Cholesterol not the killer it’s touted to be, CBC documentary says

A documentary about cholesterol and the medications that regulated called statins suggests that drugs are overprescribed and unnecessary for many

Drugs long thought to prevent heart attacks by lowering cholesterol do not provide a one-size-fits all solution, a new documentary suggests.

The Cholesterol Question, airing on CBC’s The Nature of Things Thursday Oct. 30, delves into the medications called statins; drugs that are among the most prescribed in the world.

It turns out a high cholesterol level doesn’t necessarily mean a heart attack or stroke is around the corner.

“There are far more powerful risk factors for developing plaque in the arteries,” says Dr. Barbara Roberts, a medical professor at Brown University, and director of the Women’s Cardiac Center at Miriam Hospital in Rhode Island.

Smoking, diabetes, obesity, high blood pressure, a sedentary lifestyle and strong family history of heart disease are far more significant, Roberts says. She has researched and treated lipid disorders since the 1970s and is an outspoken critic of widespread statin usage with her book The Truth about Statins: Risks and Alternatives to Cholesterol-Lowering Drugs.

“Cholesterol is a relatively weak risk factor,” Roberts says.

So why the emphasis?

“Because we have a class of medicines that is marvelous at lowering cholesterol,” she says. “But just because you lower cholesterol, doesn’t necessarily mean you lower risk.”

Cholesterol is a fat-like substance made in the liver and found in certain foods like eggs, meat and dairy products.

Low density lipoproteins (LDL) are considered “bad” cholesterol, as they can cause plaque buildup in the arteries. High density lipoproteins (HDL) are considered “good” cholesterol, helping the body to get rid of LDL. Non-HDL cholesterol, called triglycerides, is another type of fat.

The general school of thought is to get LDL levels as low as possible.

The film follows Aaron Holm, a Toronto-born software professional now living in Seattle, who has hypercholesterolemia and has been urged by doctors for 20 years to take statins. Holm, 42, was in his early 20s when a routine blood test showed off-the-chart cholesterol levels.

But after a bad drug reaction for an arrhythmia, his instincts told him to avoid medication — particularly because he felt fine.

“I was playing varsity volleyball at the University of Toronto,” he says. “My body felt great and it didn’t feel any different than it had before I was told I have high cholesterol.”

Holm did plenty of research and read everything his loved ones sent him. Every few years he’d see a doctor and get similar test results, then ignore their advice.

He has always led a healthy lifestyle, with plenty of exercise and a good diet.

Roberts, who is featured in the documentary, has led studies over the last 40 years and criticizes the way pharmaceutical companies interpret data. In particular, women and men are vastly different with how cholesterol levels and medication impact them, she says.

In men a risk factor is high LDL. In women, high LDL levels are not shown to cause any increase in heart disease, Roberts says.

Then there are the side effects of statins, including muscle pain, muscle damage, increased risk of diabetes and cataracts, fetal defects when taken during pregnancy, liver and kidney damage.

“These are not innocuous medicines,” Robert says. “And we know that just eating a plant-based Mediterranean-style diet lowers your risk…with no side effects.”

The largest studies examining men with vascular disease show absolute risk reduction with statins is modest, at best, she says: 6 per cent for men. It’s even lower for women. Yet calculations can be made for a “relative” risk reduction of up to 30 per cent, and those are the figures given to doctors and publicized.

“You can game the system,” Roberts says. “These randomized double-blind controlled trials are supposed to be the gold standard for clinical research, but there are lots of problems with them.”

Doctors told Holm for years he’d never make it to 40, so he learned to live in the moment. Then children came along, so he decided to take further tests, which he does in the film. Tests show that his arteries are thickening, although plaque is not building up.

And though he’s leaning toward starting the medication in the film, he once again decided against it.

“I know exactly what my body feels like and it hasn’t changed at all, which makes all of this very abstract,” he says. “I’m good at listening to my body. If I need more sleep, I get more sleep. If I need to eat differently, then I eat differently.”

The film concludes that cholesterol — even from saturated fat — is not as big a risk factor as people have been led to believe. Processed foods and refined carbohydrates, particularly with sedentary lifestyles, are the real culprits.

“Let’s all eat eggs and lots of green, leafy vegetables, lots of olive oil,” Roberts says.

http://www.thestar.com/

Unfortunately the documentary is only available in Canada.

Graham