Why a statin a day won’t keep a heart attack away— for many of us
Why a statin a day won’t keep a heart attack away— for many of us
by the ANH team
Two new UK studies have been published, one of which takes primary prevention of coronary heart disease (CHD) to a ridiculous extreme, while the other, a University of Cambridge meta-analysis, seriously calls into question the use of statin therapy for those with no history of cardiovascular disease.
Effectiveness of statins in primary prevention called into question
According to a ‘hot-off-the-press’ University of Cambridge meta-analysis (65,229 participants), published in the Archives of Internal Medicine, there is actually no evidence for the benefit of statin therapy in preventing death amongst those at high risk of cardiovascular disease who don’t actually have a history of the disease.
This won’t be welcome news for the drug companies who rake in billions of dollars from statin drugs each year, and who appear to be marketing their use in primary prevention to an increasingly younger target group.
Over the past few years there have been several negative cholesterol-lowering drug trials, which have resulted in calls for independent re-examination of previous positive trials by independent experts, and for a complete reappraisal of the cholesterol lowering theory. See article by Michel de Lorgeri in Journal of Lipid Nutrition.
In May 2010, there was more bad news about statins, with the publication in the British Medical Journal of a study which found that statin use was associated with increased risks of moderate or serious liver dysfunction, acute renal failure, moderate or serious myopathy, and cataract.
Below are some recent reports about the Cambridge study. It’s interesting that given the importance of the findings, there has so far been very little reporting of the study in the mainstream press. But are we surprised, given the way in which pharmaceutical companies appear to control the editorial agenda of this medium— at least when it comes to healthcare?
Meanwhile, researchers from the National Heart and Lung Institute, Imperial College London have had a study published in the American Journal of Cardiology, entitled: 'Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices?'.
The researchers used previous studies to compare the increased cardiovascular risks of fast food consumption with the decrease in risk provided by statins. They found that the risk reduction provided by a daily dose of most statins is ‘more powerful’ than the risk increase provided by the fat intake of a daily 7-oz hamburger with cheese and a small milkshake.
The researchers concluded from their study that statin therapy could indeed neutralise the cardiovascular risk caused by harmful diet choices. They added, ridiculously, in our view, that the routine availability of free statins in establishments offering unhealthy food would be a ‘modern’ means of offsetting cardiovascular risk from consuming that food. A free one-off sachet of low dose statin would, the researchers explained, offer ‘cardiovascular benefits opposite to the effects of equally available salt, sugar and high fat condiments’.
Chips, tomato sauce and drugs with your burger?
So, why do we think issuing statins as a side order to your burger is a bad idea? Firstly, statins are a category of drug, with associated side effects, interactions and other important considerations, which include warnings about when they are contraindicated, and when they should be used with caution.
Prior to it being prescribed (usually by a doctor), many things should be taken into account about the condition and health of those for whom it is intended. Of key importance is that it should never be taken by those pregnant or breastfeeding. Statins block (amongst other things) an enzyme necessary for the production of cholesterol in the body, which is of vital importance in the formation of a baby and breast milk, for the growth of children, and for the maintenance and repair of healthy adults too. Thus it has been associated with birth defects.
We can only assume that the researchers’ ‘fast-food’ outlet statin sachet idea was perhaps not meant as a serious proposal. We certainly hope not, as this would target children and very young adults in particular, whose bodies, hormones, brains and nervous systems are still growing and developing, and they are therefore especially vulnerable to harmful effects from exposure to statin drugs. Just as importantly, there is no evidence that they would benefit from them either!
How would you have to retrain fast food retailers?
If you take the idea of issuing statins alongside fast foods to the next stage, the following are among the questions that would need to be asked of purchasers:
'Is there any possibility that you may be pregnant or breastfeeding?' (It is recognised that statins may cause birth defects if taken by pregnant women)
‘Do you have HIV?'
'Do you have liver disease?'
'Have you recently had a liver function test, and would you mind telling me the result?'
'Have you recently consumed large quantities of alcohol?'
'Are you currently taking antibiotics, or taking any of the following medications: Warfarin, Verapamil, Ezetimibe…etc.?'
Also, would there be any safeguards in place to ensure that hungry customers did not return again and again, or venture into further establishments during the course of one day for yet another burger with an accompanying dose of statins?
A ridiculous idea, wouldn’t you agree?
Have occasional, one-off statins been researched?
We can’t help further ridiculing the concept proposed by supposedly serious researchers, no doubt keen to make their drug company funders happy so they can maintain their research grants. So, if you don’t eat fast foods all that regularly, or only occasionally, how might your statin side order affect your health?
The effects of ‘one-off ‘statins, taken only with the consumption of an occasional unhealthy meal, have never been established. They are only available to take as a regular dose. Whilst their cumulative effects on reducing low-density lipoprotein (LDL) cholesterol (often called ‘bad’ cholesterol) are well studied, the idea of successfully ‘offsetting’ a high fat meal against a one-off dose of statins is pure speculation.
In addition, a 7-oz hamburger with cheese and a small milkshake provides a complex mixture of macronutrients, including fat, carbohydrate, protein, as well as vitamins, minerals and other micronutrients. All of these have particular properties, and each may have its own particular, and unknown, influence on cardiovascular risk.
The regular diet as well as the lifestyle of the individual will of course also have a huge influence, along with many other factors. The researchers appear to have oversimplified things by focusing only on the influence of total fat and trans fat on cholesterol levels.
Natural prevention of heart and arterial disease
Is the cholesterol lowering strategy for reducing heart disease risk really as important a factor as the statin producing drug companies would have us believe?
There is increasing evidence that LDL cholesterol is not actually the 'guilty party' in heart and artery disease, but that it has a role at the 'crime scene'. Inflammation of the arteries, as well as other risk factors such as raised homocysteine, are likely to be much more important culprits. When arteries are inflamed, LDL cholesterol is actually transported from the liver to the arteries specifically to deal with the inflammation, and in order to attempt to restore healthy blood vessel walls. High density lipoprotein (HDL) cholesterol returns excess cholesterol to the liver.
Therefore, reducing inflammation by avoiding sugar, refined and processed foods, salt, cigarettes, and alcohol is key. As is increasing anti-oxidant, fibre and phyto-nutrient rich fruit and vegetables, together with avoiding an excess of inflammatory saturated fat and trans fats. Also key is successfully balancing omega 6 and omega 3 fats. Evidence points to a low 'ideal ratio' of omega-6 to omega-3. It is likely to be between about 1:1 to 4:1. The ratio tends to be over 15:1 in the typical Western diet, and this appears to promote inflammation.
Natural sources of vitamins and minerals, at good levels, are of crucial importance for heart and artery health, and prevention of cardiovascular disease. Anti-oxidant vitamins and minerals A, C E and selenium, the B vitamins and folates, as well as the important minerals: magnesium, chromium and potassium are essential. Vitamin D has a crucial role in lowering inflammation within the body, and this is believed to be the reason why it helps to prevent cardiovascular disease.
The health of the liver also greatly influences the balance of inflammation within the body. Generally speaking, anything good for the liver helps reduce inflammation, whilst anything bad for the liver helps to promote it.
Diet aside, the role of exercise is critical to the reduction of all chronic disease risks, especially heart disease.