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Posted April 27, 2014: by Bill Sardi
New and controversial guidelines for heart health have been issued and commercial interests have prevailed in expanding the number of Americans who should be on statin cholesterol-lowering drugs by millions. Some doctors agree with the new guidelines, others don’t. Where does that leave you?
The New England Journal of Medicine (NEJM) recently dealt with this issue in an article entitled The Guidelines Battle On Starting Statins [New England Journal Medicine Vol. 370: page 1652, April 24, 2014]
The NEJM article posed a hypothetical case of a 52-year old jogger who smokes tobacco, has a family history of blindness (father) due to diabetes, often works under stress as a busy tax accountant, has a total cholesterol of 180 and low HDL “good” cholesterol of 35 and blood pressure of 130/85.
This man has three risk factors for heart disease: smoking, being male and low HDL cholesterol. His 10-year risk for a heart attack is 10.9%. The new guidelines suggest he start taking a statin drug. Under old guidelines statin drugs would not be recommended.
In the scenario posed in the NEJM article, the doctor wants this man to consider the new guidelines and they agree to meet again in 2 weeks. As the patient leaves the office with his hand on the doorknob he asks his doctor: “Doc, I really want to know what you would do?”
It’s not like his doctor has no self-interest in the advice he offers. The doctor has 500 patients who meet the new criteria for statin drugs. This doctor stands to add another 500 office visits on his appointment book for evaluations for any liver toxicity or other side effects from the statin drugs and for prescription refills. There are also drug consultation fees.
What is large in the patient’s mind is that he avoids diabetes and subsequent blindness his father experienced. There is no evidence statin drugs prevent that problem.
A number of doctors commented on this fictional patient and his treatment plan. The doctors who chimed in on this fictional case offered no advice about a low carbohydrate diet or avoidance of refined sugars that has spawned the diabesity epidemic.
Most said the patient should focus on smoking cessation rather than take a statin drug. Smoking increases the risk for retinal problems his father experienced.
None of the doctors mentioned that until he does cease smoking, tobacco is depleting vitamin C and causing unstable arterial plaque.
Fourteen years ago a NEJM report noted that sudden-mortal heart attacks are largely caused by unstable plaque where a calcium cap on the top of plaque ruptures and results in a blood clot that impairs the delivery of oxygen to the heart.
Back then I had occasion to write the editors at NEJM and ask them to publish my letter noting that a Duke University study showed that unstable arterial plaque is caused by a shortage of vitamin C. The NEJM editors predictably refused to publish my letter.
Commendably, many of the doctors commenting at the NEJM nixed the idea of starting this patient on statins, and for good reason. Some noted statin drugs pose more problems than imagined health benefits, though none said statins don’t prevent mortal heart attacks, only a small number of non-mortal events (1 in 200 healthy statin drug users over 5-years).
One doctor asked, if the patient’s risk for a heart attack is ~10%, will statin drugs cut that risk in half, to let’s say 5%? So the risk is not reduced to zero. So would an additional 5% risk reduction be worth taking a statin drug for the next 10 years?
Another physician chimed in that statin drugs have never been shown to decrease mortality rates in non-manufacturer sponsored trials and said the patient would only be subjected to the drug’s side effects.
A pathologist said: “it is important to respect the wishes of patients who want to have a healthier old age than their parents. If the risk of low-dose statins is reasonably low and the cost of $4-10/month acceptable,” then placement on a statin drug would seem reasonable, according to this doctor.
But should doctors acquiesce to misplaced patient fears and subject patients to risk of side effects (diabetes, cataracts, muscle pain, memory problems) when benefits are largely imagined? And statin drugs don’t prevent diabetes or blindness, the patient’s greatest fears.
One doctor did bring up an interesting factoid, that statin drugs need to be taken at bedtime when the body makes the most cholesterol and they must be taken with water as only 5% of the drug is bioavailable and this drops to 0% when taken with milk or a snack. I wonder how many of the 30 million Americans taking statin drugs are aware of that?
Only one physician suggested CT scan be performed to determine the degree of calcification of this patient’s arteries. It is calcium, not cholesterol, that threatens lives with mortal heart attacks. A recently completed study revealed that neither cholesterol, nor blood sugar nor blood pressure predicts future mortal heart attacks. But a calcium arterial score of zero equates with one-half of one-percent risk for a mortal heart attack over 5-years!
That statin drugs have been a misdirection over the past 40+ years is not an admission that modern medicine is ready to make. With billions of dollars at stake, the cholesterol/statin drug cash cow continues. Your doctor may tell you, unlike the fictional patient in the NEJM, that you DO have high cholesterol and you should start on a statin drug or you will die of a sudden mortal heart attack. The problem is, there is not a shred of evidence to back up that statement. ©2014 Bill Sardi, Knowledge of Health Inc.
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