Heart Health

Statin denialism

Published 8.12.2017
Every point made in this editorial about statins can be made about weight loss and energy balance denial (ie those who insist that calories don’t matter).

Those making extraordinary claims have the onus of presenting the evidence to back up their claims. Statins (and eating less and moving more) have evidence that they work. Are the side effect to statins? Yes, for some people there are. (I’m going to end the parallelism I established here, but will note that the side effect to eating a bit less can be a bit more hunger, and moving more can cause some sore muscles.)

The bottom line though is that most people who take statins do not suffer side effects, and do see their cholesterol levels decline. Also noted is the fact that statins are off-patent now, which means generic versions of the drug are available and prescribed. Generic means cheap — at least when it comes to drugs.

Ironically evil “Big Pharma” is now on the side of the anti-statin folks, because it would rather have patients prescribed newer, still on patent and therefore more expensive drugs.

I agree with his assertion that people have an almost infinite capacity to deceive themselves, which again applies in many more areas than just heart drug efficacy. Many of the “effects” people suffer when on drugs may be due to other factors— including just aging. Time only moves in one direction, and nobody gets out alive. Aging is not a disease, but it is a fact of life.

The body (heart) is not the same at 55 as it was at 25, and changes accelerate over time. I used to joke about “the wheels seeming to fall off” somewhere in the 50s, based on observations of the changes I would see in relatives and friends as they aged. Healthy adult humans, again in my observational experience, tend to reach a plateau sometime in their late 20s, and, provided they don’t become ill or obese, don’t change much in outward appearance through their 40s. However, once they enter their sixth decade of life, changes in skin, hair, eyes, ears become all too apparent.

Not that this is the case for everyone, even if they are healthy, it’s simply the overall trend that noticed amongst friend and family in my life. One of the reasons this site exists is that I was taken aback when my own “wheels” started coming off in my early 40s— a decade too early based on my hypothesis. So hypothesis falsified? Perhaps, but it did light a fire underneath me to get my ducks in a row healthwise as best I could.

Almost all the evidence points to excess weight being a problem during aging. As I’ve noted previously, I’m not talking about 20 pound of excess weight, I am talking about carrying more excess weight than your body can compensate for— which for many people coincides with a body mass index (BMI) in the obese range. Sure, BMI was developed for use on population scale, and for athletes and very muscular people it can be inaccurate. Neither of those facts changes the truth that for many people (including me) being obese diminished health. No, my markers weren’t awful, but markers (blood test results) aren’t the only gauge of health.

It isn’t just bloggers and supplement salesman who get criticized. The author, Larry Husten, also notes that there academic statin skeptics who also cherry pick the available data. Arguably they are the more dangerous faction, as their credentials lend credibility to the argument. Certainly there input is amplified on sites throughout the internet and by supplement sellers.

Nissen didn't discuss them in his editorial but there is also a small but vocal group of cholesterol skeptics in the academic community. They often indulge in scare-mongering tactics in their use of anecdotal evidence and cherry-picked data. Mann pointed to one tactic that appears to have started to gain some traction in the more general medical community:

"There is a group of people who keep saying that the lack of a clear mortality benefit in primary prevention means there is no benefit. It just makes no sense to put no value on avoiding nonfatal MI or stroke. (Has anyone in their family had a stroke??) Yes, the benefit is small for most, but some people have high baseline risk and some have a preference for avoiding small risks. That's putting to one side the argument over whether statins lower mortality in primary prevention or not."

Statin supporters aren’t innocent either, as they often overstate the benefits of statins or dismiss any talk of side effects out of hand. For many people, taking a statin might mean lowering an already low risk, but for some patients, statins lower a higher risk. The result is that the reduction of absolute risk (everyone) is much less than the reduction in relative risk (people who were are higher risk to have an event.)

To this non-medical observer, the issue would seem to be the automatic prescription at a certain age (and this does happen) rather than prescribing it as a result of the relative risk for a given patient. As I’m not a cardiologist, I don’t know how such a protocol would be implemented, nor to I have clinical experience. I have read enough commentary from doctors though to acknowledge that most patients only want a pill to solve the issue, they are not interested in permanent lifestyle change.