The People's Perspective on Medicine

Show 1085: The Statin Standoff and New Drugs for the Heart

Cardiologists don't agree on how well statin cholesterol-lowering drugs work to prevent heart disease. What do you know about the statin standoff?
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The Statin Standoff and New Drugs for the Heart

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Cardiologists agree that we should all be getting regular exercise and eating a healthful diet with lots of vegetables and fruits. But they don’t agree on which of us should be taking statins to protect our hearts. Just how much do these cholesterol-lowering drugs actually reduce the risk of a heart attack? The answer to the statin standoff is surprisingly controversial.

Lowering Cholesterol Beyond Statins:

Dr. Steve Nissen, chair of cardiology at the Cleveland Clinic, is on the pro side of the statin standoff. He also explains the results of the FOURIER study of evolocumab (Repatha). The study was published in the May 4, 2017, issue of The New England Journal of Medicine.  This new medication lowers LDL cholesterol far more than any previous drug could. The study showed evolocumab reduced heart attacks and strokes, but it did not protect people from premature death.

A Statin Skeptic:

Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, and editor in chief of the prestigious journal, JAMA Internal Medicine, remains unconvinced that statins help healthy people. (People with heart disease are another story.)

She helps us understand why the statin standoff is so controversial. Just how much do statins help? Dr. Redberg explains the statistics. She is convinced that we all need to know about the pros and cons of statins so that we can be informed when we participate in making an informed decision about whether or not to take one.

Heart Failure:

Heart disease, characterized by clogged arteries and heart attacks, is only one of the threats our hearts may face. Dr. Alan Maisel of the University of California, San Diego, explains the distinction between heart disease and heart failure. What are the symptoms that signal heart failure? How can it be treated?

Only a portion of our conversation with Dr. Maisel could be included in today’s show. If you are interested, we offer the entire interview here.

Those who are interested in heart failure may wish to consider a recent article in The New England Journal of Medicine (July 6, 2017): Declining Risk of Sudden Death in Heart Failure. The authors report that sudden death has declined substantially since 1995 among people with heart failure participating in clinical trials. They attribute this drop to increased use of evidence-based medicines.

This Week’s Guests:

Steve Nissen, MD, FACC, chairs the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute. He has served as president of the American College of Cardiology and chair of the CardioRenal Advisory Panel of the Food and Drug Administration. He is the co-author, with Mark Gillinov, MD, of Heart 411: The Only Guide to Heart Health You’ll Ever Need.

Rita Redberg, MD, FACC, MSc, is Professor of Medicine at the University of California, San Francisco. She is a cardiologist and Director of the UCSF Women’s Cardiovascular Center. Dr. Redberg is the editor of one of the world’s pre-eminent medical journals, JAMA Internal Medicine. She has written some provocative articles with colleagues about saturated fat, cholesterol and statins. Her editorial in JAMA Internal Medicine, “Statins for Primary Prevention: The Debate Is Intense, but the Data Are Weak,” reflects the statin standoff.

Alan Maisel, MD, is Professor of Medicine at the University of California, San Diego and Director of the Coronary Care Unit and Heart Failure Program at the Veterans Affairs San Diego Healthcare System. Dr. Maisel’s seminal research on BNP was published in The New England Journal of Medicine, July 18, 2002.

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The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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The lack of mortality benefit reported in the Evolocumab FOURIER study, in spite of the lowest LDL levels in medical history is not surprising, since increased mortality associated with low cholesterol has been known for decades. In addition, it is clear from both failed CETP inhibitor drug trials, and the PCSK9 drug trials, that lowering cholesterol with a non-statin drug is a futile exercise which provides no health benefit. I would agree with Dr Alessandro Battaggia’s report, that intensive cholesterol lowering with expensive non-statin drugs has a “tendency to harm”. This is a medical practice that should be halted immediately. For more see:

I don’t hear it mentioned at all really, but 15 yrs ago my cardiologists prescribed Crestor, a statin, to raise my HDL. My LDL was only slightly elevated at the time.
Over the years this has worked and my HDL has improved to a normal level or higher level.
I have always taken a small dosage. I split a 25 mg pill into 12 1/2 mg daily.

I am a sufferer of many serious side effects after taking statins for a number of years for PRIMARY risk only. I feel that the possible side effects of statins are grossly understated. These side effects can profoundly decrease quality of life for many previously engaged and active people, and without quality, or perceived quality of life, what is the point of possibly living longer?

Thus, this is a private information. I am very thankful for this publication. Best for you!

Is the only way to read Dr. Redberg’s editorial to purchase it from JAMA??

I believe so. We cannot provide it.

My doctor swears up and down high dose folic acid for high cholesterol. He says these studies are so skewed. Using statins, the risk of death might be lowered for 1.3% to 1.1%. But statins remove important nutrients, like coq10.

I was reading a book by a famous cancer doctor on how futile curing cancer is. He says the problem is the human body is so complex no one truly knows anything. Some people, no matter how well they eat and exercise, just have bad genes.

I think we have a clock built into our genes and changing the date of our death is difficult to extend. To me exercise and eating right are more about improving the quality of our life than necessarily extending it. It might, who knows. I have a personal trainer (which I highly recommend), I eat meat and have a huge plate of raw vegetables for breakfast everyday. At my age, 66, having good bowel movements daily is definitely a quality of life issue. But a lot of quality of life is about your mental health. I’ll work until I drop, mainly because I found something I love to do. I see people retire and just waste away. If you’re young try to find a passion in life, it is truly a gift to find one.

Thank you for these informative interviews. I intend to ask any physician prescribing me a medication whether she/he receives money from the manufacturer.

Later I thought, you guys should ask during broadcasts the same question any time an interviewee recommends a drug.

I am 75 years old in reasonably good health because I have been blessed with good genes. My father was 1 of 11 children. 10 men and 1 woman. All lived to be 95 to 110. My dad had high cholesterol as do I and my 3 sisters and 1 brother. My siblings are all 11 to 20 years older than I. I have been in 1 triglyceride study in1985 and 5 cholesterol studies since including the last two injection types of which I had sign my life away because of unknown risk of very low cholesterol. ( I am very good candidate for cholesterol studies because mine has been as high as 400 untreated and now runs 275 untreated with no statins). No doctor to date has asked me about my family history and/or used that information to make medical decision on my behalf. My personal opinion is most if not all doctors are in practice to make money and not place the patients health first even above their own has created this drug craze.

There are too many stories that go against using statins. My past PC doctor said that half of his heart patients have normal cholesterol levels. I know a friend of mine that ate almost perfectly, ran daily, and lived a good life and he had a heart attack in his 50s that almost killed him. My grand parents did everything wrong relative to supposedly “proper diets” to protect the heart. They had no heart issues. I could go on and on with real live cases but the point is that I don’t believe we really know enough about this condition to immediately jump on meds. Let the researchers figure out why the French have low incidences of heart issues even though they have a relatively high fat diet and drink alcohol daily. Two practices we are all told not to do in this country.

My husband will be 84 this August and had heart problems for 20 years before the doctors found it. His cholesterol was 300 plus, so I attacked his diet. He had a spontaneous bypass of a main artery to his heart some twenty years ago that the Drs. didn’t see until he had to have a bypass 5 years ago after a heart attack. They started him on statins and it seemed his health was deteriorating. We studied up on his meds and threw out the statins. His health today is that of a 60 year old. I ought to know because I’m 63. My husband takes nothing but aspirin and vitamins.
Sincerely Lisa, from CA

Interesting that my heart failure presented solely as a chronic cough, especially at night, that wouldn’t go away. No other noticeable symptoms. After driving around with this for 5 days I finally called my MD, thinking I had some upper respiratory infection? She sent me to the ER and hours later I was admitted to the local Heart Center for a week! Did not hear “cough” listed as a symptom?
Cardiomyopathy diagnosed ( with HF) as a result of being given a toxic chemo 20 years ago for breast cancer treatment. Fooled me ( and some of the MDs). My life has changed forever. Determined not to be hospitalized again anytime soon!

We all know that more than 50% of the people who have heart attacks don’t have a cholesterol problem, and that the so-called plaque buildup in your arteries is mostly
It would seem to me that they should be looking at the “”C-Reactive Protein’ Test for more answers…
Namely “”Inflammation” in your bodies arteries….
Taking supplements that are labeled as “”Anti-inflamatory” ” to reduce your ‘C-Reactive Protein” number may go along way to survival..
Of course ‘Big Pharma” can’t make any money selling you supplements, could they ???

It is extremely important to explore means of doing effectiveness studies in primary care practices rather than in specialty practices. The USA with foundation support should take open source software and create the means of doing Comparative Effectiveness studies across states and across the USA, thereby facilitating the design of the most cost-beneficial care to prevent strokes and heart attacks from:

1) CoQ10 twice a day (NNT of 4 for MI in one year in patients post-MI)
2) Chronotherapy as with ramipril at BEDTIME (HOPE trial) with 20% reduction of strokes, heart attacks, onset of diabetes / DIABETES complications
3) Statin therapy
4) Repatha rx……etc

There should be a nationally available EMR / EHR / HIE /CE where EMR = Electronic Medical Record, EHR = Enterprise Health Record, HIE = Health Information Exchange with true interoperability, CE = Comparative Effectiveness clinical trial management with facilitated LOCAL training / recruitment of PRIMARY CARE PATIENTS at the time of a regular primary care visit. There should be systematic training and primary care utilization of Comparative Effectiveness & Continuity of Care Facilitators as one key member of every primary care team. This mechanism should very minimally interfere with the usual doctor patient relationship except for agreement for clinical trial participation.

This EMR / EHR / HIE / CE set of capabilities with physician – patient interaction facilitation can be derived from open source programming of Veterans Administration VisTa / CPRS software now in beta testing. It takes national will and national leadership that should come from the united interests of physicians and patients to participate in care that is continuously getting better, especially with regard to cost-effectiveness.

Use regular language please if you would like layman to understand.

Another question that wasn’t answered was whether these studies were conducted on both men and women. It is my understanding that the first studies on statins were conducted only on men. If I remember correctly earlier People’s Pharmacy programs on this topic, they indicated that for women statins were not recommended for women who had not had a heart event. Historically most of the research on heart issues was conducted only on men because they were having heart issues in their primary high earning years, while women’s heart problems occurred much later, and probably were not considered worth thinking about.

This is gold for the pharmaceutical companies and trageic for anyone else.

What does Dr Nissen or Dr Redberg think about the ongoing study of Dr Carleton Esselstyn of people with advanced coronary disease who followed a very low fat / vegan / high nutrient diet and so far have had a 100% success rate in ELIMINATING coronary events for about 15 years? To me that seems to dwarf the results any drug studies.


Per month? Year? ?

I’m a 68 yr old white male my diet for the last 35 years consisted of chicken and fish, little dairy, and no fried food. I’ve been a runner for over 40 years and exercise daily 5 miles five times a week and immediately afterward the gym the same 5 days. My resting heart beat is 48 and my blood pressure is 100/60 t0 118/68. I exercise harder than my age would indicate. I bicycle, swim, horseback ride and physically challenge myself always active summer and winter.

I recently was diagnosed with cardio artery disease 40% blockage main artery, but have no symptoms. My cholesterol ranged from 170 to 210 prior which I never understood I’m not a junk eater and was a wine toddler.

I’m stunned and on a statin and feared that the statin will cause diabetes which runs in my family. Mom had heart failure two brothers died of cardiomyopathy at 51 & 47 respectfully. I always thought of myself as the poster boy for not getting heart problems and completely lost at this point and time. I continue my same lifestyle and tweaked my diet a little by adding more raw vegetables as opposed to cooked. I would appreciate any feed back available.


Try eliminating the chicken. I have a strong family history of heart disease. I’m active, and my weight is normal. My total cholesterol without dietary interventions is 220-235. And my LDL is sky high, my HDL… bargain basement. I had tried statins for years and finally got sick of the muscle pain, lousy memory, exhaustion. My friends are vegan and begged me to try their diet. I bought several highly rated cookbooks (very important to make this diet doable)… 4 months later, my cholesterol was 170, my LDL dropped BELOW 100 (statins never did that) and my HDL was finally normal! 5 years later I’m still vegan but eat fish occasionally. Don’t knock it until you’ve tried it!

I would suggest looking up the benefits of selenium, which is lacking in soils especially along the East Coast, as well as other essential nutrients such as omega-3s that you may be sweating out more rapidly than your neighbor Couch Potato.

My goodness! All I have to say to Dennis is that it’s not fair!!! His lifestyle is the dream
of every internist and cardiologist, yet he now has heart disease. It’s 2017 and we
still only have questions about statins…no definitive answers. Big pharma keeps
raking in the $$$. Side effects abound with diabetes, muscle deterioration, memory
loss and the like. I would like to see physician comment on all the replies.

A whole food plant based diet has been proven to reverse heart disease. See for 100’s of videos based on scientifically conducted studies. . all free for the viewing.

All these remarks seem to avoid the subject of muscle pain caused by the statins. While I acknowledge that they seem to be good for lowering cholesterol, I would also stress that during the 14 years that I was on statins, I seemed to be fine.

During the 15th year my legs developed terrible pains in the muscles. I could not sleep at night. Soon I could not go up or down stairs and just walking was difficult. I learned that the statins were responsible and that they actually were causing deterioration in the muscles themselves.

I stopped statins on January 15. It is now July 7 and I am back to walking 30 minutes on my treadmill at 2.6 mph, going up and downstairs, and playing golf again. It took 6.5 months for my leg muscles to recover and there is no way I will ever take another statin.

Instead, I’m watching my diet, doing the required exercise for diabetes and taking 1.5 to 2 teaspoons apple cider vinegar in 1/2 glass of cranberry juice every day. I will have another cholesterol check in September and we will see what the results are. However, no more statins – I don’t want to spent the rest of my remaining life in a wheelchair (which was where I was headed!) I am 83.

regarding the study on Repatha, above. “evolocumab reduced heart attacks and strokes, but it did not protect people from premature death.” I always assumed heart attacks and strokes were a major cause of death. So if these events are reduced, yet premature deaths are not prevented, what is killing these people on this drug? doesn’t make sense to me.

I think I’m going to read a little about the Dr’s thoughts on what I should be taking for a statin, yet all you give is about the drs. Most unsatisfying.
Alex G

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