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Maybe you shouldn’t be taking a statin for your high cholesterol

 Wow-this is a really big story, which was buried in the medical literature almost as quickly as it emerged.  And for good reason.  The serum cholesterol (the amount of cholesterol you have floating around in your blood) has been assumed to be, along with the systolic blood pressure, to be the two most important variables which determine whether a person will have heart disease in the future.  The Famous Framington Risk Indicator says so [1] based on a landmark study initiated in 1948.  That is why your family doctor measures the two periodically.  If your systolic blood pressure is consistently above 140 or your cholesterol is significantly above 200 mg/dL, chances are you are going to get a “ticket”-a prescription for a drug to lower the offending variable within acceptable limits.  Or at least a grace period to stop eating donuts and get more exercise.

First, a Deep Dark Secret, and then, a question.  Here’s the DDS: about ten years ago, the medical community thought that it was the diastolic (second) blood pressure reading that was important for heart health-so when 60 year old Stanley walked in for his yearly physical and had a b.p. of 160/80 bpm, the doc muttered “100 plus your age for your systolic b.p., Stan, you’re doing great”.  Uh-oh.  Turns out that once again, the medical community was 100%, belligerently sure of something that later proved not just to be  to wrong, but profoundly wrong (for additional  examples, see,  “hormone replacement therapy for women, the absolute necessity of” or “the PSA test for prostate cancer, why every man is a fool not to have yearly determination”, etc.)).  Here’s my question: if, as it is currently believed, the systolic blood pressure is the important number, despite the fact the diastolic reading and “100 plus your age” has been around for decades, why did it take a large study to figure out that was wrong?  Consider the example at hand: you are a physician and the patients you see that have good diastolic blood pressures seem to get heart disease much more often than you’d expect-might you, after decades of private practice, start to wonder what was going on?

 Finally, to the point of this article.  A recent study has some very interesting data for both patients and their doctors with respect to regulating cholesterol. An analysis of published studies involving over 32,000 subjects found no evidence that use of statins is associated with a reduced risk of death for patients with no history of heart disease [2]. Interestingly, of those that did die of heart disease, there was no correlation between their “bad” cholesterol levels and their risk of death, that is, among the people that died, those with high cholesterol were just as likely to die as those with lower cholesterol.

Let’s put this in perspective and in summary at the same time:  if this study is correct and you are taking Mevacor or Altocor (Lovastatin), Zocor (Simvastatin), Lipitor (Atorvastatin), Lescol (Fluvastatin), Pravachol (Pravastatin), or Crestor (Rosuvastatin) just to “lower your cholesterol” and you don’t have heart disease, it looks like you are exposing yourself to the risks of statins without any measurable benefit (oh, sorry, that’s wrong-statins are billion dollar a year drugs-there certainly is a great benefit to Pharma….just not to you).

This could conceivably cost Pharma billions of dollars in sales and change the way doctors see heart disease.  I was personally impressed by the fact that there was no correlation found between those individuals that died of heart disease and their “bad” serum (blood) cholesterol values-how did that happen if cholesterol is supposed to be predictive of heart disease?  Could it be that “the lipid hypothesis” –the idea that cholesterol in the blood is a prime determinant of risk is seriously flawed?  If you don’t have heart disease and are taking a statin, perhaps a discussion with your physician is in order-but don’t expect that he is aware of this study.  Bring it with you.  Statins, like all drugs, have risks-and some of the risks are serious.

[1] http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof

[2] Kausik K. Ray; Sreenivasa Rao Kondapally Seshasai; Sebhat Erqou; Peter Sever; J. Wouter Jukema; Ian Ford; Naveed Sattar. Statins and All-Cause Mortality in High-Risk Primary Prevention: A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants. Arch Intern Med, 2010; 170 (12): 1024-1031

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