EVALUATE STATINS

“We've all seen the drug ads, like this one touting Torvastatin, Lipitor, as reducing the risk of a heart attack by about a third. That means in a large clinical study, 3% of patients taking a sugar pill had a heart attack, compared to 2% of patients taking Lipitor. Going from 3 to 2 is indeed a drop by a third in relative risk, but the drop in absolute risk was only 1%, which sounds less impressive.”

“Those more recent targets might actually be closer to normal for the human species. Even after we learned to use tools so we could hunt, normal LDL has been in the 50 to 70 range. But today, the average in the Western world is more like 120 mg per deciliter. No wonder heart disease is our leading cause of death in men and women.”

“In primary prevention trials, like trying to prevent your first heart attack, there is no increased diabetes risk. You only see that in secondary prevention trials, people are trying to prevent their second heart attack, for instance. This might be because their risk of diabetes is higher in general, or they're using higher doses of statins. Intensive dose statin therapy is associated with a greater increased risk of new onset diabetes.”

“But whether or not the overall benefit-harm balance justifies the use of medication for an individual patient cannot be determined by a guidelines committee, a health care system, or even the attending physician. Instead, it is the individual patient who has a fundamental right to decide whether or not to take a drug is worthwhile. It's your body, your choice.”

“So that's why these drugs are only recommended for people at relatively high risk of having a heart attack, for whom the pros of cholesterol lowering outweigh the cons of taking the drug. OK, but when it comes to LDL, if lower is better for longer, and the earlier the better, and the only reason we're not giving more drugs is the downsides, what if there were safe, simple side effect free solutions to lowering our cholesterol?”

“Those more recent targets might actually be closer to normal for the human species. Even after we learned to use tools so we could hunt, normal LDL has been in the 50 to 70 range. But today, the average in the Western world is more like 120 mg per deciliter. No wonder heart disease is our leading cause of death in men and women.”

“Recently, guidelines started scrapping targets in favor of just pushing for LDL levels to be as low as possible because the lower the better. No threshold seems to exist below which LDL cholesterol lowering does not further reduce risk. When it comes to LDL, it's possible that lower is better for longer, even if you start out at low risk. The risk reduction of major vascular events is independent of the starting LDL cholesterol.”

“In primary prevention trials, like trying to prevent your first heart attack, there is no increased diabetes risk. You only see that in secondary prevention trials, people are trying to prevent their second heart attack, for instance. This might be because their risk of diabetes is higher in general, or they're using higher doses of statins. Intensive dose statin therapy is associated with a greater increased risk of new onset diabetes.”

“Recently, guidelines started scrapping targets in favor of just pushing for LDL levels to be as low as possible because the lower the better. No threshold seems to exist below which LDL cholesterol lowering does not further reduce risk. When it comes to LDL, it's possible that lower is better for longer, even if you start out at low risk. The risk reduction of major vascular events is independent of the starting LDL cholesterol.”

“But whether or not the overall benefit-harm balance justifies the use of medication for an individual patient cannot be determined by a guidelines committee, a health care system, or even the attending physician. Instead, it is the individual patient who has a fundamental right to decide whether or not to take a drug is worthwhile. It's your body, your choice.”

“So that's why these drugs are only recommended for people at relatively high risk of having a heart attack, for whom the pros of cholesterol lowering outweigh the cons of taking the drug. OK, but when it comes to LDL, if lower is better for longer, and the earlier the better, and the only reason we're not giving more drugs is the downsides, what if there were safe, simple side effect free solutions to lowering our cholesterol?”

“We've all seen the drug ads, like this one touting Torvastatin, Lipitor, as reducing the risk of a heart attack by about a third. That means in a large clinical study, 3% of patients taking a sugar pill had a heart attack, compared to 2% of patients taking Lipitor. Going from 3 to 2 is indeed a drop by a third in relative risk, but the drop in absolute risk was only 1%, which sounds less impressive.”