Man grabs at his heart. He has a heart attack. risk of heart attacks, heart attack patients

Most cardiologists take it as absolute fact that cholesterol is a bad actor in the heart disease saga. They believe that LDL cholesterol in particular is responsible for causing clogged coronary arteries. Because statins lower LDL cholesterol very effectively, doctors conclude that such drugs prevent heart disease in most patients. Every once in a while a report surfaces that contradicts the theory.

Q. My father has been taking various statins for over 20 years. At first he was prescribed Zocor. Later he was told to take Lipitor. More recently his doctor had him on rosuvastatin.

Dad has had some aches and pains but has been able to tolerate these statins reasonably well. He has always maintained an active lifestyle. He walks daily and loves to play golf and tennis.

A few weeks ago he suffered some serious chest pain. When the cardiologists examined his coronary arteries they discovered that two were almost completely closed off (nearly 98% clogged) and another two were also in bad shape, though not totally blocked. They put stents in four arteries and he is now doing well.

What has us confused is how this could have happened. We thought statins were supposed to protect people from clogged coronary arteries and heart attacks. How could dad have ended up in such bad shape after all those years of a good diet and statin treatment?

A. We’re pleased to learn that your father is recovering well from this ordeal. That said, the question you raise is complicated and the answers remain controversial.

The Cholesterol Hypothesis:

Ask most physicians what causes heart disease and heart attacks and they will tell you it’s primarily a cholesterol problem. Too much bad LDL cholesterol and/or too little good HDL cholesterol leads to plaque development and clogged coronary arteries. They point to numerous randomized controlled trials that show lowering LDL cholesterol reduces the risk of heart attacks, strokes and deaths from heart disease.

It seems like an open and shut case. That’s why tens of millions of Americans take statins such as atorvastatin (Lipitor), fluvastatin (lescol), lovastatin (Mevacor), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

How Good Are Statins?

What is rarely mentioned in this discussion is how many people have to take a statin in order to prevent one heart attack. It’s a surprisingly large number. This is what is called the absolute risk reduction and most people zone out the minute we start talking about statistics. Please hang in there with us as we describe a major meta-analysis by statin enthusiasts (Lancet, Aug. 11, 2012).

These cardiologists and statisticians analyzed data from 27 clinical trials. Over 170,000 people participated in these studies. Cutting to the chase, here is what they found:

If 1,000 people took a statin instead of a placebo for five years there would have been 11 fewer “major vascular events.” Put another way, 5.2% of the people getting placebo experienced an “event” over the five year period whereas 4.1% of those on a statin had such an event. That represents a 1.1% improvement. Depending upon your perspective this kind of risk reduction is either fabulous or modest. We offer no editorial opinion.

The Guidelines:

We can say that the American Heart Association and the American College of Cardiology have concluded that virtually every older person should be on a statin, regardless of risk factors. You could be a vegetarian and a marathon runner and it wouldn’t matter. The guidelines encourage all men over 63 to take a statin and all women over 70 to be on such drugs.

The Cholesterol Hypothesis Under Fire:

Over the last couple of decades we have seen a number of health professionals resist the tidal wave of enthusiasm for a statin in every medicine cabinet. Most of these physicians have been general practitioners or internists. But there is now a cardiologist and lipid specialist who has joined their ranks.

Robert Dubroff, MD, was an associate professor of medicine in the Division of Cardiology at the University of New Mexico in Albuquerque, NM. He is a lipidologist, which means he understands cholesterol and its impact on blood vessels better than most health professionals. Dr. Dubroff recently retired and has written some intriguing articles. His most recent is titled “Cholesterol Paradox: A Correlate Does Not a Surrogate Make” (Evidence Based Medicine, March, 2017).

A Cardiologist Challenges His Colleagues

Dr. Dubroff introduces his article this way:

“The global campaign to lower cholesterol by diet and drugs has failed to thwart the developing pandemic of coronary heart disease around the world. Some experts believe this failure is due to the explosive rise in obesity and diabetes, but it is equally plausible that the cholesterol hypothesis, which posits that lowering cholesterol prevents cardiovascular disease, is incorrect. The recently presented ACCELERATE trial dumbfounded many experts by failing to demonstrate any cardiovascular benefit of evacetrapib despite dramatically lowering low-density lipoprotein cholesterol and raising high-density lipoprotein cholesterol in high-risk patients with coronary disease.”

Dr. Dubroff refers to a randomized clinical trial called ACCELERATE. It undermined the very foundation of the cholesterol hypothesis of heart disease. That’s because the new drug evacetrapib was just about the perfect medicine. It lowered “bad” LDL cholesterol 37% and also raised “good” HDL cholesterol by 130%. No single drug has ever accomplished such impressive changes in the directions most cardiologists strive for.

The trouble was that despite such stellar numbers there was no benefit in terms of things patients care about. The drug did not reduce cardiovascular events or reduce deaths in high-risk patients.

More Bad News for the Cholesterol Theory:

Dr. Dubroff also points out that:

“Many experts cite numerous RCTs [randomized controlled trials] of statins in support of the cholesterol hypothesis, but we should not ignore the dozens of cholesterol-lowering trials that do not…Even when researchers demonstrate a statin mortality benefit, the findings are underwhelming. A recent analysis concluded that statins would only postpone death by a median of 3.1 and 4.2 days for primary and secondary prevention, respectively.”

That was after years of statin use. For example, the famous 4S study produced survival gains of 27 days after 5.8 years of simvastatin therapy (BMJ Open, Sept. 24, 2015). That extra month of life was in very high-risk patients who either had already experienced a heart attack or were suffering severe symptoms of heart disease. In trials where people were at lower risk of a heart attack, the life-extending potential of statins was substantially less than a month. That was even after years of treatment.

What Does It All Mean?

Cholesterol remains a prime suspect in heart disease. That said, there are a great many other factors that can increase the risk for heart attacks and strokes. Diet and exercise are cornerstones for good health. An article in JAMA (March 7, 2017) suggests that almost half of the deaths from heart disease, stroke and type 2 diabetes are related to poor dietary habits.

You can also read our summary of the research at this link:

You Are What You Eat: Is Your Diet Killing You?

Statins Aren’t Magic Bullets:

There are many people who truly benefit from statins. But as the person who shared the story at the top of this article pointed out, there are no guarantees that a statin will always prevent clogged coronary arteries.

No one should ever stop prescription medicine without medical supervision. These days many doctors have adopted the concept of shared decision making. That means that patients should participate in the process of deciding about their treatment program. To help with that process we have prepared a Guide to Cholesterol Control and Heart Health. It can be accessed from the Health Guide section of our website.

Share your own statin story below in the comment section.

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  1. Bill
    California
    Reply

    Statin use for me has been similar to getting getting off SSRI’S. The Statins cause the Ill feelings while taking them. Getting off or lowering the dose of SSRI’S causes the same feelings the Statins do while on them. Took a while to do the research myself. I have one stent in and believe the blockage was from caused smoking.

    Used a vape pen to quit smoking and do not drink alcohol. 19 months on Statins. All blood work was good before Heart event and is all good now. No more vertigo,feelings of ill health every day gone after three days of the stop.Was on 80 mg Statin daily. Ouch. Do the research and talk to your Doc to really get all the input you can before you plunge on any med change. Peace.

  2. Doug
    Ny
    Reply

    Early this year 2017 I had a massive heart attack at home. While in the hospital my LAD was 100% blocked and circumflex was 95% blocked. During the 3 hr operation I had another big heart attack. The blockages were hard and he couldn’t get through them. After 3hrs of torture and 3 stents and being awake for the thing. I thought it was over. Well 5 months later at cardiac rehab I was getting weird jaw pain again. Cardiologist and hospital were on site. Here we go again 5 months later more stents 90% blocked LAD. All stents blocked. Another 3 hrs on operating table…2 days in hospital…How could this happen to me ?? I worked out everyday and did tons of cardio and eat pretty clean….5 months how can this happen? Took all the drugs..Bystolic…Effient…Atorvastatin..asprin..Wtf.

  3. Mary
    NY
    Reply

    Thank you all for sharing. Upon hospital discharge after the placement of 2 stents I noted one of my new prescriptions was unfamiliar. I asked about it and was told it was to prevent new deposits from building up inside the stents. When I got a good look at the name and saw it ended in “statin” I remembered I had heard enough bad stuff about the group to decide not to take any in the past, but I had forgotten why.

    Plenty of reason, I see. My aim is always to get off and stay off all drugs, especially prescription drugs. They have to be considered potential poisons, because if no risk of serious harm were associated with them they would be available over the counter.

    So now I have to find out what mischief the beta blocker can do. Thanks again. Love, Princess

  4. Jim
    Florida
    Reply

    Years of overdosing on Simvastatin has left me with type 2 diabetes and vascular parkinsonism. Don’t kid yourself. Statins are poison for lot of us. What I don’t understand is why all these crackpot cardiologists are so anxious to do us in.

  5. Ginger
    Wilmington NC
    Reply

    I will never go on a statin drug because of research I’ve gotten from People’s Pharmacy. I have high blood pressure & my total cholesterol looks high, even though my HDL is great. My cardiologist did a test on my blood and it showed that my cholesterol particles were mostly the big bouncy kind. It’s the small sticky particles you have to worry about clumping together & causing blockages. I love my cardiologist- he explains things so I can understand. He told me to NOT let my primary physician put me on a statin.

  6. Craig W
    Bangor Maine
    Reply

    I’m not sure what this article is stating about statins. How can you infer that statins didn’t help ” Dad’s coronary arteries”. As you know statins not only reduce cholesterol but aid in the reduction of the inflammatory process. Maybe Dad’s arteries would have occluded at a much faster rate if he were not on statins. Where is the science behind this.

    • ladyliza
      Reply

      We have all been duped by the statin industry. My mother was on Zocor when I saw her blood test results and her cholesterol was normal. She was in so much pain. I mad e the doctor take her off the drugs and within 3 weeks her pain was gone. Her blood tests results remained good. She was only eating fish and vegetables in her 90’s.

      I suspect the doctor was receiving a kickback. Propublica.com offers for free a database that shows if your doctor is receiving money from a pharmaceutical company. Check out your doctors!

  7. Margie
    Houston
    Reply

    Of course this article does not even go into the fact that you may suffer from the side effects of statins such as decreased mobility, muscle pain, diabetes etc. even while you are not gaining a substantial decrease in cardiac disease. I question the risk/benefit.

  8. Nancy E.
    NC
    Reply

    My husband was/is on statins since the 1990’s. Imagine my shock when his heart cath showed he needed 5 by-passes. I told the doctor, something is missing.

  9. William
    Camano Island Washington
    Reply

    I’m a Lipitor Diabetic. Three months after I started Lipitor I was Diagnosed as Diabetic. My blood Sugars were up more than One Hundred Points. We have Type Two Diabetes in my family history. Before Lipitor I was recording blood sugar readings of Ninety-Nine to One Hundred. Within Three Months of starting Lipitor I recorded Two Hundred or Higher readings. I asked My Doctor Why He didn’t tell Me the Lipitor would raise My Blood Sugar levels. His reply was,”Would You rather Die of Heart attack or Diabetes”! I’ve stopped taking Lipitor and My Blood Sugar Readings have returned to Pre Lipitor levels.

  10. Kelly
    Texas
    Reply

    This is food for thought. The study results are underwhelming and do call into question the need for statins. I’m still curious about what role adherence play in statin failure? Are poor outcomes associated with lack of compliance or simple failure of the medication?

  11. Teresa
    Waco, TX
    Reply

    I am surprised there was no mention of artery calcification due to the lack of properly balancing magnesium, calcium and vitamin D. For years post menopausal women were instructed to take 1200 to 1500 mgs of calcium to strengthen bones and prevent osteoporosis but there was no mention of how important magnesium plays in that equation.

    This has been a travesty for so many women in my generation (age 66) who do not understand this issue much less know about it. So many women are taking too much calcium supplementation along with bone building prescriptions which over time results in artery calcification throughout the body including three brain. My 91 year old Mom just passed and I saw her go thru this process for 15 years…dementia (MRI showed calcification throughout her brain and a stroke (70% of her right carotid artery was blocked with calcification which the surgeon removed).

    By the time I learned about magnesium’s benefits, it was too late for her. Please discuss this in your blogs and refer your readers to Dr. Carolyn Dean’s websites as I have seen her name mentioned before in your blogs. She and her Completement Formulas have made my life worth living again. Thanks for all you guys do as well as I thoroughly enjoy your website and products.
    Teresa
    Waco, Tx

  12. Deloris
    Reply

    I took 10 mg simvastatin for about a year and half and ended up with shortness of breath caused by calcification in my coronary arteries. I didn’t have any serious heart issues before this. While I didn’t have a heart attack, I needed to have 3 stents inserted. Arterial calcification is an under-reported statin side effect. I believe my condition was aggravated because I also took a calcium channel blocker (5 mg amlodipine) at the same time I took the statin. It should be noted that a CCB prevents calcium from entering the cells and that statins deplete Vitamin K which directs excess calcium in the bloodstream to the bones. The FDA only warns that the drug combination is dangerous when high doses of simvastatin are prescribed, saying that the CCB increases the statin’s effectiveness. I think the combination is far more complicated than this.

    • Pat
      Reply

      I sure hope you got a new Doctor also. Good Luck!

  13. Julie
    Hazlet, NJ
    Reply

    How can we find Direct Testing Labs in out areas?

  14. Sandra E
    Sioux Falls, SD
    Reply

    As Howard N posted, the book The Great Cholesterol Myth spells out in great detail how statins do nothing to prevent heart disease.The real culprits are sugar, stress, inflammation and oxidation. Keep up the good work letting us all know that statins do nothing.

  15. joan
    Reply

    Has anyone ever thought that stating can cause a heart attack? Our primary physician put my husband on a stating some years ago. He was overweight and everything pointed to clogged arteries. The thought was that at 67 the stain would slow things down. He was on the statin….I think it was lipitor….for 3 days.

    One night, he was complaining of muscle pain. Cramps in his legs and befoRe you know it he had severe chest pain. He had a heart attack. The heart is a muscle and stating are known to cause muscle pain. So the primary physician sent him to a cardiologist who insisted the statin could not have caused the heart attack. He tried another statin, same thing. Leg cramps. And so he tried crestor. Even that caused the leg cramps.

    My husband said no more. I’ll take my chances. And he did. 3 and a half years ago and 12 years after the first stating he had a heart valve replaced. At that time Drs saw 4 clogged arteries and replaced them. That was his demise. He had been under anesthesia for almost 7 hours. When he came home he was fine for a couple of months. Then he started forgetting things. Big things.

    We took him to a neurologist and she said, we often see these problems s after being under anesthesia for a long time. He had dementia. He lived about another 9 months. It was awful, for him and his family. His life ended with a major stroke. This all started with statins. I’ve learned a big lesson from this. No statins for me. I am 77 the same age my husband was when he died.

  16. roger
    waxhaw, nc
    Reply

    In November, my wife and I watched THE SCIENCE OF NATURAL HEALING from Great Courses. The cardiologist speaker stressed more vegetables, etc. I thought “I can do that”. As a 75 year old that has survived 2 heart attacks, bypass, and 4 stents, there was reason to try. So, to test myself stopped taking all pill drugs–4 including statin, zetia, metformin. Kept taking insulin.

    About 70 days later next blood test. Weight down from 205 to 193. circulating blood sugar–from A1c down from 211– 2 years ago, and 160 previous blood test, to 139. So, normal A1c. BUT, cholestrol jumped 40 percent. Now, back on statin and continuing mainly vege diet. Reading a summary by Doc Gumshoe, metformin works better than any other pill or combination of pills. Considering whether to start that one again.

  17. Gail
    Tx
    Reply

    I had been on a small dose of statin drug for many years but developed severe muscular pain and was instructed to stop by my rheumatologist. The pain decreased. I have always wondered if sugars cd be contributing to the increased cholesterol.

  18. J. David Auner
    Springfield, MO, USA
    Reply

    Statins reduce risk of progressive vascular disease 20 to 30% in most patients. Exercise helps another 15 to 20% depending on how done. Somebody at higher risk levels with an American diet likely needs to do 6 things to avoid progressive vascular disease and inflammation to change their outcome. “Multiple risk reduction” is the term Family docs and the Federal Gov’t use for the more aggressive approach – needless to say few docs can get this done with 4 minutes of face time twice a year. Insulin resistant people also only get a 15% reduction in vascular risk from excellent glucose level control – diabetics have risk similar to people who have already had a vascular event and vascular disease is how most diabetics die.

  19. Ed
    14227
    Reply

    The terms “good diet” and “healthy diet” are bandied about in these kind of studies without regard to specificity. As Drs. Esselstyn an McDougal point out, repeatedly, statins will NOT overcome an unhealthy diet. Doing a study, allowing greater than 10% fat ingestion, is not a legitimate evaluation of statins and/or cholesterol.

    Please consider having Dr. Esselstyn or Dr. McDougal on your radio show to present an alternative evaluation of what, exactly, constitutes a “healthy diet”, and what effect(s) a “healthy diet” would have had when applied in the studies of the effect(s) of cholesterol buildup in the body.
    Edward H. Maziarz
    ebmsystems@aol.com

  20. Val
    Portland, OR
    Reply

    I have been on simvistatin for over 7 years now. And although the statin did lower my bad cholesterol, the major reduction came only after I began deep water aerobics 5 times a week.

  21. Bill
    Fort Worth Texas
    Reply

    In non-academic language:

    Lipids are the bicycle tire patch on the tear of inner tube, not the cause of the tear itself.

    The tear is caused by a multitude of factors which I outlined in my PhD paper.

  22. Dore
    MI
    Reply

    You said “there are many people who truly benefit from statins” who are they? I’m being pressured to take one.

  23. Howard N.
    FL
    Reply

    As Stephen Sinatra, MD, mentioned on a past People’s Pharmacy show, it’s inflammation in the body that’s causing heart attacks and strokes, yet how many doctors test THAT? He recommends two important blood tests: C Reactive Protein and Homocysteine. If both of those levels are higher than optimal level (over 0.8 mg/dL and over 9.0 umol/L, respectively), you could have LOW cholesterol, but have clogged arteries and be at significant risk of a heart attack or stroke at any time!

    Most doctors will not order those two tests when asked because they are not trained in what to do with the results. I get them both tested for only $37 total at a walk-in “direct testing lab”, which most states allow. For recommendations on how to lower above-optimal levels, I trust information from Dr. Sinatra, Dr. Julian Whitaker, and Life Extension.

    Thank you, Joe and Terry, for continuing to get the word out about the “cholesterol myth,” as Dr. Sinatra calls it–you are truly saving lives!

    • Liz
      Houston, TX
      Reply

      Howard, your comment that ‘most doctors will not order those two tests when asked because they are not trained in what to do with the results’ is a topic in and of itself. I believe inflammation is the key. It’s just so hard to believe that it’s 2017 and we don’t have an answer as to what to do with the test results. Thank you Howard and People’s Pharma

    • Julie
      North Carolina
      Reply

      I was on a statin drug for several years when I suddenly developed elevated blood sugar. This was after I had just read about a possible link between statins and developing type 2 diabetes. When I mentioned this to my doctor she acted like my concerns were ridiculous and her exact words were, “I have plenty of diabetic patients who take statins.” She did not recognize the irony of her statement. I refuse to take statins anymore. They gave me brain fog. I eat a healthy diet, am at an acceptable weight, and have no other risk factors for heart disease. I think these drugs are over prescribed.

      • Gale
        Maryland
        Reply

        I had the same experience on 10 mg of Simvastatin. As soon as I started taking the drug, my blood sugars went way up. The doctor kept saying the benefits out way the side effects. Finally this past December, I decided it was time to stop taking it and see if there were any changes in my aching body. Within two weeks, I felt like a new person. The arthritis in my hands is still there, but I can move much more comfortably. As an added surprise, the vertigo I have been dealing with for over 4 years is almost gone. After some research, found there is a side effect with statins and vertigo. And now, I can walk up the steps and driveway without feeling like I am out of breath. My rapid heartbeat also went away. Will never, ever take a statin again.

    • Thai
      Reply

      I don’t know where you live, but my doctors with Sutter Health in N. Calif. always test Homocysteine and CRP at my yearly physical, and I do understand what each represents. Years ago when I was much younger (about 50 yrs old and at low risk of heart problems due to lifestyle, diet, heredity, good weight, etc.) and asked about testing for these factors, my doctor readily added them to my yearly physical.

  24. gary
    Costa Rica
    Reply

    I read an article about eight years ago that discussed the term “number needed to treat”. It appears to be the equivalent term of “absolute risk reduction”. That article also pointed out that the number of people needed to take statins, in relation to an actual positive impact on reduction of heart attacks was astronomical. Closer to 2980 to 1. I would be interested to learn of other studies supporting the argument that statin prescriptions are written to support Big Pharma, and not actually prevent heart attacks.

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