Can we assume the reductions in cholesterol translate into benefits for health?

The aorta is the major blood vessels that carries blood from the heart to other parts of the body (except the lungs). Sometimes, individuals can be born with a narrowing of this vessel – a condition known as ‘coarctation of the aorta’. This defect can be repaired surgically. Those with this condition have been noted to be at generally elevated risk of cardiovascular disease including heart disease.

One way to gauge the extent of ‘heart disease’ is to measure the thickness of the walls of coronary artery – known as the ‘coronary intima-media thickness’ (CIMT), assessed via ultrasound performed via a catheter inserted into the vessel via the groin or arm. In a recent study, individuals who had had surgical repair for coarctation of the aorta were treated with a high-dose statin to see what effect it had on CIMT as well as health outcomes [1].

There were 155 individuals in the study, about half of which were treated with 80 mg of atorvastatin (Lipitor) each day, while the other half got no treatment. The trial lasted for 3 years.

The atorvastatin led to a significant reduction in both total cholesterol levels as well as supposedly harmful ‘LDL’ cholesterol. However, those taking atorvastatin saw no reduction in their CIMT measurements compared to those who took nothing.

The researchers also assessed the impact of high-dose atorvastatin on more important measures such as risk of heart attack and stroke and death from these things. There were no benefits to be had here, either.

In this study with this group of patients, long-term reduction in cholesterol did not translate into any benefits at all. This challenges the concept that cholesterol reduction is fundamentally healthy. However, we have much more evidence that challenges the ‘lower cholesterol is better’ paradigm, including the fact that several drugs that successfully reduce cholesterol have been found to have no benefits whatsoever and some of which actually harm health. Dietary modification of cholesterol has been found to be ineffective too.

Should we be too surprised then, that the ‘benefits’ of cholesterol reduction do not always turned out ‘as expected’

References:

1. Luijendijk P, et al. Beneficial effect of high dose statins on the vascular wall in patients with repaired aortic coarctation. Int J Cardiol. 2014 Jun 28 [Epub ahead of print]

 

13 Responses to Can we assume the reductions in cholesterol translate into benefits for health?

  1. Janknitz 25 July 2014 at 6:53 pm #

    Ha! Thank you so much for posting this! I was born with coarctation so I’m followed by a cardiologist every 5 years (no problems whatsoever since my repair at age 8).

    The cardiologist first praised my HDL/trig ratio (100/55), but at a followup appointment, he tried to talk me into statins ANYWAY. He said they (meaning Kaiser HMO) wants to see LDL under 70 for individuals with congenital hear disease, mine’s 123, which I think is fine for a menopausal woman.

    Can’t wait to send him this study ;o)

  2. Gregory Barton 26 July 2014 at 2:16 am #

    “Should we be too surprised then, that the ‘benefits’ of cholesterol reduction do not always turn out ‘as expected?’”

    The problem with the claim that cholesterol causes heart disease is that it tends to causal reductionism:

    “The explanation for an event or situation is reduced to a single, simple cause when there are other factors that contributed to it. The goal is to provide a simplistic answer to a complex problem while avoiding a more in-depth analysis, which could reveal flaws in one’s arguments.”
    http://mason.gmu.edu/~cmcgloth/portfolio/fallacies/causal.html

    Other possible causes are neglected:
    - uncontrolled high blood sugar, http://www.sciencedaily.com/releases/2008/03/080313124430.htm
    - infection, pathogen burden http://www.medscape.org/viewarticle/416495
    - hormone deficiency (thyroid, testosterone, estrogen) Broda Barnes, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834340/

    The danger of cholesterol reductionism is that it leads to complacency: ‘my cholesterol is low, I don’t need to worry about heart disease’.

    So, should we be surprised that the ‘benefits’ of cholesterol reduction do not always turn out ‘as expected’? No, we shouldn’t.

    • M. Cawdery 26 July 2014 at 9:19 am #

      ““The explanation for an event or situation is reduced to a single, simple cause when there are other factors that contributed to it”

      That is probably why in these statistical analyses the authors never give the proportion/percentage of the total variance accounted for by the factor they have “embraced as gospel”. That info would give the game away.

  3. Vanessa 26 July 2014 at 7:33 am #

    I thought the Malcolm Kendricks and Aseem Malhotras etc of the world had already pointed out that cholesterol levels had no impact on cardiovascular disease? That Ancel Keys had just isolated data from the WHO information to ‘prove’ his hypothesis? That cardiologists tell us that about half or more of those patients with heart disease have normal or low cholesterol levels? That studies in elderly people show that high cholesterol levels are associated with longevity? Isn’t the cholesterol hypothesis at last being challenged? It seems not…

  4. M. Cawdery 26 July 2014 at 9:23 am #

    Dr Briffa,

    As someone who has an extensive knowledge of statins, cholesterol, etc., have you ever been invited to join committees reviewing the subject such as the recent NICE committee?

    Have you ever been asked by journals such as the BMJ and the Lancer to act as a referee on papers on this subject?

    I suspect not.

    • O 27 July 2014 at 6:38 pm #

      Why are you trying to get him disciplined/struck off for posting information that is available to anyone with academic journal access that goes against your own views?

  5. Moy Peralta 26 July 2014 at 5:16 pm #

    I commend Dr Briffa’s article, I really do. But for over a decade now I have listened to growing numbers of doctors taking the softly-softly approach on the erroneous cholesterol hypothesis, (historically, not erroneous, but falsified – and one of our innumerable healthcare disasters).
    One truly loses patience. It is, for pete’s sake, now an undisputed fact, concealed by government bodies with financial and profitable agendas, that all statin drugs are harming the populations being force-fed with them. It is like a slowly growing holocaust – the destruction of humans by other humans.
    Online, I feel we have reached the point where these articles preach only to the converted – to those long-since quite aware of the facts. None of my friends, neighbours or acquaintances are aware of the doctors or scientists continually attempting over the years to inform the public, against all odds. Such outspoken information will never feature on mainstream media broadcasts, themselves a bit of a farce. I have a multiplicity of neighbours – and even a brother-in-law – who refuse to relinquish their cholesterol-lowering drugs despite resultant worsening ill-health. Why? Their prescribing GP’s inform them that they NEED them!
    When did we all become so brainwashed, so gullible, so devoid of basic common-sense about ineffective ‘treatments’… and so increasingly diseased and crippled by pharma drugs in mind, body and spirit for the past few decades…
    Until people band together against the particular medical falsehoods which envelop us, nothing will change. Not even from articles like this which are so easily derided, squashed or simply ignored by those in power constructing the agendas.

    I apologise for possessing, apparently, the pessimist gene.

    • David 26 July 2014 at 10:19 pm #

      We didn’t become brainwashed. For previous generations it was the norm to do as the doctor said. The revolt is only just starting.

    • helen 27 July 2014 at 10:59 pm #

      ^Moy I too find it frustrating that the people that use these and other drugs think that they are helping them, when their worsening health should be alerting them otherwise. But what can you do other than inform them and then leave them to their own devices? The information is out there but they are either too frightened or too unintelligent to read anything that might challenge the perceived knowledge of “the Doctor” . The most common thing I get told is “what would you know you havent studied for years to get a qualification” like a formal education is the be all and end all of the ability to aquire knowledge on a subject. The only differences I see between myself and some medical people is that I didnt sit a formal test to examine my book learning proficency & I have an open mind.
      It frightens me sometimes that people have become so addicted to the ‘drugs cure’ mentality that they have forgotten to use their common sense and the collected wisdom of the healing professions when they actually did heal. To me drugs have a very small application and should only be taken short term to correct a problem the fact that your body not only has to try to heal itself with limited resources (nutritional and emotional) it also has to try to counter the poisons that the drugs really are. NO wonder so many people get worse rather than better.

    • Christopher Palmer 31 July 2014 at 2:34 am #

      Moy,

      If a person is familiar with evidence, and/or very sound reasoning, to think something is wrong, and then seeks to right that wrong by working to spread the rate of cognition amongst fellow humans that something is wrong and can be righted then they are undoubtedly possessed of a rare kind of optimism. Believing a better world would be possible if only people could be encouraged to conspire to fashion one is a perfectly sound ambition for a realist. Sadly people do so like to put a gloss on the more ugly aspects of the world in which they live, without venturing near the thorny issue of causality – especially where the issue of causality wags a finger at their own stupidity.

      The spread of ideas works a bit like the spread of infectious diseases but with certain important difference. In the early phase of conversion one contact is not enough to pass on the new idea, whereas, say, with a virus it might be. And the herd mentality is striking in the mindset of public opinion. The individual mind resists being converted to a new idea where subscription rates are low, yet if subscription rates are higher amongst the surrounding population an individual mind will convert and become ‘infected’ by the most superficial and fleeting of ‘contacts’.

      While you sense your ambition to reverse the opinion of your neighbours is having no effect there are some tricks and practicalities worthy of appreciation.

      One ‘contact’ with just one ‘source’ will not convert one mind from the masses. But is there a persons in the set of people who subsequently have a contact with another source indicating broadly the same paradigm shift in thinking, and so on, then there comes a time when confidence is dented. The number of contacts needed to ‘convert’ will diminish as the number of ‘converts’ rises. A switch in public opinion involving an abject reversal of an idea rests heavily upon the critical mass (or balance) of the numbers involved.

      Also, compare ideas to mighty and mature oaks. Nobody in their right mind would undertake to transplant a mature oak tree. From the recipients point of view such a major transplant as the complete and mature specimen is to be avoided at all costs. The first contact wisely concedes it is only possible (and expedient) to transplant a ‘seed’ of the new idea. The second contact might hope to transplant the cognitive equivalent of a sapling, then maybe the third may get chance to have the replacement idea branch out a bit. No idea will flourish in an infertile and unreceptive mind, and fertility of the mind has to be cultivated and not forced.

      Suppose something. Suppose in three months you, and other statin sceptics, could encourage five people to read a book on the cholesterol con. There are several to choose from but Dr Kendricks offering is perhaps the most appealing to the newly curious. Then suppose in the next three months each of these each encouraged another five people, and so on. On a scrap of paper figure how many converts there would be after just two years. You can imagine the word radiating out, as if like ripples from a stone cast in pond.

      Now imagine this process beginning simultaneously in more than one locality. Imagine several stones casting out ripples from various parts of the pond. Sooner of later the ripples from one stone must meet with another, and so on. Simply keep on initiating the merest of ripples until all those fools begin to see not all about this pond is a picture-postcard, landscape flattering, flat calm.

      Opinion upon cholesterol will change just so long as people are moved to become better informed about cholesterol and about the prospects for side-effects in takers of statins. My reasoning has it that 100% of takers must suffer physiological side-effect, not the least of which is interfering unnecessarily with the vital synthesis of vital cholesterol.

      Cholesterol is not the atherogen or cytotoxin it has been made out to be. On the other hand the cytotoxic and atherogenic properties of homocysteine and certain oxides of cholesterol ought not be in doubt, these are actually indicated by in vitro and in vivo evidence.

  6. jerome Burne 27 July 2014 at 11:38 am #

    It is interesting, not to say depressing and alarming, that the lead contender from the son of statin drugs waiting in the pipe-line, currently known as PCSK9 , is looking to get a license solely on its ability to lower cholesterol. Several months ago when the American authorities greatly expanded the number of people eligible for statins (NICE has just followed suit) there was talk of the FDA requiring evidence that drugs claiming to cut heart attack risk had to do more than show they could lower cholesterol.

    This caused something of a wobble in the shares of PCSK9, being developed by Merck together with Amgen, because it has never shown that it can do this and because it is expected to be hugely profitable with a price tag of around 20,000 dollars a year. But within a few days all was well. The FDA announced that in the case of PCSK9 the only requirement for a license would be to show cholesterol lowering.

    The interesting bit is that Merck also makes ezetimibe – a cholesterol lowering drug that has been on the market for about 10 years but has never been shown to cut anyone’s risk of heart disease.

    I’m not saying that any tinkering with data on PCSK9′s effectiveness is going to take place but it is the case that Merck was also the manufacturer of the an-inflammatory drugs Vioxx that significantly raised the risk of heart disease and which turned out to have had its data very thoroughly tweaked and was pulled from the market. The company eventually paid out about five billion to settle court cases.

    • dennis 28 July 2014 at 7:23 pm #

      I agree entirely with all that has been said about statins I shall leave it at that

  7. Peter 29 July 2014 at 12:13 pm #

    It seems to have been established that cholesterol is combined/conjugated with other materials in the blood and is laid down at sites of inflammation in arteries, ie plaque formation. Therefore if you reduce the circulating cholesterol you will reduce the plaque formation, this may well be true. HOWEVER, I have yet to see any evidence that cholesterol reducing drugs reverse already formed plaques.
    As these plaques will perhaps only be metabolised and removed once the inflammatory primers have been eliminated, it seems that the plaques will remain intact and the haemodynamics, ie, increased BP both systolic and diastolic, will not change. Therefore NO benefit to overall health will be seen.
    The best way to reduce/prevent plaque formation is to change the diet, a course of action which the Briffa has advocated for some years. Chuck out the sugar,(incl. chocolate most has >40% sugar in it) and the flowery margarines and the like, using salted butter instead. Bring back lard and beef dripping, yum, yum and make your cakes with these and then fill them with fresh whipped cream from the cow!! Aye and you wont get fat either!!
    I’ve had an elevated BP for some years and against my feelings was put on a course of A2 blockers, didnt really seem to do very much, and I resisted the demand to increase the dose.Recently I went into hospital for a hip replacement, and as I have a mild clotting factor defect and my eldest son had suffered a severe DVT, I thought about taking serropeptase. The consultant who did the job did not object. I asked for my meds just before the op. and was told you are not having a BP reducing drug before you go under a general anaesthetic. Subsequent BP measures in hospital showed my BP had gone down a bit (I still had a BP so they werent too woried!). COntinuing to take fairly high doses of serropeptase my BP has continued to fall and is about 125/90 OK for my age grrr. Serrapeptase has been used in Germany for 30 + yrs and is considered a perfectly OK regime for the treatment of elevated BP. It is believed to gradually remove plaques without big chunks breaking away and blocking important arteries.
    Serrapeptase is an enzyme breaking down effete or ‘dead’ protein. Silk moths have in their gut a species of Serratia bacteria which produces this enzyme. When the moth is ready to come out of its pupa it regurgitates it’s stomach contents and hey presto a hole is formed in the pupa by the dissolving action of the enzyme and the moth, otherwise unscathed, emerges! Just what the doctor never orders for removing effete proteins in the UK population!!

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