We can say that the American Heart Association and the American College of Cardiology have concluded that virtually every older person should be on a statin, regardless of risk factors. You could be a vegetarian and a marathon runner and it wouldn’t matter. The guidelines encourage all men over 63 to take a statin and all women over 70 to be on such drugs.
The Cholesterol Hypothesis Under Fire:
Over the last couple of decades we have seen a number of health professionals resist the tidal wave of enthusiasm for a statin in every medicine cabinet. Most of these physicians have been general practitioners or internists. But there is now a cardiologist and lipid specialist who has joined their ranks.
Robert Dubroff, MD, was an associate professor of medicine in the Division of Cardiology at the University of New Mexico in Albuquerque, NM. He is a lipidologist, which means he understands cholesterol and its impact on blood vessels better than most health professionals. Dr. Dubroff recently retired and has written some intriguing articles. His most recent is titled “Cholesterol Paradox: A Correlate Does Not a Surrogate Make” (Evidence Based Medicine, March, 2017).
A Cardiologist Challenges His Colleagues
Dr. Dubroff introduces his article this way:
“The global campaign to lower cholesterol by diet and drugs has failed to thwart the developing pandemic of coronary heart disease around the world. Some experts believe this failure is due to the explosive rise in obesity and diabetes, but it is equally plausible that the cholesterol hypothesis, which posits that lowering cholesterol prevents cardiovascular disease, is incorrect. The recently presented ACCELERATE trial dumbfounded many experts by failing to demonstrate any cardiovascular benefit of evacetrapib despite dramatically lowering low-density lipoprotein cholesterol and raising high-density lipoprotein cholesterol in high-risk patients with coronary disease.”
Dr. Dubroff refers to a randomized clinical trial called ACCELERATE. It undermined the very foundation of the cholesterol hypothesis of heart disease. That’s because the new drug evacetrapib was just about the perfect medicine. It lowered “bad” LDL cholesterol 37% and also raised “good” HDL cholesterol by 130%. No single drug has ever accomplished such impressive changes in the directions most cardiologists strive for.
The trouble was that despite such stellar numbers there was no benefit in terms of things patients care about. The drug did not reduce cardiovascular events or reduce deaths in high-risk patients.
More Bad News for the Cholesterol Theory:
Dr. Dubroff also points out that:
“Many experts cite numerous RCTs [randomized controlled trials] of statins in support of the cholesterol hypothesis, but we should not ignore the dozens of cholesterol-lowering trials that do not…Even when researchers demonstrate a statin mortality benefit, the findings are underwhelming. A recent analysis concluded that statins would only postpone death by a median of 3.1 and 4.2 days for primary and secondary prevention, respectively.”
That was after years of statin use. For example, the famous 4S study produced survival gains of 27 days after 5.8 years of simvastatin therapy (BMJ Open, Sept. 24, 2015). That extra month of life was in very high-risk patients who either had already experienced a heart attack or were suffering severe symptoms of heart disease. In trials where people were at lower risk of a heart attack, the life-extending potential of statins was substantially less than a month. That was even after years of treatment.