What do you think when you hear the words ‘raised cholesterol’? For many people, these words are synonymous with ‘heart disease’ and an early demise. It is this reaction that underpins the idea that putting downward pressure on blood cholesterol levels is inherently good for us.
There are many potential flaws in this thinking, though. One major issue concerns the fact that while raised cholesterol is associated with an increased risk of heart disease, it is associated with a reduced risk of other conditions including cancer. None of this evidence proves that raised cholesterol protects against cancer, but then again, this sort of evidence does not prove that raised cholesterol causes heart disease, either.
However, if we are to judge the relationship between cholesterol and health, it makes sense to take as wide a view as possible, and this generally means focusing on overall risk of death (which captures all conditions).
Elderly individuals are generally at a greater risk of death than younger ones, so what is the relationship between cholesterol levels and overall risk of death in this population? A study just out looked at the relationship between cholesterol levels and overall risk of death in Swedish adults aged 70-90 [1]. The results showed no association here (in other words, ‘raised’ cholesterol levels were not found to be associated with an increased risk of death).
However, this study also assessed the relationship between the taking of statin drugs and overall risk of death. Individuals taking statins at age 85 were at a significantly reduced risk of death between the ages of 85 and 90.
Again, this sort of evidence does not tell us if statins actually reduced the risk of death (only that these two things are associated with each other). In fact, if lower cholesterol was not found to be associated with reduced risk of death, but taking cholesterol-reducing statins was, then this supports the idea that any benefit statins may have is not due to their cholesterol-reducing properties.
However, in reality, it may be that statins have no benefits in terms of reducing the risk of death at all. It might be that the association between statin taking and reduced risk of death is due to the fact that statin-takers are more health-conscious than those who do not, or perhaps they tolerate statins better and are inherently healthier individuals.
We can be much better informed about the impact of statins on overall risk of death by looking at the results of ‘randomised controlled trials’. A relevant review of the evidence was published earlier this year in the Journal of the American College of Cardiology [2]. Here, the results of several similar studies were pooled together in the form of what is known as a ‘meta-analysis’. The study focused on elderly individuals who had no history of established cardiovascular disease.
This study found that while statins reduced the risk of heart attack and stroke, death from these conditions was not reduced, and neither was risk of overall risk of death.
So, while the first study showed an association between statin use and reduced risk of death, evidence from clinical trials shows no benefit in reality. This last study asks further questions about the widespread use of statins in healthy individuals, including the elderly. Even in a group at relatively high risk of succumbing to cardiovascular disease and death by virtue of their age, the evidence shows that statins do not save lives.
References:
1. Jacobs JM, et al. Cholesterol, Statins, and Longevity From Age 70 to 90 Years. J Am Med Dir Assoc. 2013 Oct 3 [Epub ahead of print]
2. Savarese G, et al. Benefits Of Statins In Elderly Subjects Without Established Cardiovascular Disease. A Meta-Analysis. J Am Coll Cardiol. 2013 Aug 14 [Epub ahead of print]
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It is interesting that there seems to be protection against stroke, because saturated fat also has some protective effect in this regard (tho on margin of significance).
They should try a combination pill with statins, co-Q10, vitamin K2 together with a high cholesterol and squalene diet. If the effect of the drug is independent of its HMG-CoA inhibitory effect, which causes the side effects instead, then counteract that part by supplying all the essential HMG-CoA metabolites.
Hello,
Could you put this into context?
“Individuals taking statins at age 85 were at a significantly reduced risk of death between the ages of 85 and 90.”
Does “significantly” mean ‘statistically significant’ or absolutely significant?
Could you clarify what exactly this means, because it is not intuitive? On appearance, this sentence contains a contradiction.
“This study found that while statins reduced the risk of heart attack and stroke, death from these conditions was not reduced, and neither was risk of overall risk of death.”
Thanks.
Jim
I do wish that GPs wouldn’t try to frighten us into taking statins.
Nice graph of TC versus mortality from various causes in 164 countries.
http://metabolichealing.com/assets/pdf/cholesterol-mortality-chart-1.pdf
That is a nice graph, but it is astounding how few data points are controlling the curves for cholesterol values >220. The red curve could have been drawn horizontal (i.e. no correlation) above 220.
I am just taking Johns, Malcoms, Zoe’s and Uffes and many others word for it! My mind is becoming dazzled with the controversy and arguments going on over this issue. On a personal note I know that I feel so much better not taking any drugs or even supplements at all. At the moment I am having treatment for an ongoing kidney condition, but the medical establishment are amazed that I don’t take anything. They say that other than the kidney problem I am very fit. I am 69 years old and noticing that the friends I have that are fit and healthy are the ones with a healthy lifestyle both with Eating Real food and gentle but not excessive exercise, such as walking or cycling. I love your blogs John, just keep em coming! I always pass them on!
There’s a big push in today’s papers (Saturday 12th Oct) to claim Statins are responsible for the 40% reduction in deaths from strokes…
http://www.telegraph.co.uk/health/healthnews/10374523/Strokes-fall-by-40-per-cent-due-to-increased-statin-use.html
what’s your take on this paper then? Is it sponsored by the very companies that pedal statins to the general public and have most to gain?
@paulc – Go and read the research paper or even just the abstract. What that actually says and what The Telegraph “advertisement” reported is akin to them saying that chalk is cheese. They could then add that said cheese has been found on the moon.
Would you say that a 71 years old, slender, regular exercise taking, woman with MODI diabetes (excuse the tautology) under tight control, could be regarded as ‘generally healthy?’
When my doctor or practice nurse peer at me and suck their teeth at my disinclination to take statins I get a little nervous. It’s such a relief to be without the side effects though.
It might be interesting to note that Fred Kummerow, a 98-year-old emeritus professor of comparative biosciences at the University of Illinois, explains the primary causes of heart disease. He argues that, contrary to decades of clinical assumptions and advice to patients, dietary cholesterol is good for your heart — unless that cholesterol is unnaturally oxidized (by frying foods in reused oil, eating lots of polyunsaturated fats, or smoking). Read more: Interaction between sphingomyelin and oxysterols contributes to atherosclerosis and sudden death. Fred A Kummerow. Am J Cardiovasc Dis. 2013; 3(1): 17–26.
Indeed, recent prospective study showed that consumption of omega -6 PUFA increases mortality: Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. Ramsden CE et al. BMJ 2013;346:e8707.
Furthermore there are at least two studies which showed that low cholesterol is associated with increased mortality.
Lipids and all-cause mortality among older adults: a 12-year follow-up study. Sarria Cabrera MA, et al. Scientific World Journal. 2012; 2012: 930139.
Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up.Tuikkala P. et al. Scand J Prim Health Care. 2010;28:121-7.
“This study found that while statins reduced the risk of heart attack and stroke, death from these conditions was not reduced, and neither was risk of overall risk of death.”
I’ve avoided them up to now – because they don’t seem well understood and seem to affect muscle function, but if the above is true, perhaps they don’t do much harm and may do good. Having a stroke or heart attack isn’t good, whether or not you die from it.
“This study found that while statins reduced the risk of heart attack and stroke, death from these conditions was not reduced, and neither was risk of overall risk of death.”
So what’s the point in taking them?
Statins, flavor of the month yet again with the Daily Mail and Telegraph. This old story does the rounds every few months. Just take a look at the French diet and how strokes and heart problems are a lot less than here in the UK. The best advice is stay away from cheap ready type
meals and food.
@paulc Statins are not mentioned in the original paper. Read Zoe Harcombes take on the Telegraph article http://www.zoeharcombe.com/2013/10/statins-and-strokes-disgraceful-headlines/#comments
@Michal Piják I’ve found 93 (and counting) studies which show that low cholesterol is associated with increased mortality http://healthydietsandscience.blogspot.co.uk/search/label/Cholesterol%20and%20Mortality
Mark, my point is that given the same risk of death, I’d rather not have suffered a stroke of heart attack. For example, Andrew Marr had a stroke.
http://www.bbc.co.uk/news/uk-politics-23919353
He is not dead but is still suffering the effects.
Jonathan, et al…
The bottom line is, there are SAFE, natural alternatives to statins…
MR PALEO
http://www.misterpaleo.blogspot.com
I remember him actually blaming his stroke on an interval session he did on a rowing machine.
Does that mean we should ban rowing machines, or at the very least interval sessions?
Conclusions:
If cardiovascular serious adverse events are viewed in isolation, 71 primary prevention patients with cardiovascular risk factors have to be treated with a statin for 3 to 5 years to prevent one myocardial infarction or stroke.
This cardiovascular benefit is not reflected in 2 measures of overall health impact, total mortality and total serious adverse events. Therefore, statins have not been shown to provide an overall health benefit in primary prevention trials.
http://www.ti.ubc.ca/newsletter/do-statins-have-role-primary-prevention