I dug back into the archives for this one, folks. This is the remastered version of ‘You get a statin, and you get a statin, and YOU get a statin!’ I’ll link to the full post below. I don’t think a day goes by that we’re not trying to undo the stamped in concrete mainstream narrative that cholesterol causes heart disease. It took long enough, but there’s a mounting number of physicians – including cardiologists – who’ve actually taken the time to learn the truth about this long held lie and are bold enough to speak out about it. If you’re interested in learning the real story behing cholesterol, heart disease, and statin medications, then this post is for you.
“Researchers report that only 35% of adults who are eligible to take statins for prevention of cardiovascular disease are actually using them. They said that misinformation about statins’ side effects could be a factor.”
-Medical News Today, Dec. 4, 2023
Reading scientific studies takes skill and practice. And caffeine…a lot of caffeine. Sometimes alcohol. The authors of these studies are assumed to demonstrate at least a modicum of integrity when conducting research. Otherwise, what are we even doing here? You’re not allowed to ‘cherry pick’ studies whose results don’t align with your interest. You’re not supposed to ‘pay people off’ to falsify study results. You can’t ‘change the endpoint’ of your study halfway through because the data isn’t turning out the way you predicted. And you certainly can’t ‘pull participants’ out of your study because they reported having side effects from your intervention/medication in order to make your results look better.
But they do. They do it all the time.
When you publish a paper, you’re expected to ‘disclose conflicts of interest’. Why? Because it’s unethical not to, that’s why. If you have no conflicts to disclose, it lends credibility to your research findings. It means what you’re saying is probably legitimate. Otherwise, I don’t know if I’m reading real information or just some shady shit.
It’s sad to say, but data-manipulated industry-funded ‘science’ forms the very foundation of mainstream medicine as we know it today. Studies cost money. Lots of money. Who has money? Pharma has money. If someone wants to promote a finding or make it disappear, it takes dollars to make that happen.
Heart Disease, Cholesterol, & Statins: Wading Through the Swamp
Evaluating the Real Risks & Benefits of Cholesterol & Statins
Heart disease is the number one cause of death in this country. Period.
For decades, it was believed dietary fat and saturated cholesterol were the drivers of this disease process. That conviction was so strong that the winners of the 1985 Nobel Prize for discovering statin medications (Michael S. Brown, Joseph L. Goldstein) predicted the eradication of heart disease by the early 21st century. Forty years and billions of statin prescriptions later, heart disease still sits in first place for death.
What is Coronary Heart Disease?
“Coronary heart disease is a type of heart disease where the arteries of the heart cannot deliver enough oxygen-rich blood to the heart.” -National Institutes of Health (NIH).
If you’re reading this, chances are pretty good you have a heart. Having a healthy heart is a big deal because your heart has a big job. It has to pump oxygenated blood through miles and miles of blood vessels to all the rest of your body. Or you will die. No oxygen means no working organs. That’s no good. The heart not only has to pump oxygen to your entire body, but it also has to pump oxygen to itself to keep working. Simply put, heart disease is when there’s a problem with your plumbing. A blockage in the system preventing oxygen from getting to arguably your most important organ – your heart.
Statins: Part 1
The ‘statins’ are a powerhouse class of medication used to lower cholesterol. The first statin medication was developed by Merck in 1987. Currently, there are eight statin medications approved for use by the FDA, and close to half of the American public is taking one.
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol)
- Lovastatin (Mevacor, Altoprev)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Ezetimibe/simvastatin (Vytorin)
More than a billion people worldwide are taking these drugs. Some quick math means Pharma is grossing more than a trillion dollars in annual revenue from the sales of statins alone. That’s because they work.
There’s no question that statins lower cholesterol. There’s no question that heart disease kills more people in this country than any other disease. The question is behind door number 3. Does cholesterol cause heart disease? Let’s get into it.
What We Thought Caused Heart Disease: A Short Story
Cholesterol, right? Too much red meat, too many eggs, too much fat? Everyone knows this. They told us that for years. Cholesterol is fat. Fat makes you fat. Stop eating fat.
Come with me on a brief walk down Memory Hole Lane, shall we? Let’s go all the way back to the 1950s…
Once upon a time, there was this guy. A scientist – a scientist bought and paid for by the sugar industry – a man by the name of Ancel Keys.
Ancel had a theory—one that would shape dietary guidelines for decades. One he no doubt came up without vested interest writing it on a napkin and slipping it into his pocket. He believed dietary fat and cholesterol were the root cause of heart disease. Sounds logical, no? So, he conducted a study, collecting data from 23 different countries. Unfortunately, he found there absolutely no link between dietary cholesterol and heart disease in 16 of the 23 countries, so he just threw those data in the garbage. And with the seven remaining country’s data, the, the lipid hypothesis was born.
The sugar industry, eager to keep its cash cow alive, threw its weight behind it, paying off Harvard scientists in the 1960s to shift the blame from sugar to fat. The result? By the 1980s, “low-fat” was the new health gospel, and cholesterol was the villain.
Cue the birth of statins.
The problem is that the entire premise of cholesterol causing heart disease has never been conclusively proven. In fact, multiple studies have shown that higher cholesterol levels are not only not harmful in many cases, but actually protective, particularly as we age. A 2015 study published in the BMJ Open analyzed 68,000 older adults and found that people with higher LDL cholesterol actually lived longer than those with lower LDL.
Yet, here we are, decades later, still handing out cholesterol-lowering drugs like candy.
Statins: The Multi-Billion Dollar Answer to the Wrong Question
Pharma saw its golden opportunity. If cholesterol was the bad guy, then a drug that lowers cholesterol must be the hero, right? Enter statins, hailed as the ultimate solution to heart disease.
But there’s a problem. A big one.
Despite decades of mass prescribing and promises of eradicating heart disease, heart disease remains the #1 cause of death. If statins were truly the miracle they claim to be, shouldn’t heart disease be disappearing?
So, what gives?
Saying goodbye to butter was tragic. Thankfully, at the same time we were told cholesterol and fat were evil, we were being told sugar was…good? Amen. Sugar’s still on the table.
Sure, it was. Just empty calories. Free bees. I remember learning in medical school that the only people who needed to worry about sugar were dentists. What’s to worry about? Filling cavities put their kids through college. Please. That’s job security.
Enter An Important Industry Character: Sugar
From a dietary standpoint, this wasn’t the end of the world. Who doesn’t like sugar? I loved sugar. That was an easy move for me. I don’t think I ate fat for 20 years. Remember Snackwells? Omg. ZERO fat in Snackwell cookies. Those little sandwich cookies were fire. I could eat an entire box in one sitting. Absolutely NO fat. Free calories. Just like drinking water or breathing air. Right? Upcoming posts on how drinking tap water and breathing chemical air will kill you
It seemed like overnight, fat was gone. Saturated fat was actually sentenced to solitary confinement. The food industry pulled all the fat out of food and replaced it with sugar. In addition to all the new low-and-no-fat foods on shelves, other exciting fake foods were ushered in to take the place of fat. Ultra-processed fully hydrogenated oils were used to make margarine, ‘vegetable oils’ (side note – they don’t use any actually vegetables to make vegetable oil), and deliciously flavored coffee creamers. What could possibly go wrong?
A few things, actually. Thirty years after the first statin medication was approved, and 40 years of us eating nothing but sugar, this unfortunate information was revealed:
“A newly discovered cache of industry documents revealed that the sugar industry began working closely with nutrition scientists in the mid-1960s to single out fat and cholesterol as the dietary causes of coronary heart disease and to downplay evidence that sucrose consumption was also a risk factor.”
Funny little world. The sugar industry in bed with the guys making cholesterol lowering medication? Well, slap me silly and call me crazy. Turns out science has been bought and sold since science was science. They lied. And they lied about lying. The University of California San Francisco (UCSF) published these inconvenient documents in the Journal of the American Medical Association (JAMA) revealing scientists were paid off to produce fraudulent studies implicating fat and cholesterol as the most likely causative factors in heart disease.
See? This is why you don’t lie. Lies always come out. Don’t do it. Just be honest.
Decades of industry sponsored research. Gazillions of dollars in hush hush agreements. Corruption at the deepest level between Big Sug and Big Pharm. Try as they did to make fat and cholesterol the root of heart disease, scientists knew it was something else altogether. Something they hoped to keep secret forever. But it was right there, hiding in plain sight.
It was sugar.
The internal documents confirm the ‘Sugar Research Foundation’ had a lot to lose, but even more to gain. When refined, sugar was like heroin. Processed sugar is eight times more addictive than cocaine. High fructose corn syrup is even worse. Just like the drug cartel, they paid off scientists – 3 Harvard professors to be precise. They paid them to produce studies showing sugar was good and fat was bad.
Can you believe this? I mean, this is Harvard. I never in a million years would have thought Harvard would hire anyone capable of falsifying their publications.
“Critics cheer resignation of ‘anti-Semitic plagiarist’ Harvard President Claudine Gay: Bye Felicia” -FOX, Jan 2, 2024
Sorry, I couldn’t help myself.
Fun fact – The documents uncovered by UCSF also disclosed one of the Harvard professors that was paid to publish fraudulent research on ‘sugar is good, fat is bad’ went on to be named head of the USDA.
You literally can’t make this shit up.
That same criminally run USDA went on to develop the 1977 dietary guidelines to restrict real, God-given foods like butter, red meat, and coconut oil because they “caused heart disease”. Eat all the processed sugar and refined grains that you want. Grains are the foundation of the Food Pyramid. Sugar is “an empty calorie”. Fat will kill you.
So fat was gone. Cholesterol was down. Heart disease rates should have hit the floor. Right?
No – that didn’t happen. Heart disease actually went up. Wayyy up. Rates of heart disease TRIPLED, to be precise.
OK – so we have Ancel in bed with Big Sugar and Big Sugar in bed with Big Pharma. We have an inconvenient truth that needs to be buried.
Time to call in Big Science.
Big Science Rescues The Lipid-Hypothesis
The Framingham Study
One of the major landmark trials sold to the public sealing the deal on the causal link between cholesterol and heart disease was the Framingham Study. This was a large study in Massachusetts that started in 1948. The investigators followed 5000 patients over several decades and published several risk factors observed to be associated with the development of heart disease, including diabetes, smoking, high blood pressure, and high cholesterol.
The investigators did find a correlation between cholesterol and heart disease. Home run for Pharma.
But it was only in a small subset of people in the study – people with something called ‘Familial Hyperlipidemia’ (FH). FH is a genetic condition which affects about 1 in 300 people. These folks have impressively high total cholesterol levels, typically over 300. In those patients, there was an observed correlation between high cholesterol and heart disease risk. Time for Industry to celebrate right?
Maybe not.
What was more interesting was that there was no difference in the cholesterol level between FH patients who developed heart disease and those who didn’t. What?? The gene responsible for causing FH also increases risk for clotting. That will be important to remember for later. So, to restate, Framingham studied thousands of people and their associations with various risk factors for heart disease. Here were their conclusions in terms of which increased risk:
Smoking? Yes.
Diabetes? Yes.
Hypertension? Yes.
High cholesterol? Well….
The cholesterol/heart disease correlation wasn’t found throughout the study. It was only observed in this one group of participants with really high cholesterol levels due to a genetic condition (FH). But when evaluating those participants as a separate group, there wasn’t any correlation between cholesterol levels and heart disease. That detail may have been incidentally left out of the study findings.
A completely unreported finding was that as cholesterol levels went down in older participants, mortality went up. So, if you were 65 or older, death from any cause went up as cholesterol went down.
According to Framingham, you want MORE cholesterol as you get older, not less.
The Numbers Game
I’m going to sidebar over here to something that makes me positively crazy: misleading statistics.
Mark Twain said it best, “There’s liars, damn liars, and statisticians.”
The results of your drug trial suck? Who cares. We’ll make them look good by spinning the numbers. Scientists can turn shit into gold with statistical manipulation. You’d be absolutely amazed – or horrified – at the mathematical gymnastics done by some investigators before submitting their studies for publication.
Outside of downright lying, how can they say this? We all know that isn’t true. They can get away with this by mixing and matching how they report two important statistical terms: relative versus absolute risk reduction. These are similar but very different ways to view the potential benefit a medical intervention might have.
I absolutely hated statistics in college. You are likely going to hate me for the same reason after reading this section, but it’s important so hang in there with me for a minute…
Absolute risk reduction is a real number. Let’s say we do a study where 10 out of 100 people in our control group (no treatment group) have a heart attack. In our treatment group, only 5 out of 100 people have a heart attack. The absolute risk reduction is just the difference between the two risks: 10% – 5% = 5%. Boom. That’s it. 5% fewer people had a heart attack because of the treatment.
Relative risk reduction is statistical gymnastics. It shows how much risk is reduced in relative terms compared to the original risk. See, it already sounds shady. The relative risk reduction is calculated as the absolute risk reduction divided by the risk in the control group. In our above example, that would be 5% / 10% = 0.5, or 50%. Wow! That sounds much more impressive, doesn’t it? This means the treatment reduced the risk of a heart attack by 50% compared to not getting the treatment.
Even if that sounded all gobbledygook, you can see how I took the same exact study findings, the words ‘risk reduction’, and arrived at two totally different conclusions. That vaccine reduces my risk by 5%? No thank you. By 50%? Well, maybe.
Absolute risk reduction is also referred to as ‘Numbers Needed to Treat’ or NNT. It’s the inverse of the absolute risk reduction and it’s just what it sounds like. How many people need to take this drug to prevent one heart attack? In our little study here, the NNT is 20 (1/5%). Twenty people need to take the medication for one of them to avoid a heart attack. That also means 19 of those people get ZERO benefits but are subject to the same potential for harm or side effects from the therapy.
Apologies for grinding you through this, but this very basic misunderstanding of benefit and risk is extremely common among medical professionals. It’s referred to as ‘health illiteracy’ because your doctor is just as illiterate about statistics as you probably are. Physicians are taught about informed consent. But I took statistics in college – not med school. I bet any money if you asked your doctor if the risk reduction they were referencing was absolute or relative, they would have no idea what you’re talking about.
Keeping everyone in the dark about the numbers makes us all easy to manipulate. Science uses absolute risk to report potential harms and then turns around to use relative risk to report benefit. It’s insane. But it’s classic industry B.S.
This is one of my favorite examples:
Comparison of absolute & relative risk benefits of cholesterol reduction in the JUPITER RCT
Data from the “Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin” (JUPITER) randomized controlled trial (RCT) [20], expressed as the percent of subjects in the rosuvastatin group (Crestor) compared to the placebo group without myocardial infarction (MI) mortality.
The JUPITER trial was massive. It included an incredible 18,000 participants. It was perfectly positioned to lay down the hammer on any doubt the industry had on its superstar statin, Crestor, and it’s earth-crushing power over heart disease.
“Dr. Steven E. Nissen, director of cardiology at the Cleveland Clinic, proclaimed, “It’s a breathtaking study. It’s a blockbuster. It’s absolutely paradigm-shifting,”
Paradigm shifting?! omg. Are you ready for it? Participants taking Crestor had a 54% relative risk reduction in deaths due to heart attacks. WOW. 54%?? That’s incredible! Call the White House! It sounds almost too good to be true – until you do the rest of the math.
54% relative risk reduction converts to a 0.41% absolute risk reduction.
To be clear, the landmark study that had everyone wetting their pants over Crestor had a 0.41% absolute risk reduction. Less than one half of one percent of study participants experienced benefit. And these odds are the best of the best – a drug company funded the trial. This is their own data – the link is below. Check it out for yourself. I wish I was lying to you.
Less than one half of one percent benefited from taking Crestor.
This mentally ill math is done to intentionally mislead consumers. Pharma knows how to spin data, cherry pick it, extort it, and when it’s not convenient, make it just disappear. It’s unethical, it’s immoral – it’s outright deception. This is the madness which results in malpractice.
Statins: Part 2
Should I take a statin?
I am a medical doctor, but I might not be your medical doctor. This is not medical advice. This is just me telling you the numbers based on the statistics I just taught you against your will. If we look at the data in terms of Relative Risk reduction, it doesn’t look too bad. If we remove the smoke and mirrors, however, it’s just plain terrible. Here’s what we know from the available data on the potential benefit of statin therapy which comes almost exclusively from industry sponsored trials citing data couched as relative risk reductions. So even with the shenanigans, this is as good as they can make the data look:
- High Risk People (known heart disease or high risk for heart disease in the next 10 years)
39 people need to take a statin every day for 5 years to prevent one non-fatal heart attack .
- Low Risk People (less than 10% chance of having a heart attack or stroke in the next 10 years)
217 people need to take a statin every day for 5 years to prevent one non-fatal heart attack.
I don’t know about you, but I find this underwhelming at best. Want to know what the “Numbers Needed to Treat” for Tylenol is? Tylenol?? It’s TWO. You need to treat two patients with Tylenol for 30 minutes to alleviate ONE headache. Even that is pathetic.
I should also mention here that in addition to being almost all industry-funded trials, the researchers removed any participants who had side effects from the statin medication. It’s called a “pre-randomization run-in”. Just helps them pick ‘the most suitable candidates’ for the study.
lol, ok.
If you have had a heart attack, your cardiologist is going to put you on a statin. Period. Without even knowing what your cholesterol is you are leaving that hospital on a statin. Let’s say you take that statin medication for 5 years without side effects (because remember they took those people out of the trials), you do so with the understanding that if you don’t, you’re gonna die. Maybe not tomorrow, but sooner than you otherwise would have – right? OK. On average, if you take that statin for 5 years how much would you think taking it would add to your days here on earth? A few extra months? Several years? Nope. Guess again.
4.2 days.
4 days? Are you serious?? Those had better be some good days…
Statins: Part 3
How Do Statins Work?
We know unequivocally that statin medications lower cholesterol. No one is debating this.
Statin side effects are extremely common, however. More than 50% of patients who have been prescribed one stop taking it within one or two years due to side effects. Pain and fatigue are the most reported adverse events, but there are others to take note of. These medications are not benign – they carry real potential for harm.
No drug is without risk. No good comes without some degree of danger. We don’t always jump into something for which the full extent of risk is known. I get that. But we know there are well-established risks associated with statin medications. You should be ‘informed’ of what they entail. Here are some of them:
- Liver toxicity
- Muscle damage
- Memory loss
- Erectile dysfunction
- Increased diabetes risk
- Mitochondrial damage
In contrast to their potential harm, we believe statins have two slightly beneficial effects on the body: they lower inflammation and decrease the risk of clotting. Given that heart disease is one which involves both inflammation and clotting, this is interesting. These effects might explain why patients who have already had a heart attack seem to demonstrate slight benefit from taking these medications.
The Real Deal On Cholesterol
Look, cholesterol is important. We know this because every single solitary cell in your body makes it. Cholesterol is a key component of every cell membrane. Your brain is a great big ball of cholesterol. There are rare genetic disorders that can occur resulting in an inability to produce cholesterol. These babies don’t survive. Low cholesterol isn’t ‘good’ – often it’s bad. Low cholesterol is associated with shorter life expectancy, mood disorders like depression and suicidality, and low hormone levels,
Cholesterol is essential. You need cholesterol to make estrogen, testosterone, DHEA, synthesize vitamin D and to build every single solitary cell membrane in your whole body. You make cholesterol for a reason – and it isn’t to kill you from heart disease.
Bottom line is this: Cholesterol does not and cannot cause heart disease by itself.
Heart disease is an inflammatory disease that the liver is trying to repair. Cholesterol is sent to damaged arteries to repair them. It is insulin resistance, oxidation, and endothelial damage that result in cholesterol being found at the scene of the crime. That’s why we find it there. It isn’t causing the problem; it’s there to help fix the problem.
You arrive home to find your house is on fire. You see the fire department is there. Did the firemen set the fire or are they there to put it out?
Is there a correlation between cholesterol and heart disease? Sure, there is. But it is not at all straightforward, and clearly not causational. The conclusion that cholesterol simply causes heart disease is weak at best. There is an association between the two because of multiple other factors.
What Really Causes Heart Disease
I think I’ve demonstrated that cholesterol is not the defacto cause of heart disease. Here’s the real story. Heart disease is a disease of the immune system. It is the result of inflammation and clotting. This increase in clotting and inflammation is largely the result of something called insulin resistance. Poor lifestyle choices, ultra processed foods, lack of exercise, and smoking contribute to this vascular inflammation. When the arteries serving the heart (and everything else) become inflamed, they become damaged. The liver attempts to heal this damage by sending out a repair crew of phospholipids, protein, and cholesterol. THAT is why we see changes in lipid levels in the setting of coronary artery disease.
- Chronic inflammation due to insulin resistance
- Endothelial damage
- Oxidation of LDL cholesterol
- Arterial plaque formation and progression
Most people have absolutely no idea that they are walking around with pre-diabetes, insulin resistance, or metabolic syndrome. These are the real killers.
Statin medications absolutely, unequivocally lower cholesterol. If they have any cardiovascular benefit, however, it has nothing to do with their effects on lipids. Statins have two other mechanisms of action: they have anti-inflammatory properties and a slight blood thinning effect. I would liken their benefit to that of aspirin. Perhaps this explains the Framingham findings in patients with FH.
So I will concede that statins do have some benefit in some patients – benefit similar to that of aspirin.
The attack on total or LDL cholesterol is completely misguided. We have so many other biomarkers that are far better.
- NMR CardioIQ
- Fasting insulin
- Hemoglobin A1c
- Coronary calcium score
- hsCRP
- Homocysteine
- Total cholesterol/HDL ratio
- Triglyceride/HDL ratio
What can I do to lower my risk?
Lots. Start here:
- Control your blood pressure (ideally <120/80)
- Control your blood sugar (hemoglobin A1c should be <5)
- Don’t eat ultra processed foods
- No refined carbohydrates
- Correct insulin resistance (fasting insulin <5)
- Keep moving – but knock it off with the triathlons already
- Manage Stress
- Quit smoking
- Take supplements to improve immune system function and insulin sensitivity
The ‘lower the better’ for total and LDL cholesterol dogma is over. Like most things in the health space, reducing risk for heart disease comes down to largely diet and lifestyle measures. I’ll close on my data destroying campaign with this article published three months ago in the British Medical Journal. You’ll see why there is obviously no industry funding here. This work was the result of a 22 year trial on 177,860 participants aged 50-89 without diabetes, not on statin therapy. Take us on out, gentlemen:
“Is LDL cholesterol associated with long-term mortality among primary prevention adults?
A retrospective cohort study from a large healthcare system.”
Kevin E Kip, David Diamond, Suresh Mulukutla, Oscar C Marroquin – BMJ, March 18, 2024
- Low LDL cholesterol linked to higher odds of dying from cardiovascular mortality.
- LDL of 100 to 189 mg/dl had the lowest risk of long-term mortality.
- High total cholesterol or high triglycerides to HDL ratio increased risk of heart attack.
- Only a fraction of people with cardiovascular events have high cholesterol.
Conclusion
While statins have a well-documented effect on lowering cholesterol, the rest of the story leaves us in a bit of a quandary. We’ve established a few inconvenient truths here:
- LDL cholesterol does not cause coronary disease
- High cholesterol is protective against all cause mortality in older patient populations
- Statins do not appreciably decrease cardiovascular risk
- Outside of slight anti-clotting/anti-inflammatory properties, statins have an unfortunate side effect profile
- The low fat, high carbohydrate diet increases risk for insulin resistance
- Insulin resistance is the number one driver of atherosclerosis
- Metabolic biomarkers like triglycerides, HDL, hemoglobin A1c, and fasting insulin are much better indicators of risk and of the real pathophysiology that drives heart disease
But that’s just what the science shows.
Before making any medical decisions, you deserve fully informed consent. Don’t ever just blindly accept a prescription from your doctor and walk out the door. You want to understand what’s wrong, what your treatment options are, what are their risks and benefits. Ask questions, expect answers. Your doctor should have them or at least be willing to find them. If not, look for one who does. In the end, it’s you who makes the call in accordance with that you believe is best for your body given the best possible information.
Don’t forget – you are the patient. It’s your body. Us doctors over here? We work for you.
It’s essential for both patients and healthcare providers to consider the bigger picture of disease prevention. I always go back to this mantra in my head:
The further away we get from nature, the more we fuck it up.
I don’t believe statins are going to save us from heart disease. In the end, keeping those heart vessels open is about way more than cholesterol. It’s about nurturing the entire system – from the food we eat, to the way we move, to the time we dedicate to sleep, to the way we manage our perceived stress. Our system operates as one cohesive network of energy. We need to optimize each and every part of it to ensure our heart has the best chance to thrive.
Take good care of your heart. It‘s the only one you got 🙂
