Lowering High Cholesterol

What you need to know about cholesterol, what is normal, and how to lower it – and the downsides and alternatives to statins.

Promise of longer life a myth

A study in the Lancet found that in these cases, even though the drugs prevented a few heart attacks, none of the patients lived any longer as a result. That’s bad enough – if you are told this pill will cut your risk of a heart attack, you assume that it will also make you live longer. But it gets worse. Men over 69 didn’t benefit from taking statins at all, they didn’t live longer and didn’t have fewer heart attacks, and women of any age didn’t benefit either. That’s right, not at all.

According to the study’s author, Harvard professor John Abramson, you do benefit a bit if you have a high risk (eg high cholesterol or are overweight) and you’re aged between 30–69 years. But the amount is hardly impressive. Fifty of you have to be treated for five years to prevent just one event involving the heart. To put that another way – out of 100 people who have been told by their doctors that they have a high risk of getting heart disease, 98 of them won’t get any benefit from a statin prescription at all.1

Suppose you were a woman with a very high risk of heart disease – how much benefit could you expect from taking statins? To answer this question for the GP magazine Pulse, Dr Malcolm Kendrick (author of The Great Cholesterol Con) analysed a major statin trial called HPS – which is frequently quoted as showing statins benefit women – and concluded that if you took statins for 30 years, you would gain, on average, just one extra month of life.

The downside of statins

All this might not matter too much if there was no downside to being prescribed statins for years. But since they can cause a variety of side effects, you might actually be at more risk from them than from a possible heart attack. Your doctor will very likely tell you about the risks of muscle pain and weakness (myopathy) and a harmful change in liver function, although he/she will say they are very rare. But again that may not be the whole story. One study in the British Medical Journal found that when 22 professional athletes with very high cholesterol levels were put on statins, 16 of them stopped the treatment because of the side-effects. Competitive athletes are known to be more sensitive to muscle pain than normal people.2

One of the reasons the studies for side effects, which doctors rely on, report low levels is because people who have any illness or who don’t respond well are excluded from the trials. The same British Medical Journal article found that in one recent big trial – used to show how safe statins are – almost half of the 18,000 people recruited to begin with weren’t included. But there is another reason why official adverse drug reaction (ADR) figures for statins are very low: when patients say the drugs are having a bad effect, doctors don’t believe them. While 98% of 650 patients surveyed reported a foggy mental state, only 2% of their doctors accepted it could be linked with taking statins. The figures for nerve pains in hands and feet (96% vs 4% believed) and muscle pain (86% vs 14%) were equally bad.3 Even more worrying is the question mark hanging over a possible link between statins and cancer.4 They certainly give cancer to laboratory animals and one of the big trials called Prosper, which involved elderly patients, found taking statins raised your risk. This was dismissed at the time because no other trials had found it. But because cancer is much more likely to occur in older patients and because Prosper is the only trial done on older patients, it’s quite possible that fewer patients had heart attacks but developed cancer instead.5

Why cholesterol is a good thing

Despite the poor odds in the statin lottery and the side-effects that have been downplayed, there is another reason for thinking seriously about a non-drug approach. All the talk of aggressively lowering cholesterol tends to ignore just how vital it is to the smooth running of our bodies. For example, it helps repair damaged arteries, is the raw...

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