If we could only patent broccoli…. Mark Berger MD
Disregarding the fact that dozens of statin trials have shown minimal or no benefit in reducing cardiovascular disease or postponing death, the latest enlightenment for statin treatment comes from the Merck sponsored IMPROVE-IT trial (Cannon, NEJM, 2015) which showed that adding ezetimide (which blocks intestinal absorption of cholesteroll) to simvastatin lowers LDL better than simvastatin alone, with the 2% absolute reduction in combined endpoints hailed as a significant breakthrough in the treatment of cardiovascular disease. Two percent. But relative risk falls 40% or more, and this is what the physician and patient public hears. So an ABSOLUTE risk reduction of 3.6% to 2% is translated into a RELATIVE risk reduction of >40%. That is deception by any other name. Yet another deceptive statin trial targeting elevated cholesterol as the primary cause of heart disease, when other underlying metabolic — or even infectious — mechanisms are at work and disregarded…
Despite conventional dogma, total cholesterol and LDL-C are poor markers for cardiovascular risk as nearly 75% of individuals who suffer a heart attack have normal levels and 50% have optimal levels (Fonarow, American heart Journal, 2009). And if lowering cholesterol were the panacea to treating heart disease, then the people who had their cholesterol lowered the most, would benefit the most. But this has rarely been demonstrated. In fact, many trials have shown that those individuals with the lowest cholesterol levels are the least healthy and most prone to infections and cancer, while those with the highest cholesterol levels live the longest and are the healthiest, particularly women (30 year follow-up Framingham study, JAMA, 1987). Statins have never been shown to lower overall mortality in women, weather they have heart disease or not. Their risk of having a heart attack may go down a little, but the risk of dying from other maladies goes up. And the small subset of the population that truly benefit from statin treatment, middle aged men with a history of heat disease, do so for reasons other than cholesterol lowering, such as decreasing inflammation, lowering triglycerides, and decreasing the risk of an arrhythmia. These benefits would all be great if statins were innocuous. But that isn’t the case. The known side effects of muscle aches, liver disease, diabetes, and cognitive impairment are minimized and downplayed, frequently being attributed to old age.
Demonizing saturated fat has also been popular due to its association with raising cholesterol. This, however, also has come under fire, as 2 large meta-analysis (Siri-Tarino, 2010, AJCN and Chowdhury, 2014, J Annals Int Med) showed no correlation between saturated fat intake and heart disease. And the biggest nutrition trial ever performed, the Women’s Health Initiative (JAMA, 2006) testing the notion that fat causes heart disease showed no association, which should have put the issue to rest. So dozens of trials show no beneficial effect in lowering cholesterol, yet when the latest drug-sponsored report shows minimal benefit, everyone’s back on the cholesterol lowering bandwagon.
Perhaps the ultimate detrimental effect in focusing on cholesterol as the treatment target is that it has distracted us from what is much more likely the cause of heart disease and most chronic diseases; inflammation secondary to nutrient poor food, tainted water, polluted air, toxin exposure, inactivity, and high stress levels. Lowering inflammation is critical, as cholesterol increases and LDL becomes oxidized in times of stress, toxin exposure, and injury. Cholesterol is required for repair of all damaged tissues, including the endothelial cells lining the vessels. So treat the underlying causes of inflammation and lower cholesterol levels will follow. The current “standard” treatment recommendations, however, are a classic example of hitting symptoms with the medication hammer, and forgetting to address causation.
Eating an anti-inflammatory diet and following a healthy lifestyle have been shown to have a far greater impact on cardiovascular health and chronic disease than any medication. The Lyon Diet Heart Study (DeLorgeril, Circulation, 1999), showed that following a Mediterranean style diet rich in fruits and vegetables, whole grains, and healthy fats resulted in a reduction on cardiovascular risk of nearly 70%. In 2009, the Potsdam study (Arch Intern Med, 2009) showed that by following 4 healthy behaviors (not smoking, eating healthy, staying physically active, and maintaining healthy weight) the likelihood of developing ANY chronic disease, including heart disease, decreased by 80%. And in a recent study published in none other than the Journal of the American College of Cardiology, 2014, showed that by eating a healthy diet, being physically active, maintaining a normal weight, moderating alcohol consumption, and not smoking could decrease your risk of heart disease by 80%. No statin can even come close. Health is not a statin deficiency.
But as there are patents for drugs and not broccoli, the myth continues….