This article takes a critical look at statin anti-cholesterol drugs, and asks the hard questions. Do statin drugs work? Who do they work for? Who do they harm? Who should be taking them, and who should not be taking them? Examples of Statin Drugs are Lipitor, Zocor, Simvastatin, Pravachol, Crestor, Mevacor, etc. These drugs reduce the production of cholesterol by the liver by inhibiting an enzyme called HMG-CoA. Due to a belief that cholesterol causes coronary artery disease, statin drug reduction of cholesterol is a mainstream medical treatment intended to prevent heart disease. Do statin drugs prevent coronary artery disease, heart attacks and mortality from heart disease? This article will answer that question.
After many decades of study and clinical trials, it has become clear that the benefit of statin drugs (if there is any) is probably not due to reduction in cholesterol, rather it is due to an anti-inflammatory effect of the drug.(link)
Asking A Few Questions
In this article we will revisit anti-cholesterol statin drugs while asking the following questions:
2) What is the efficacy of statin drugs in secondary prevention (patients with known underlying heart disease)?
3) Which subgroups benefit from statin drugs, and which subgroups of the population are harmed by statin drugs?
The Elderly - Low Serum Cholesterol Predicts Increased Mortality
First, let's take a look at the medical practice of prescribing statin anti-cholesterol drugs for the elderly. Contrary to current dogma, higher cholesterol levels in the elderly are not a heath risk. Studies show that higher cholesterol in the elderly is associated with increased survival, while lower total serum cholesterol values in the elderly are a robust predictor of increased mortality. (1, 4,5)
The Prosper Study - Statins for the Elderly
When statin drugs are given to the elderly to reduce cholesterol values as was done in the PROSPER study, there was no mortality benefit for either primary or secondary prevention of heart disease. (1,6,7) True, there was a reduction in cardiac mortality of about 20% in the secondary prevention group in the Prosper study, however, this was counterbalanced by an increase in cancer mortality, yielding no over-all mortality benefit in the final analysis.
Perhaps the best summary of the results of three decades of statin drug studies in women can be found in the Judith Walsh MD report in JAMA May 2004. (8) Again, Dr Walsh found that statin drug treatment to reduce cholesterol in women provided no mortality benefit in both primary and secondary prevention of heart disease. As we found in the PROSPER study for the elderly, statin drug use in women (with known heart disease) resulted in a reduction in mortality from heart disease, and a reduction in heart attacks in this secondary prevention group, however, this was offset by additional deaths from cancer and other mortality which yielded no over-all mortality benefit in the final analysis. (8)
MEN and Women- Primary Prevention- Dr Ray Archives of Internal Medicine