I had an email recently from a journalist friend of mine this week which included a communication he’d had from a reader. The reader had been refused health insurance on the basis of his ‘raised’ cholesterol. It was suggested to him that he would be eligible for insurance once his cholesterol ‘problem’ was ‘under control’. His doctor suggested statins. However, he was concerned that the risk:benefit ratio for statins was weighed more heavily in favour of risk. He took umbrage at the fact that he was being forced to take “poison” (his words) in exchange for insurance.
I have to say, I have enormous sympathy for this man’s plight. I don’t know his medical history, but the likelihood is he has no history of prior ‘cardiovascular’ disease or events such as heart attack and stroke. This would put him into what is termed the ‘primary prevention’ category.
The majority of people who take statins fall into this category, and even quite conventionally-minded researchers have started to ask questions about the appropriateness of statins in this group. It is a plain and simple fact that while statin use are limited in their ability to prevent heart attacks. Studies show that around 1 or 2 in every 100 men treated with statins will be spared a heart attack. In other words, 98-99 per cent of men will not benefit in terms of heart attack prevention.
The risk of significant side-effects from statins is not inconsiderable, either. They increase the risk of type 2 diabetes, and also a significant minority will suffer side effects such as muscle pain, fatigue, mental symptoms, liver damage and kidney damage. Last week one of my blog posts highlighted the idea that statins may also be contributing to weakening of the heart muscle known as ‘heart failure’ or ‘congestive cardiac failure’. An unbiased review from 2010 concluded that statins don’t have overall benefits for healthy people.
So, chances are the man who was refused insurance would not see any improvement in his health as a result of taking statins. If anything, his health is more likely to suffer. Yet, if he were to take statins and see a subsequent reduction in his cholesterol, he would apparently be eligible for health insurance.
This, to me, seems an utterly mad situation and one which serves neither the man nor the insurance company. But it’s the sort of situation that can arise all too easily when insurance companies become convinced that cholesterol levels are a major arbiter of health (they are not). Lowered cholesterol does not assure improved health or health risks over time, but the common thought is that it does.
A similar situation seems to exist with regard to life insurance. I was recently talking with a business executive who told me his life insurance premium had tripled on the basis of a recent test which revealed a ‘raised’ cholesterol. He was informed that if he got his cholesterol level down, his premium would fall too.
The suggestion here, of course, is that by taking statins and reducing cholesterol, this man would be less likely to die. However, in the primary prevention category, statins do not reduce overall risk of death. Again, insurance company policy seems out of step here with what the evidence shows.
The people who establish such policies and calculate insurance premiums are usually professionals known as actuaries. Not all actuaries, it seems, are similarly blinded. Back in 2011 the trade magazine The Actuary carried from a piece from an actuary to deftly disassembled the cholesterol theory (you can read about it here). Let’s hope that more professionals in the insurance industry catch on.
In related news, Merck have withdrawn a cholesterol reducing drug on safety concerns – http://uk.reuters.com/article/2013/01/11/business-us-merck-cholesteroldrug-withdr-idUKBRE90A0MB20130111
I personally know of a healthy young man living in Canada, and fully employed, whose employer refusues to pay an annual bonus if your cholesterol numbers are not within the government guidelines. Talk about blackmail!
Here’s the link PhilT was talking about – the one above didn’t work for me but I found this one – http://uk.reuters.com/article/2013/01/11/us-merck-cholesteroldrug-withdrawal-idUKBRE90A0MB20130111
Call me a cynic, but no doubt the Insurance companies are hand in glove with some drugs companies. Pimp our statins, and we will convince people it’s good to lower cholesterol, because you get cheaper premiums. This angers me so much. It’s a blatant con, and strictly speaking it is in contravention of the Trading Standards legislation. But who, among the people who really could stop this nonsense, is going to risk being called a heretic? We are at their mercy because of dogma that is almost religious in its fervor.
Re the point about Merck withdrawing a “cholesterol reducing drug”.
The drug – Tredaptive – is actually an HDL cholesterol raising drug. HDL cholesterol is often referred to as “good” cholesterol as people with higher levels tend to have lower rates of heart attack. So for some time drug companies have been trying to develop drugs to do that, without any success – one called torcetrapib pushed it up by 30% but also increased your chance of dying from a heart attack
The lifestyle changes that protect the heart – diet exercise etc – also push up HDL without the side-effect and so does the B-vitamin niacin as well as lowering LDL.
Tredaptive was a combination of niacin and a drug called laropiprant that prevents the flushing effect that comes with niacin that some people find very unpleasant.
In the trial that showed no benefit for Tredaptive that lead to its withdrawal it was given as an add-on to statin therapy but it failed to lead to any improvement.
What has never been tested is exactly what effect laropiprant has. Not clear if it reduces effect of niacin or if it causes side effects.
The Merck announcement of withdrawal claimed serious side effects but in its release in December gave no details.
So still a lot of uncertainty.
There is a good discussion of all this on heart.org at: http://www.theheart.org/article/1490635.do
It’s outrageous that insurance companies would use cholesterol as a marker. My mum was on statins for many years (thankfully not anymore) and the daily joint and tendon pain she was having was apparently due to her “age” or the wrong kind of statin. Funnily enough, since coming off them – no more pain.
My son works at Whole Foods. He is a slim and amazingly healthy young man who radiates well-being. He has followed a low-carb, paleo, grain-free diet for many years to treat his “ADHD” and eats more mindfully than anyone I know. Every year, Whole Foods employees are required to take an health “biometrics” assessment and based on the results may qualify for an increase in the employee-discount. The past two years, my son has scored “platinum” on every marker except for LDL and total cholesterol. Of course, his total cholesterol is high because his HDL is through the roof and his calculated LDL is higher than recommended because of his high HDL and low triglycerides. But, that is enough for him to be denied the increase in the discount and to be counseled to lower his LDL/total by decreasing dietary fat. He is quite frustrated by this, but, of course, will not change his diet!