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Posted March 5, 2015: by Bill Sardi
We are now living in the post-cholesterol era of modern medicine. Despite the dethronement of the 40+year paradigm that saturated fat consumption and elevated levels of circulating cholesterol are the primary causes of obesity and coronary artery disease, it is business as usual in the ranks of physicians.
This was not a misdirection corrected by new evidence. It was a complete fabrication from its beginning as a recent review revealed there was no supporting scientific evidence for dietary fat and cholesterol guidelines issued in 1977 and 1983. [Open Heart Jan 29, 2015] Other sources have already noted that saturated fat primarily raises low-density lipoprotein (LDL) cholesterol but this blood fat does not significantly increase the risk for cardiovascular disease [Applied Physiology Nutrition Metabolism Dec 2014]
Inexplicably both the American College of Cardiology and the American Heart Association have issued guidelines that expand the number of candidates for cholesterol-lowering statin drugs to include any adult whose risk for a heart attack is only 5% over a 10-year period includes subjects who don’t have elevated cholesterol but have other risk factors. [American Journal Cardiology Nov 1, 2014]
When it comes to cholesterol modern medicine should be diagnosed with a split personality disease. One small camp says phobia over fat and cholesterol represents misdirection while another larger camp advocates expansion of cholesterol guidelines to include millions more Americans on the candidate list for statin drugs. This royal battle pits commercial interests against science.
Is there discussion at MedScape, the physicians’ education website, on how to change prescribing habits or alter dietary recommendations in light of this new evidence? None can be found. Physicians are practicing mindless medicine and serving their own interests. Managing cholesterol numbers brings patients in the door.
This schizophrenic approach to cholesterol (schizophrenia is defined as when people interpret reality abnormally) is further evidenced by a recent published European study. The study claims less than 10% of patients at high-risk for a stroke or heart attack who have uncontrolled LDL cholesterol levels are taking a high-dose statin drug and that there is considerable opportunity to improve therapy among high-risk individuals. [PLoS One Feb 18, 2015] But higher dose is not the answer because cholesterol was never the problem.
Indeed, a recent study reveals high-dose statin drugs aren’t any more effective than low-dose statins and the cholesterol level of no more than 1 in 4 patients achieves the target goal of less than 70 milligrams/deciliter of blood for LDL cholesterol. [Therapeutic Clinical Risk Management Jan 23, 2015] Another study shows only 40% of at-risk patients meet their goal for LDL cholesterol levels. [American Journal Medicine Nov 18, 2014]
So by their own measure, statin drugs don’t even achieve their stated goal of lowering what is falsely alleged to be the most dangerous form of circulating cholesterol yet the drum continues to beat for statin drugs.
Alarmingly, researchers in Japan now report that statin drugs may actually promote coronary artery disease in three ways: (a) calcification (stiffening) via inhibition of synthesis of vitamin K2, (b) impair heart muscle function via the depletion of coenzyme Q10, and (c) may impair the biological action of selenium used to produce a key antioxidant enzyme (glutathione peroxidase) that can result in heart failure. These researchers propose statin drug guidelines be critically reevaluated. [Expert Review Clinical Pharmacology March 2015]
Have 30 million Americans been duped into taking cholesterol-lowering statin drugs?
In the past decade there has been a tremendous increase in the percentage of American adults over age 40 who use cholesterol-lowering medication, rising from 1 in 5 adults in 2003-2004 to 1 in 4 adults in 2011-2012. Better than 80% of these adults solely relied upon a statin drug to lower their circulating levels of blood cholesterol. Approximately 71% of adults with diagnosed cardiovascular disease, 63% of those with diagnosed diabetes, and 54% of those with diagnosed high cholesterol report they take prescription cholesterol-lowering medications. [National Center Health Statistics Dec 2014]
A recent study claims that statin drug users regardless of whether they had arteries narrowed by cholesterol plaque or not, had a lower mortality rate overall, not just from coronary artery disease. The authors of this study suggest statin drugs are of benefit regardless of whether they reduce cholesterol or not. However, the science used to back this claim is a bit specious.
The study data shows all-cause mortality rate over a 2-year period was 1.40% among non-statin drug users and 0.46% among statin drug users, a difference of less than one-percent. However, if the relative difference between these numbers (1.40 vs 0.46 percent) is used, which is what is often stated, then there is a 304% relative mortality reduction, which is a way of over-exaggerating the difference.
This data indicates over 98 out of 100 statin drug users have to subject themselves to the potential side effects of these drugs (cataracts, diabetes, liver toxicity, muscle deterioration and mental confusion) for 1 more patient to survive. [Atherosclerosis Jan 31, 2015] In today’s confusing world of cholesterol pills, this miniscule measure of life-saving effectiveness is deemed to be cost-effective medicine.
Meanwhile, in Japan a study of very old (85 years) adults reported a 1.7 times greater risk for death among very old (85 years) adults who had low cholesterol. Mortality decreased by almost 1% for every 1-point increase in total cholesterol. [Clinical Interventional Aging Feb 13, 2014] Go figure.
In a recent study among older Chinese adults a higher LDL cholesterol level was associated with a lower mortality risk from all causes of death. [Atherosclerosis March 2015]
In 2012 the Japan Atherosclerosis Society questioned whether cholesterol drugs should be used at all given the fact almost all Japanese population studies show that all-cause mortality (not just heart disease mortality) is lower as cholesterol levels rise. [Journal Lipids Nutrition 2012]
Despite the changing science it is still likely patients will be lectured in a cardiologist’s office that they need to take a statin cholesterol-lowering drug or they may suffer a sudden mortal heart attack. The odds that a statin drug will spare you from experiencing a non-mortal heart attack is 1 in 200 healthy statin drugs users and 1 in 70 high-risk users. [BloombergNews.com 2008]
Given that an apple a day has been shown to prevent as many deaths from heart attacks and strokes as a statin drug, the [British Medical Journal 2013], the difference between apples and statin drugs appears to be the (false) assurance these drugs offer. Fearful patients with a family history of heart disease often want a number to monitor. Cholesterol is that number. However, as a recent study reveals, monitoring cholesterol numbers has ended being used as a free pass to eat more food. [Medscape April 24, 2014]
An unfounded fear, cholesterol phobia, drives patients to demand statin drugs. A similar circumstance is when women are confronted with facts showing there is no benefit and maybe potential harm from undergoing a mammogram. Even after being informed of this women often opt for a mammogram because, as one leading doctor said, “women opt for reassurance.” [Knowledge of Health] Mammograms and statin drugs are expensive ways of hand-holding fearful patients.
Finally, there may not be much of a savings achieved by eating an apple over taking a statin drugs these days. According to PharmacyChecker.com, a 20 milligram Lipitor tablet can be purchased for as little as 63-cents. [PharmacyChecker.com] The price of apples these days is about the same.
A cardiologist these days may be nothing more than a witch doctor in a white coat who can cite specious numbers to substantiate his statin drug prescribing habit. Truly, it is an era that can be described as “Alice in Cholesterol-Land.” ©2015 Bill Sardi, Knowledge of Health, Inc.