It’s official: forget about cholesterol and LDL
A couple of weeks ago, we changed the subject and engaged with the debate started by the ABC’s catalyst program on cholesterol and heart disease and statin drugs. Once a month I attend a book club evening at my friend Andrew’s place, where we discuss fine literature and drink fine wine.
Fine wine attracts medicine men, and at the meeting last Wednesday we had a robust debate about the cholesterol and statin story until the wines induced more mellow feelings. I really want to get away from this subject now, but the story just gets worse and worse – see NEWSFLASH below.
Other viewpoints
Our friend Bill is a true believer, and has written two posts by way of his counterpoint:
http://scepticalnutritionist.com.au/?p=1121#more-1121
http://scepticalnutritionist.com.au/?p=1201#more-1201
Norman Swan at the ABC is on Bill’s side
So is Lyn Roberts, the head of our heart foundation.
Newsflash: Risk Calculator for Cholesterol Appears Flawed – New York Times, Nov. 17
From the article by Gina Kolata: ‘The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines. “It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”
The controversy set off turmoil at the annual meeting of the American Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night … ‘ Steven Nissen used the calculator for a 60-year-old African-American man and a 60 year-old white man, both with no risk factors — normal cholesterol and blood pressure, not diabetics or smokers. They both had a 10-year risk of 7.5% and should therefore be prescribed statins.
Dr Malcolm Kendrick reported similar results from his calculations for healthy males. ‘Women get another seven years of statin free life,’ he reports. ‘A super healthy woman, with optimal risk factors, reaches the dreaded 7.5% risk aged 70. An ‘average’ healthy women, with average BP and cholesterol levels, would have to start a statin aged 63.
Kendrick’s post is headed You need a statin – now what was the question? Obviously the question for the American Heart Association and the American College of Cardiology was: how do we get everybody on these drugs?
The answer, in Dr Kendrick’s words, is this: ‘So, there you are. You can do absolutely everything ‘right’ and be as healthy as healthy can be – according to the AHA and ACC. Yet, by the age of sixty three you need to take a statin – for the rest of your life.’
New Guidelines will double statin drug prescriptions
Just as we’re debating this complex topic, the American Heart Association comes to our rescue with new recommendations. Lowering cholesterol is no longer the main game, and lowering LDL was a dead end. So is this the end of this awful era of bad science built on bad assumptions? Will sanity prevail at last? Do the new guidelines address the over-prescription of statins?
No, they effectively double the target population for them: US heart panel recommends statins for a third of US adults.
This prompted two cardiologists to write an op-ed piece in the New York Times under the heading Don’t Give More Patients Statins. Why the plea? ‘This announcement is not a result of a sudden epidemic of heart disease,’ say Drs Abramson and Redberg, ‘nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else.’
The new guidelines have lowered the bar for statin prescription to a 7.5% risk of heart disease or stroke over the next 10 years, compared to the previous guidelines’ 10 to 20% risk. With the stroke of a pen, the AHA has doubled the number of people who need statins.
Bad cholesterol?
Another more surprising stroke of the pen has crossed the arch villain of heart disease (LDL) off the list of risk factors. After giving millions of people sleepless nights worrying about their LDL levels, leading cardiologist Steven Nissen told the press: ‘The evidence was never there’( for the LDL targets). Past committees ‘made them up out of thin air.’ No, I’m not making this up.
Bad Science?
The authors of the op-ed piece make the following 3 points:
· The new guidelines would be helpful ‘if statins actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects. However, none of these are the case.’
· The new guidelines are not supported by objective data;
· The group that wrote the recommendations had conflicts of interest, i.e.’ recent or current financial ties to drug makers. In addition, both the American Heart Association and the American College of Cardiology … are heavily supported by drug companies.’
A recent BMJ report (British Medical Journal) also deplored the ‘… widespread financial conflicts of interest among the authors and sponsors of clinical practice guidelines [which] have turned many guidelines into marketing tools of industry. Financial conflicts are pervasive, under-reported, influential in marketing, and uncurbed over time.
Bad advice?
The reaction across the Atlantic was not enthusiastic. The UK Telegraph ran this headline: ‘Wider use of statins ‘disturbing’ And the cardiologist cited here writes in the BMJ that it’s time “to bust the myth of the role of saturated fat in heart disease,” and points out that since we started following advice to remove it from our diets, cardiovascular risk has gone up. … Now evidence is piling up showing that sugar could be an independent risk factor for metabolic syndrome …’
When two Irish doctors conducted a study and reported ‘a categorical lack of clinical evidence to support the use of statin therapy in primary prevention,’they were gagged by the Health Service Executive. In their BMJ paper, they stated that ‘the superiority of exercise over drug therapy extends even to secondary prevention (where patients have developed disease).‘
Comes back to the point I made in the original post below: eat real food and get off your butt, often. And here’s a good piece of advice from a Crikey.com reader: ‘There seems to me to be a very simple method for non-scientists to sort out the truth from the BS in these debates: FOLLOW THE MONEY
· Climate Change? The big bucks are with the deniers
· GM? The big bucks are with the pushers. Biotechs.
· The Cholesterol CHD theory? The big pushers are big pharmas.’
Hope that helps
Kim
More resources
USF professor gains national attention after nutrition myths video goes viral