Statins: Bad Science Used To Push Cholesterol-Reducing Drugs

| September 12, 2011

I had a patient in my practice this week who was seeking advice about the prevention of heart disease. He’d been statins for several years, and then started to get what he felt might be side-effects.

He stopped the statin and the side-effects went away. As he rightly pointed out, the relief from his symptoms might have been entirely coincidental and nothing to do with the fact that he stopped his statin medication. However, he was disinclined to restart. My patient told me that he expects his doctor to be up in arms about this. He has, apparently, an unbridled enthusiasm for statins and believes ‘everyone should be taking them’.

As I pointed out to my patient, the reality is the vast majority of people who take statins are destined not to benefit from them. And then we have the problem, of course, of toxicity and side effects.

Not to mention the cost. What is it then, that causes doctors to be so enthusiastic about drugs that, on balance, have limited benefits and can cause serious harm?

Well, some of this has to do with the fact that doctors make money from cholesterol reduction. In private medicine, the cholesterol concept suddenly makes ‘patients’ out of essentially healthy people.

Here in the UK, national health general practitioners are remunerated for their cholesterol-reducing efforts with patients.

But a major part of the problem too, I think, has to do with how the ‘benefits’ of statins and other drugs are communicated to doctors by drug companies. As I’ve pointed out before, the emphasis is usually on reductions in the ‘relative risk’ of, say, heart disease. But if the overall risk is small, the real reduction in risk (known as the ‘absolute risk’ reduction) becomes vanishingly small.

Another problem is that data can be presented to doctors that gives a misleading account of a drug’s effects for the unwary. I spotted a prime example of this recently in the on-line version of the GP magazine Pulse here.

The title of this piece reads: Ezetimibe plus statin ‘halves death risk’. What the piece is really about is that some primary care trusts have banned GPs from prescribing ezetimibe (a cholesterol-reducing drug), supposedly on the basis of cost. Some doctors, it seems, are upset about this. The piece cites some evidence in which individuals taking ezetimibe plus the statin simvastatin were about half as likely to die compared to those taking simvastatin alone. In case you haven’t clicked through to the actual piece, here’s how the opening paragraph of the piece reads: ‘A cholesterol-lowering drug that has been blacklisted by some PCTs on financial grounds has been shown to reduce mortality in patients following a first acute myocardial infarction.’

One problem: the study that purportedly shows that ezetimibe saves lives actually does nothing of the sort. The study is ‘epidemiological’ in nature, and can only tell us that ezetimibe is associated with a reduced risk of death. You see, individuals who take ezetimibe may have a reduced risk of death that has nothing to do with ezetimibe. Maybe, for example, they’re particularly health conscious and in addition to pressing their doctors for more and stronger medication, they’re also active and eat good diets.

The fact that the study in question here is epidemiological means that the statement that ‘A cholesterol-lowering drug…has been shown to reduce mortality…’ is simply wrong and misleading.

To know if ezetimibe really does save lives, we need clinical ‘intervention’ studies. We now have several of these. And here’s what you and your doctor need to know: Not one of them has shown that ezetimibe benefits health or health markers. Some of the studies actually suggest the ezetimibe does more harm than good.

The Pulse piece ends with the following paragraph: ‘Dr Peter Fellowes, a GP in Lydney, Gloucestershire and a member of the GPC clinical and prescribing subcommittee, said: ‘I don’t think it should be blacklisted. It is very useful in patients who are statin intolerant. The arguments against ezetimibe and the more potent statins are entirely cost based as I see it, and that is a sorry state of affairs.’’

I’ll tell you what’s a ‘sorry state of affairs’: When a doctor is advocating the use of an expensive and potentially toxic drug that has no proven benefits on health. And it doesn’t help that a magazine for GPs presents information on cholesterol-reducing drugs in a misleading and utterly imbalanced way, either.

Here’s to a healthy heart

Dr John Briffa
Editor
for The Cholesterol Truth



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Sources:

‘Ezetimibe plus statin ‘halves death risk’ published online 02.09.11, pulsetoday.co.uk

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Category: What Doctors Don't Tell You

Comments (1)

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  1. Christopher Palmer says:

    Now that I have inclination to study the cholesterol contention and statin side effects that may well harbour purpose above simple curiosity I am better aware of the explanation behind statin side effects.Firstly I am now pretty secure in my thoughts that if nature gave me the ability to synthesise cholesterol it did so with good reason, and secondly I am pretty secure in my willingness to think that if nature gave me the ability to synthesis cholesterol it would also provide facilities to match the level of synthesis with requirement. It seems bloody foolish, in the least, to interfere with natures intentions. That doesn’t let cholesterol of the hook entirely, because fluctuation in serum cholesterol levels could be indicating something useful, albeit that something useful may not be entirely in line with contemporary mainstream interpretation by the cholesterol faithful.Your readers may be interested in something I found both instructive and sobering.Only a portion of the cholesterol we need is provided by diet; we synthesise the lions share, mostly in the liver. Cholesterol synthesis is a process stemming from one branch of the ‘mevalonate pathway’. The Mevalonate pathway has several branches that result in the synthesis of several important biochemical of which cholesterol is just one. Statins are not sufficiently selective to only act upon the ‘cholesterol branch’, oh no, Statins interfere at an early step in the biochemical chain that equates to the ‘trunk’, and in so doing they impede synthesis, not only of cholesterol, but also of a half-dozen or so other vital biochemicals. This lack of selectivity goes a long way to explain statin drugs side-effects.Someone who has genuine first hand and professional reason to study statin side effects is Dr Duane Graveline. If any reader passes by your blog, reads your excellent discussion of your experience in general practice and bias in the ‘Pulse’ article, the drops down to my comment, and is curious to know more about the several vital boichemicals whose synthesis is impeded by the action of statins acting at a very early step in the mevalonate pathway, and want to read the explanation of the inevitable and several debilitating side effects then they could do now better (second only to following you, of course) than get a copy of Dr Gravelines book, ‘The Statin Damage Crisis’. If a truck driving dullard like me can take something from it then most people ought to find it intelligible enough to counter the the statin-ist and cholesterol propaganda, geared of course, to nothing more than making money from confused and malleable people – meaning most patients and many GPs (!)I am fast trending to think that there was a mis-carriage of justice resulting from an unfortunate conclusions and ‘evidence’ drawn from an experiment involving feeding rabbits a cholesterol rich diet, to which they would not have been especially well suited anyway, around 100 years ago. Quite likely the cholesterol rich food fed to the rabbits became oxidised and contaminated with oxycholesterol and those conducting the experiment lacked the wherewithal to know the difference or recognise the significance.More recent evidence has come to light indicating that effects of oxycholesterol in the diet of animals is far more deleterious than the effects of dietary cholesterol. Cholesterol was tried and sentenced upon evidence that ought to have indicted oxycholesterol. That circumstance was unfortunate, but has transpired in decades since is an unmitigated disaster so close to a crime against humanity that I cannot discern the difference.Eee, by ‘eck, I could spit feathers. (!)

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