%. So, I am very optimistic about the future and what is possible in terms of reversing this condition and for now I plan to maintain my low dose statin, along with the other conventional heart medications but to continue optimizing my diet and lifestyle. Once I see the regression of the plaque taking place and feel like I have successfully addressed the underlying pathology I will eventually stop taking those drugs. But for now I believe it is the best thing to do. So please do your homework before making such sweeping statements. I have no love for drug companies. Having worked with them for over 20 years in the field of clinical research I have very intimate knowledge of how research data is manipulated and turned into propaganda for profit hungry corporations. I urge you to check out the authors I mentioned to gain a more informed perspective on this issue.

      • Tom, Dr. Sinatra believes some people should take statins because they are “anti inflammatory and reduce blood clotting potential” and not for lowering cholesterol (you’re right). I do respect Dr. Sinatra and believe he is more responsible than most doctors especially giving his patients CoQ10. I have actually followed his work for the past couple of years. However, I also believe he does not know everything and that he has to deal with a lot of patients who aren’t willing to make the sweeping changes that you have made. I certainly believe SHORT TERM LOW DOSE statin use is appropriate in some acute cases, but that is rare. I believe hi dose long term use is never appropriate and causes too much damage and that there are always better ways to deal with cardiovascular problems with skilled application of nutrition and lifestyle changes.

        I am very glad to hear how you are recovering, but I doubt statins have very much to do with it at all – again that is just my opinion. Statins dont address root causes, though they are certainly better than nothing in some cases. I think if Dr. Sinatra had a patient like you who was willing to totally change diet and lifestyle, he would rarely prescribe statins even in advanced cases. Problem is most people arent willing to do that so he probably feels the need to prescribe low dose statins as well.

        My main point in posting here is that statins cause a lot of problems especially in higher doses and long term use that Chris did not bring up and there are almost always much more effective, safer, healthier ways to prevent and heal cardiovascular disease – but most people are not willing to make the changes. In all of the reading and research I have done (extensive) I believe this to be true. I believe there are much better ways to reduce inflammation than taking statins – but again many are not willing to make those changes.

        I also wanted to suggest to you to make sure your thyroid is healthy – might want to read Dr. David Brownstein’s book on the thyroid and its connection with cardiovascular disease. Most doctors dont know how to test for subclinical thyroid problems – so reading this book is highly suggested. Also, dont forget your fermented foods and probiotics and gut flora balance – so very important for every aspect of health. I assume you are also reducing omega 6 intake and avoiding hydrogenated, heated, rancid fats and sugar – huge for reducing inflammation.

        I am also very hopeful for you that you can completely reverse this condition, but it is my opinion that it will have nothing to do the use of statins. It will be your diet and lifestyle and supplement changes that will do it.

        Best wishes!!

      • Tom, I wanted to give you this interview with Dr. Stephanie Seneff: http://www.youtube.com/watch?v=_hbNSHPco0g. In this interview she explains very in depth precisely why NO ONE should be taking statins not even those with hypercholesterolemia. She explain why statins are actually very bad for the heart and cause widespread catastrophic damage. I think Dr. Sinatra and any doctor who is prescribing statins is completely wrong and he is harming his patients. Statins are poison – no one should be taking them.

        Chris you would also do well to listen to this interview – Dr. Seneff spends her life in the published literature and knows it very well. I really dont think you understand the damage that statins are causing people and this interview will explain it to you.

        It is still my very strong belief that within a few years statins will be banned because of their widespread catastrophic damage which is slowly coming out and will eventually be made known to the public. The pharmaceutical companies are fighting hard to keep this information suppressed because statins make them billions of dollars. We must all realize big pharma companies absolutely have no interested in human health, they are only interested in stock prices and profits and in fact the sicker that people become the richer they become – which is a very perverse inverse relationship.

        • DM, I have followed Dr. Seneff’s work with great interest and consider her to be a brilliant scientist. Thank you for the reference.

    • DM, thank you for your reply! I have stopped taking Crestor, Ramipril, Metoprolal, baby aspirin, and Effient. I am listening to your counsel, as well as a local ND i met with last week. I have read, “The Great Cholesterol Myth” which has helped me a lot as well.

      Fox News just came out with an article on sugar and heart disease TODAY!

      http://www.foxnews.com/health/2014/02/04/excess-sugar-consumption-from-soda-desserts-leads-to-higher-rates-of-cardiovascular-death/

      And yet, they also came out with an article on new cholesterol guidelines!

      http://www.foxnews.com/health/2014/02/03/new-cholesterol-guidelines-how-to-make-sense-them/?intcmp=trending

      So confusing. But I’m not anymore! Please stay in touch if possible. I greatly appreciate your incite on this life and death subject.

      Dave

      • I am pissed at my cardiologist. I had myocarditis( inflammation of that heart) he out me on Lipitor for preventative but never mentioned it would make me diabetic. My blood sugars were near the max before but once I took the statin, I’m positive it raised once I stopped then. Also my cholesterol is high but that they never once explained in detail small sense particle LDL. They never suggested Coq10 either. It pisses me off that they simply pull out a pad and write a prescription.

        • Tim…I had a similar thing happen to me. Unfortunately I did not know about COQ10 until after the damage was done. I went from very healthy to now needing a transplant is the space of 2 years. When I had my 2nd pacemaker implanted my LDL was 36. y family doctor said cut the pills in half. No need to cut them I threw them in the trash where they belong. Had I been warned about the COQ10 problem I could have taken supplements or I might have refused to take the statin. My LDL was never higher than 163. The whole statin industry is a scam for profit. Not to help heal patients.

    • wow, this is great info. i am 51, peri menopausal, and have cardio vascular health that nearly freaked my cardiologist out in a good way (took him a while to get my heart rate high on the treadmill in a stress test) — i run, bike, and eat very clean.

      about a month ago, chest pains started, as did other symptoms that suggested i was presenting MI precursors. of course, my research led me to discover that these symptoms could be GERD or good old fashioned menopause.

      part of my cardiologist’s screening was an ultra sound of my carotid arteries. it showed less than 20% blockage of plaque, but not spots, some significant buildup. he suggested a low dose of Liptor. i have not filled the prescription yet. i was sold when i left his office, but i have to admit this is a tough drug (i am on no other meds – maybe an advil every month) and i am frightened that the risks will outweigh the benefits.

      my HDL is extremely high, the LDL is “high” but my ratio is amazing. blood pressure consistently normal, pulse 56 BPM. again, stellar cardio health for an “old lady” —

      thanks in advance for any advice —

      any advice?

        • Mark, I think it’s peri menopause. There are certain foods that trigger its symptoms. One is wine (NO DONT TAKE MY WINE) others are certain spices, coffee, etc. Cardiologist says even the current 20% blockage would not make me have chest pains.

          I am still conflicted about taking the Lipitor. ugh.

          • Andrea, I know this blog is opposed to statin use but I’ve been on Lipitor for 15 years and got my cholesterol numbers in good shape, whereas they were not good before taking it. You have to supplement with Co-enzyme Q-10, or you may have problems with muscle cramping and pain as a side effect. A couple women I know had that problem with it and I doubt they were taking the CoQ10.

            I don’t know what it may be doing to my body in a negative manner. Only time will tell. My doctor wants me to stay on it though. I have developed cataracts which I understand are a possible side effect. However, I also have a family history of cataracts. So I cannot say for certain the Lipitor was the cause.

            • Hi Mark — i am so glad your numbers are better and that you are handling the Lipitor, as far as you know, very well. this is very good news.

              the thing is? my numbers are great. it’s the plaque that my doc wants to “try to” stop or “try to” lessen. less than 20% may be worth holding off on Lipitor for 12-18 months and then getting another ultra sound to see if there is an increase that is substantial enough to worry about.

              • Hi Andrea,
                Was the 20% blockage in your carotid arteries in your neck or the coronary arteries in your heart. I’m not a doctor but if the coronary arteries are blocked significantly that can cause a heart attack. If the carotid arteries are blocked, that could lead to a stroke. Not sure if holding off for just 12-18 months would show any change. Ask your doctor about it for sure, but it could take years for an increase in plaque to show up on an ultrasound.

                I had a CT scan of my coronary arteries around my heart (also know as a Calcium Score) done to check for blockages in those arteries. When the results came back, they gave a risk factor number of having a coronary event with the next 3 years. So I’m just guessing from that, maintaining your current lifestyle, no significant increase in plaque build up would show up for at least 3 years.

                Check with your doctor on this for sure.

                • Mark — the carotid ultra sounds were my neck area left and right. it was “less than 20%” he said. and he said while there was still a sufficient and healthy blood flow, he suggested, but left it up to me on the statins.

                  now, when you say an increase would not show up — do you mean that plaque could be greater than what it is now but not show up? or do you mean that there is little likelihood that more will accumulate over 18 months?

                  thanks, andrea

  14. My doctor started me me on Gemfibrozil and Zocor when I was about 40, by 50 I was about disabled with multiple issues including memory issues, chronic muscle and joint pain. The first thing I did when I started my recovery was to stop taking my prescriptions ( all 7 of them) Went through a medically supervised VLCD, a hip surgery was down about 90 pounds and felt awful. Started listing to Dr Kresser’s Podcast a year ago, started low-carb Paleo about 9 months ago feel better than I have in years. My new doctor is still concerned that my LDL is high, but I’ve told her I will not go back on the meds.

  15. Hi Chris,
    I am guessing you are just trying to be objective by stating that statins do reduce risk of CVD and CVD related events in groups that already have CVD when the average relative risk reduction is only an almost farcical 3%. I can’t even imagine that is statistically significant it is so minuscule. To think of it another way. What business would survive if it provided a service that showed no benefit at all for 96% of customers? This is before even taking into account the downside from these drugs which is surely understated because of lack of reporting of adverse reactions (as you note) as well as a relatively short history of using these drugs (a decade or two). Thoughts?

    • Statistical significance is very often misunderstood, even by those whose educational credentials are quite considerable. Significance only means that the probability of observing a particular result due only to random variation is less than 5% if the null hypothesis is true. “Significant” to most reasonable people means “big” or “noticeable.” So even a miniscule difference can be statisitically significant if a sample size is really big and the variance is very small (or some combination of the two). That said, the point you made is very well-taken. Even if statins very reliably reduce someone’s risk of cardiac event by a miniscule amount, that benefit cannot be evaluated without reference to the risks, which to me seem more “significant” than the benefits.

  16. Chris

    What is your opinion on this

    http://www.nytimes.com/2013/05/13/health/seeking-clues-to-a-heart-killer-in-the-dna-binding-a-family.html?hp&_r=0&pagewanted=all

    “I had bought the dream: if you just do the right things and eat the right things, you will be O.K.,” said Mr. Del Sontro, whose cholesterol and blood pressure are reassuringly low.

    But after his sister, just 47 years old, found out she had advanced heart disease, Mr. Del Sontro, then 43, and the president of Zippy Shell, a self-storage company, went to a cardiologist.

    An X-ray of his arteries revealed the truth. Like his grandfather, his mother, his four brothers and two sisters, he had heart disease. (One brother, Michael, has not received a diagnosis of the disease.)

    Now he and his extended family have joined an extraordinary federal research project that is using genetic sequencing to find factors that increase the risk of heart disease beyond the usual suspects — high cholesterol, high blood pressure, smoking and diabetes.

    The aim is to see if genetics can explain why heart disease strikes apparently healthy people. The hope is that a family like Mr. Del Sontro’s could be a Rosetta stone for heart disease — that their arteries’ profound but mysterious propensity to clog could reveal forces that do the same in millions of others.

    “We don’t know yet how many pathways there are to heart disease,” said Dr. Leslie Biesecker, who directs the study Mr. Del Sontro joined. “That’s the power of genetics. To try and dissect that.”

    Researchers have long known that a family history of early death from heart disease doubles a person’s risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age 55 or a mother or sister before age 65.

    Scientists are studying the genetic makeup of each member of the Del Sontro family, searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA.

    Until very recently, such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and time-consuming that it was impractical to take on for an entire family.

    Analyzing the deluge of data would have been overwhelming. But costs have plunged, and data analysis has advanced.

    “With the right family, you may need only one family,” said Dr. Robert C. Green of Harvard Medical School who studies genetics and medicine and is not involved in the study.

    Beyond Risk Factors

    Control of cardiovascular disease is one of medicine’s great success stories. Over the past 45 years, heart disease death rates have steadily dropped 60 percent from their peak in the 1960s.

    But doctors still rely mostly on risk factors discovered decades ago — cholesterol levels, blood pressure, diabetes, smoking, obesity and a sedentary lifestyle.

    “Risk factors are part of the canon now in medicine,” said Dr. Gary H. Gibbons, the director of the National Heart, Lung and Blood Institute. “We use them every day. Still, people arrive at the hospital every day with heart attacks.”

    Does this mean that if you come from a family with long life spans and no heart disease that there should be nothing to worry about?

    • ‘Does this mean that if you come from a family with long life spans and no heart disease that there should be nothing to worry about?’

      My brother (and I) did but he embarked on a lifestyle that included: working 100 hour weeks running a business that was hemorrhaging money, snatching takeaways (refried PUFA’s) and smoking – with the result that at the age of 50 he got 3 blocked coronary arteries that he’s now had stented. So now he’s on statins, niacin and other stuff. There was no history in either side of our families of heart issues apart from our maternal grandfather contracting rheumatic heart disease after scarlet fever as a teenager. His children lived into their late 80’s and early 90’s aside from our mother who smoked for 64 years and passed away at the age of 82 from emphysema.

    • High carbs… is my opinion. I have a worse dna. My sons have it too. My mother is 83 AND she smoked. Only found out when she was in her 60’s. Can’t do statins. I got her to cut just a little carbs (I feel she’s too old to go into ketosis, but what do I know) and even cutting about half her normal carb intake, her cholesterol came down to 5.1. No doctor system wants to look at this. I think I’m the only person with FH who opted for this diet (in the world). Couldn’t find another anywhere and it worked for me. I wish a bevy of scientists (lipid people) would come to South Africa to see how many r here and do some research on us. Our sons are in great peril. But they must come without the pre-notion that lowfat and statins is the answer. it is SO not! Dr. Kresser, I am so sorry for my brashness, but I am hysterical about my sons in whom this “thing” is quite deadly.

  17. Heads up: your section headings are mixed up. The first says “Secondary prevention (those with pre-existing heart disease)” and the second says “Primary prevention (those without pre-existing heart disease)”.

      • I think it’s the paragraph before the headings where there’s a typo:

        “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, and those without pre-existing heart disease. In the medical literature, these groups are referred to as “primary prevention” and “secondary prevention”, respectively.”

        Looks like “primary prevention” and “secondary prevention” just need to be switched.

        Great article, by the way!

          • Please understand that primary prevention means “when you do not have the disease yet” whereas secondary means after ‘you have developed the disease”.

  18. Brilliant. Chris, I am so glad you can manage to do all this work and make it “consumable”.
    It wouldn’t surprise me if they find a way to start marketing this stuff to kids the way they have with Ranitidine.

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