I’ve decided to include some of the introduction pages to my voluminous chapter on statins as a series of blogs. Not because I love them so much but because there is a concerted effort by establishment medicine to increase the market share of these dubious medications. I must have come across at least a dozen students whose parents are on statins for absolutely no reason that has been shown to benefit them. Patients need to learn more about these drugs. Let’s take a walk down statin lane and I’ll enlighten you with the truth, not the “facts that everyone knows” from Junk Food TV.
The sales of statin drugs worldwide are nearly 30 billion dollars a year. According to Consumer Reports Health Best Buy Drugs (2012) heart disease was the leading cause of death with 631,000 for 2006 the last year statistics were available. According to the AHA more than 102 million Americans have “elevated” cholesterol. The NHANES (National Health and Nutrition Examination Survey) data show 22 % of Americans 45 year’s old and older take a statin. That’s a lot of people taking these drugs. I remember when I had my first and only three day trial of a statin years ago. It felt like I was poisoned. It reminded me of the typhoid live oral vaccine I took before we all left for our trip around the world. Waking up the following morning after swallowing that first typhoid capsule I felt like I had aged 100 years: bent over, crippled, ill. I felt about as bad in the muscle aches department after three days of being on a statin, as if I had been stuck in the bottom of one of those imposing grape barrels employed at harvest time. Only this time they were all wearing football cleats and stomping on top of me face down in that grape congee.
When I started to investigate the truth about statins I wasn’t surprised to find that they don’t really do what doctors have been told they do: significantly and safely reduce the chances of developing heart disease, having or dying from a heart attack, decreasing all-cause mortality, or prolonging life. This is especially true when compared to simple lifestyle changes which can profoundly alter the course of heart disease and prolong life. In fact, there is absolutely no contradiction to the simple notion that diets low in omega 6 fats; rich in fruits, vegetables, legumes, nuts, omega 3 fats and olive oil;  and low in non-fibrous carbohydrates will massively decrease the incidence of heart disease, stroke, hypertension and cancer. Add in a program of exercise and a few other simple measures which I go over and you can kiss heart disease and many other diseases goodbye.
Now back to statins. Sure they lower serum cholesterol very effectively but is there a good tradeoff? You see they also promise to lower coronary heart disease (CHD) risk, fatal and non-fatal cardiovascular disease (CVD) incidence and intimate that you will live longer if you take a statin every day. But will you live longer by taking a statin every day? Yes, it’s true they may decrease heart attacks but sadly it’s only in one small subset of people and the risks may far exceed the benefits as you will see when I break it down into working man’s numbers. For the rest of you on a statin you are out of luck.
ALL CAUSE MORTALITY
When you really want to know if a life-saving therapy is worth the risk researchers look at all-cause mortality. That way if a medication decreases deaths due to X but increases deaths due to Y there isn’t much point in taking it. As we shall see all-cause mortality, death due to any cause, is the most important parameter to follow in any cholesterol lowering trial. Studies clearly show that statins do not improve this important statistic. In other words you will not live a day longer by taking a statin. Moreover, overwhelming evidence clearly shows that the use of statins in primary prevention i.e., preventing a first heart attack, is a pipe dream. As you will see they don’t fare much better in secondary prevention when you actually look at the number needed to treat concept. We also see an increase in all-cause mortality when one’s cholesterol level is lowered too much.
Statins can’t live up to the hype clearly and effortlessly. Moreover, much of the data supporting their use may not be trustworthy. That’s because a dark horse has reared its head called money and lots of it from statin sales and other blockbusters. This is the money of Emperors. It is now a yearly income and with that kind of largess the major drug firms can buy a lot of influence which they do on a regular basis. In fact I’ll touch on just how bad that influence peddling has become. You will be shocked at the current state of affairs.
INFLAMMATION IS THE CAUSE NOT HIGH CHOLESTEROL
As I clearly demonstrate cholesterol does not cause heart disease-rather it’s inflammation, endothelial injury, that engenders it. This is nothing new. Every researcher and reading physician knows this already. It’s only Junk Food TV that keeps you thinking that cholesterol and fat clog your arteries like so many sewer pipes filled with gunk. The major drug companies and doc’s that don’t read on their own also contribute to this ignorance.
The next logical question would be what causes this inflammation, this endothelial injury? Here the list expands to include several things that I am sure you never thought had anything to do with generating heart disease. I will touch on some of these but for the in depth discussions go to my sections on inflammation and atherosclerosis.
I am somewhat of an expert on this-having rode the apple-cart to my own execution via heart attack. So rest assured that what I will be revealing to you in this chapter and elsewhere are the real facts needed to prevent you from dying of a heart attack. In other words you are being very foolish and cavalier with your own life if you think taking a statin is all that is needed to prevent dying from a heart attack. Half of the people having heart attacks right now have their bad cholesterol at a therapeutic level with many at the optimal level. Yet still they infarct their collective hearts. Clearly there is more to it and there is, much, much more.
STATINS DO NOTHING FOR THE VAST MAJORITY OF PATIENTS
In one subset of patients, in those that have previously had a heart attack (secondary prevention) and only in a narrow age range, statins will reduce cardiovascular mortality by up to 30 percent. However, of that 30% the number needed to treat to prevent one heart attack is on the order of about 50 people. They would need to be treated for about 5 years. Only one out of 49 is protected from a heart attack within that five year period. Most studies show that you will not live one day longer on a statin either. The fact that statins have any positive effect (that too is debatable) whatsoever is because they have aspirin-like qualities independent of their cholesterol lowering abilities. If not for this peculiar and quite unexpected anti-inflammatory quality, which quite by accident saved the industry, the statins would have been the biggest dogs ever created. This is one of the most important points in the whole debate because it indirectly proves my point: heart disease is an inflammatory condition.
Understand that it has been overwhelmingly proven in several huge meta-analysis, that statins do nothing for primary prevention i.e., extending lifespan or preventing a deadly heart attack in otherwise healthy patients or even high-risk patients with no evidence of heart disease. This has been re-confirmed again (see below) in 2013. There is now frightening evidence that statins accelerate coronary artery calcification. About 75% of all patients who are on these powerful drugs are taking them for primary prevention in the misguided assumption that statins will keep them alive longer by safely preventing a heart attack. This amounts to medical fraud. Intellectually honest interpretations of the data provide no indication whatsoever that they decrease cardiovascular events, prolong life or reduce all-cause mortality in this group. Yet, this is the largest population of patients currently on statins.
Moreover, these drugs are not harmless. They age patients faster, they probably potentiate neurodegeneration, contribute to mental-emotional illness and increase aggression and impulsivity-and that’s the small stuff. They also rob your brain and body of a vital energy substrate which may eventually cause heart failure while promoting feebleness. Lastly, a study published in the Open Journal of Endocrine and Metabolic Diseases. After a comprehensive review of Pubmed, EMBASE and Cochrane review databases the author’s concluded:
… There is a categorical lack of clinical evidence to support the use of statin therapy in primary prevention. Not only is there a dearth of evidence for primary cardiovascular protection, there is ample evidence to show that statins actually augment cardiovascular risk in women, patients with Diabetes Mellitus and in the young. Furthermore statins are associated with triple the risk of coronary artery and aortic artery calcification. Cardiovascular primary prevention and regeneration programmes, through life style changes and abstaining from tobacco use have enhanced clinical efficacy and quality of life over any pharmaceutical or other conventional intervention….[I]n actual fact, high cholesterol levels have been found to be protective in elderly and heart failure patients and hypo-cholestereamic (low cholesterol) patients had higher incidence of intra-cerebral bleeds (hemorrhagic stroke), depression and cancer [one citation].
…[F]or normal healthy individuals who are eager to achieve primary prevention, we discovered that for every 10,000 people taking a statin, there were 307 extra patients with cataracts, 23 additional patients with acute kidney failure and 74 extra patients with liver dysfunction [3 citations]. Furthermore, statin therapy increased muscle fatigability by 30% [2 citations] with 11.3% incidence of rhabdomyolysis (catastrophic muscle cell death which can be fatal) at high doses. What’s more, it induces inflammatory myopathy (muscle disease), including necrotizing autoimmune myopathy with immunosuppression and the statin-related myopathy can last for 12 months.
An additional side-effect of statin therapy is erectile dysfunction, which is 10 times more in young men taking the lowest dose of statin.
…[T]he Confirm registry had shocked the scientific world with the strongest evidence that statin use is associated with an increased prevalence and extent of coronary plaques calcification [1 citation]. Ironically for a drug which was marketed to lower the risk of cardiovascular disease, the confirm registry identified a strong association of statin use to the progression of coronary artery plaque features.
Moreover, Statin use was correlated with a greater incidence of severe coronary artery stenosis as well as increase in the numbers of coronary vessels developing obstructive coronary artery disease. Furthermore, statin use was linked to an increase in the prevalence and extent of mixed calcific plaque. Five prospective studies have borne witness to the fact that statin therapy does not induce any coronary calcium regression and evolution of coronary calcium continues regardless of statin treatment [2 citations].
Randomized controlled trials in largely non-diabetic populations with no previous coronary artery disease demonstrated that, despite potent lipid-lowering effects, statin agents do not reduce the progression of CAC (coronary artery calcification) [1 citation] or aortic calcification [1 citation].
The last three paragraphs are very disturbing especially in light of the new guidelines for statin use which will see more patients on statins not less. The Confirm registry showed that statins actually accelerate atherosclerosis. The second to last paragraph tells us that those patients on a statin have more extensive and worse CAD and that statins will not decrease those lesions. In fact, they will continue to worsen while taking a statin. Lastly, those non-diabetic patients taking statins for primary prevention will experience progression of their atherosclerosis regardless of how low their LDL cholesterol is dropped. Wherever you see the words calcification in a study you can substitute the word atherosclerosis. If a study finds increases in coronary artery calcification that’s the same as saying the patient’s atherosclerosis has increased.
This article also mentions that statins increase the risk of diabetes in post-menopausal women and the elderly, increase patients fasting blood sugar, increase the risk of Parkinson’s disease (PD) in women and promote neurodegeneration (diseases like PD, Alzheimer’s and ALS), increase the risk of post-stroke intra-cerebral hemorrhage, increase the risk of interstitial lung disease, increases the risk of non-melanoma skin cancers and associated with an increased risk of colorectal cancer, bladder cancer and lung cancer. Statin therapy activates a specific gene which results in muscle atrophy, wasting and damage. Patients are at increased risk for a statin induced cardiomyopathy (heart muscle disease) as a result of statin-induced coenzyme Q10 deficiency and the activation of certain harmful genes.
This won’t be the last time that you will read conclusions like the above, it’s only the most recent. This chapter is loaded with studies showing how toxic these medications are. The above was simply the latest which summarized all previous worthwhile trials. I will spend the rest of this chapter giving you everything that you need to know about these controversial drugs. After that you can keep taking your statin or confidently toss it into the campfire where it belongs.
 Ramón Estruch, M.D., Ph.D. et al, N Engl J Med 2013; 368:1279-1290 April 4, 2013