❤ Do statins work in those who never had heart disease?

Statins are the most widespread prevention medications to manage high cholesterol and reduce the risk of heart disease.

They are often prescribed to those who have not had heart disease yet, but have high cholesterol as a preventative measure.

But, do statins really help prevent heart disease in those who have not had it yet?

The results from the best trial on statins - The JUPITER Trial - showed that statins actually increase the risk of death from cardiovascular disease.

At best, statins can help reduce the risk of death from cardiovascular disease by only 0.39% per year. This means that statin treatment can help prolong lifespan by only a few days on average.

Statins can help lower LDL-C (aka ‘bad cholesterol’), but this benefit was not translated into a lower risk of death from cardiovascular disease.

Indeed, despite countless studies on the benefits of statins on lowering LDL-C cholesterol, there is no research that shows causality (i.e. exposure-response) between statins and lower mortality.

The question remains: If high LDL-C (aka ‘bad cholesterol’) was the major cause of cardiovascular disease, shouldn't the benefits from statin treatment be better the more LDL-C is lowered?

🥊 Punchline

When prescribed for primary prevention (e.g. proactively before cardiovascular disease happens), statins fail at achieving this.

❤ Do statins work in those who have already had heart disease?

Chances are, if someone has had a heart attack, the first medication they’d get is statins.

But, do statins really help reduce the risk of a second cardiovascular event?

No research after 2004 has shown a significant benefit from taking statins.

Some trials show a small reduction (less than 1%) in the risk of death from cardiovascular disease per year.

But many trials showed a greater risk of death in treatment group, prompting the researchers to stop the trials early before this number becomes statistically significant.

This is likely explained by the importance of cholesterol in older adults. Total cholesterol in the blood naturally increases with age and is essential for the making of hormones and protection of bones (vitamin D, testosterone, other steroid hormones made from cholesterol), prevention of dementia (brain cells are all made of cholesterol), and immunity (LDL is part of the immune system). In fact, high total and HDL-C (aka ‘good cholesterol) is associated with longevity.

Furthermore, lean individuals can tolerate a relatively high LDL-C (aka ‘bad cholesterol’) because they use fat efficiently. And so reducing blood cholesterol to a minimum, especially in older individuals, may not be the best treatment option.

🥊 Punchline

Although statins may offer preventative benefits in people who already have cardiovascular disease (CVD) and abnormal blood fats, the idea that high cholesterol levels are the main cause of CVD has been increasingly challenged. People with low cholesterol levels suffer from CVD just as people with high cholesterol levels, and their risk of suffering from CVD is the same or higher.

❤ Why is the research on statins so inconsistent?

We covered how taking statins before or after a heart attack to reduce the risk of CVD may not be beneficial.

But why? Let’s understand some context first.

Before 2004, pharma research didn’t need to be independently analysed by scientists.

The 4 major studies on statins show a significant reduction of a cardiovascular event when statins are used as a treatment.

Conveniently, all these studies were conducted before 2004. And so, data was not independently investigated or re-analysed by scientists because of the ring-fencing of this data.

However, a 2004 scandal changed how research is investigated.

In 2004,  VIOXX - a prescription medication used to treat pain and inflammation caused by arthritis, acute pain, and menstrual cycles - killed thousands of people. This drug was prescribed even though it increased the risk of heart attack. The pharma manufacturer conducted, manipulated and selectively published data, willingly ignoring the negative outcomes.

VOIXX was immediately removed from the market, and new guidelines were introduced to increase transparency and scrutiny on trials conducted my pharmaceutical companies.

Going back to statins, no research after 2004 has shown a significant benefit from taking statins.

A study even divided trials into 2 groups: pre-2004 & post-2004. After the bias is removed from the trials, the benefits of statins seemed to have disappeared to a very marginal number.

🥊 Punchline

The inconsistency in research on statins is largely due to the lack of independent analysis before 2004, which led to biased results that were later corrected by more stringent guidelines and transparency measures introduced after the VIOXX scandal.