Wikipedia defines a statin as "a class of drugs that lower cholesterol levels in people with or at risk of cardiovascular disease." As you can guess, I take issue with that entire concept. The question I propose is "What effects does low cholesterol levels have on cardiovascular disease?"
I found two very nice blog posts on this very topic. I am not a doctor, therefore it is not my place to attempt to rehash the ideas of doctors. So, here are the links to those posts.
http://www.canibaisereis.com/2009/09/19/low-cholesterol-certainly-not-healthy/
http://wholehealthsource.blogspot.com/2009/07/mrfit-mortality.html
While I should not rehash, I will at least attempt to provide a gist of what was said. Dr. Guyenet's post does point on that for men increased cholesterol levels is indeed positively correlated to increased risk for coronary heart disease. However, something a bit strange happens at low cholesterol levels. The total mortality curve is U-shaped, not the increasing line we would expect based on what we hear in the news.
The point is low cholesterol is not good for your health. The risk for nearly every other mode of death is negatively correlated to total cholesterol levels. Those modes include unintentional injuries, respiratory infections and diseases, neuropsychiatric conditions, only to name a few. There is a correlation between cholesterol lowering treatments and accidental deaths, suicides, aggressive behavior, mental disorders, anxiety disorders, depression; the list goes on.
In his book "Good Calories, Bad Calories," Gary Taubes devotes much time to the concepts of cholesterol and lipids. Taubes' book contains the chapter "The Greater Good" which discusses public health advice in attempt to save or extend lives. On the topic of cholesterol, Taubes writes:
The association between low cholesterol and higher mortality prompted administrators at the National Heart, Lung, and Blood Institute once again to host a workshop and discuss it. Researchers from nineteen studies around the world met in Bethesda, Maryland, in 1990 to report their results. The data were completely consistent...: when investigators tracked all deaths, not just heart-disease deaths, it was clear that men with cholesterol levels above 240 mg/dl tended to die prematurely because of their increased risk of heart disease. Those whose cholesterol was below 160 mg/dl tended to die prematurely with an increased risk of cancer, respiratory and digestive diseases, and trauma. As for women, if anything, the higher their cholesterol, the longer they lived. (p. 81)
So, with this information from the NHLBI in the 1990s, why is there still such a push to lower everyone's cholesterol levels? As I see it, there is absolutely no reason for any woman to lower her cholesterol. For men, the situation is a bit different. There appears to be a sweet spot somewhere between 160 and 200 mg/dl. However, when I look at the website for the National Cholesterol Education Program (NCEP; http://www.nhlbi.nih.gov/about/ncep/) I see very little difference in advice for men and women. Maybe I missed it. I would be much appreciated if someone can find if I missed something. For example, this handout for individuals, http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.pdf, says nothing about the above research. What happened to that research?
Speaking of studies, let us talk about JUPITER, also known as Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (http://content.nejm.org/cgi/content/full/NEJMoa0807646; http://www.theheart.org/article/852735.do). First, keep in mind that the JUPITER study was sponsored by AstraZeneca. Second, corporate sponsored drug studies tend to favor the sponsor's interest (http://www.usatoday.com/news/health/2006-05-24-drug-studies_x.htm).
The study purports a 50% or better reduction in cardiac events. The reality is that for every 100 subjects in the study, 0.77 in the Crestor group had a cardiac event and 1.36 in the placebo group had a cardiac event. That means a doctor will have to prescribe Crestor to 120 or more patients in order to save one from a heart attack. To make it more personal, ask yourself: "Am I willing to swallow a pill every day for two years in the hopes that I'm that one in a hundred who will be saved by the drug?" Before you answer, consider the fact that incidents of the development of diabetes, muscle disease, or liver or kidney infections were higher in the Crestor group than in the placebo group. Another consideration is the fact that JUPITER was supposed to be a five-year study, but it was cut short at two years with the stated intention of giving the placebo group the benefit of taking Crestor. I ask: "Did the study authors and sponsors simply not want to see what would happen after five years of being on the drug?"
Looking at the evidence, while the definition of statins may be technically accurate, it seems practically useless. Granted, for men high cholesterol is correlated to coronary heart disease. However, remember the adage: "Correlation does not imply causation." What if both CHD and high total cholesterol are symptoms of a bigger problem? Either way, if cholesterol was the deadly killer doctors say it is, I would think that it would be an equal opportunity killer, inflicting its toll on men and women. The evidence says that is not the case. I believe there is some other mechanism at work. What? I do not know and I doubt anyone does. Though, I will keep searching until I find a study by a scientist who thinks outside the mainstream box. Until then, we have yet another example of the overreaching hysteria promulgated by the pharmaceutical industry. I simply repeat: "Say no to drugs!"
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