New Cholesterol Guidelines. Guess what? Basically EVERYONE is supposed to take statins!

If you believe the new guidelines, that is.  The complete work group report from the American Heart Association is available for free if you click on the link.

I find problems with this report, and the new guidelines that have been making news here and here and here.

For one thing, out of 15 authors, 7 have a financial relationship with the pharmaceutical industry, whether by being consultants for them, stockholders, or basically being employed by them in the capacity of having their research for the drug companies funded by the drug companies.  One of these has a SIGNIFICANT financial relationship (their words, not mine) AND is a co-chair of the study, which means they direct what research is included and how the information is used.  These are the same research studies used for the new guidelines…no conflict there, nope not at all, move along, nothing to see here…

For another thing, fully half of the expert reviewers of the guidelines ALSO have ties to the pharmaceutical industry.  ALL of them, guideline authors/researchers and reviewers alike, have their ties within the past year!!

These guidelines say that the focus should not be on numbers for lipid lowering, but on dosages for statins.  There are two basic categories:

  1. high risk people, who have diagnosed heart disease or other diseases like diabetes which puts them into the high risk category for heart disease.  These people should be on high dose statin therapy.
  2. people who do not have heart disease but have LDL-C (the bad cholesterol) levels of 70 – 189.  These people should be on moderate dose statin therapy.

The only two drugs approved for high dose statin therapy according to this work group report (new guideline) are:

  1. atorvastatin (Lipitor) at the dose of 80mg per day which is a wicked high dose, though they do include 40mg for those unable to tolerate 80mg, and
  2. rosuvastatin (Crestor) at the dosage of 40mg per day which is also a wicked high dose, though they also include 20mg per day for those unable to tolerate 40mg.

The rest of the statins are apparently OK for moderate dose therapy.  I think the key here is that they are no longer interested in absolute numbers, but in total percentage of bad cholesterol lowered.  Though they do cite numbers over and over again in the course of the review.  And, once again, though people with high triglycerides are KNOWN to have higher risk factors for heart disease and adverse events related to their heart disease, these numbers are basically completely ignored in favor of LDL-C, as though it were the only cholesterol that mattered.  In fact, it’s the only number that statins work on, which is why I think they focus so hard on it.

The third problem I have with this report is that they basically admit that statins’ cholesterol lowering effect is NOT what prevents adverse cardiac and stroke events!  What?? you say??  Yep, it’s true.  They state that niacin and fenofibrates (like gemfibrozil) lower bad cholesterol and improve good cholesterol but that they are not associated with reduced risk of events.  Which says, loud and clear, that whatever protective benefit statins have, it’s not because they are lowering bad cholesterol.

The new guidelines point out that taking a statin increases your risk for diabetes (and hemorrhagic stroke) with the risk being dose related.  So the higher your dose of statin the greater your risk for a head bleed or developing diabetes – which, by the way, greatly increases your risk for a heart disease related event like a heart attack.  And then they poo poo their own conclusions!

The new guidelines also didn’t include red yeast rice as a cholesterol lowering drug in their review.  They said there was only one Chinese study to look at that met their guidelines so they couldn’t make any recommendations.  Well, given that red yeast rice was pulled off the market for several years in the 90’s because it’s LOVASTATIN I think that’s kind of crap.  Red yeast rice is a naturally occurring form of a prescription drug, which is why they pulled it.  Don’t want competition now, do we?

I would like to point out myself, that cholesterol is produced by the body.  It is VITAL to many, if not most body processes.  It is necessary to stabilize cell membranes, it is necessary for proper nerve conduction, 25% of your body’s total cholesterol load is found in the brain.  It’s necessary for sex hormone production as well as other hormones.  Screwing with one’s ability to produce cholesterol screws with your muscles, your nerves, your sex drive, and your brain.  Anybody else notice the large increases in dementia over the past 20 years?  Kinda funny how that timeline is also when the first statin was introduced, isn’t it?

Finally, while the review does pay lip service to diet and lifestyle modification, they don’t recommend trying that first.  They now specifically recommend jumping straight to statin therapy, with diet and lifestyle modification as secondary prevention.  Eh??

Dr. Malcolm Kendrick has an interesting essay in which he makes the case for thrombus formation as the end point in a chain that involves cholesterol, but also stress, cortisol, and improper endothelial progenitor cell production.  He also references a booklet from Pfizer, copyright 1992, in which they ALSO make the same case.  Of course, this was a decade before they brought out Lipitor, so you won’t find that booklet anywhere now.  Lipitor is the number 1 selling drug in the world.  Why would they mess with a cash cow like that?

I found this essay by Stephanie Seneff, PhD, a senior research fellow at MIT.  It explains very well how cholesterol works in your body, how it’s produced, and how statins interfere with that process.  It’s no secret that I’m a much bigger proponent of proper nutrition and exercise than I am of drug therapy.  This paper is a clear explanation of what I already said – that as the research work group results show, reducing cholesterol isn’t why they protect against heart attack.  It’s not a peer reviewed paper published in a high quality journal, but this is not a paper that will EVER get published in something like JAMA simply because it goes against established paradigms and pharmaceutical interests.

So.  That’s my take on the new guidelines.  Take it or leave it, take statins or don’t, it’s your choice.  Just make sure you do your research and make an INFORMED choice.  I do think for some people the protective effects outweigh the potential (and likely) side effects.  But I don’t think that prescribing statins to upward of 30 million people, 1.5 million of which will suffer side effects from the statins, is warranted.