Cholesterol and statins.

It's lies, damn lies, and cholesterol-lowering med research report interpretations.

Somebody asked about cholesterol-lowering herbs on alt.folklore herbs. The reply included red yeast rice, along with other follies. Here's my reply to that.

Red yeast rice contains statins (mostly lovastatin, but also mevastatin, which had side effects so bad that there are no mevastatin drugs these days). You can get the same side effects with red yeast rice as you can with statins; not surprising, as statins are made the same way as red yeast rice, just using slightly different and more efficient yeast strains.

I've been looking into cholesterol and cholesterol-lowering med research recently. What follows is just the tip of the iceberg. Don't trust me, go read the studies I refer you to.
Note, the abstracts are often misleading. Find the full studies; most are online somewhere in full; if they're not linked from medline you can find them by googling for the study subject.

Absolute total mortality in statin vs. placebo groups is almost always about 1 % lowered over 5 years (14), that is, minimal, with side effects (including major ones like myopathy, rhabdomyolysis, and cancer) occuring in an average of 2/3 (12) of those actually taking their statins (or other cholesterol drugs, but statins are worst).

That's absolute total mortality, as opposed to relative total mortality. (Relative total mortality: you have 3000 people in each group, 100 die in the statin group and 130 in the placebo group over 5 years; mortality % are 3.33 and 4.33, respectively. Relative total mortality is lowered by 30 % (1 of 3.33). Absolute total mortality is lowered by 1 %...)

And that's total mortality, not heart-related mortality.

Any cholesterol-drug study telling you about relative total mortality while forgetting absolute total mortality is trying to skew your perceptions of the research paper conclusions.

Any cholesterol-drug study telling you all about heart-related mortality while forgetting total mortality is trying to skew your perceptions of the results of the paper.

A couple years ago the pharmacogiants got about 25 billion $ a year from cholesterol-lowering drugs. That's likely much higher now ... you can buy a lot of researchers for that kind of money.

So. Ditch the whole "cholesterol is bad for you" -approach unless
- you have familial hypercholesteremia
(Update: also ditch the "cholesterol is bad for you" approach if
- you have already had a heart attack
- you are diabetic.)

Further reading:

• 1) The "dietary fat is bad for you" -approach is not a good idea:
  Taubes G. Nutrition. The soft science of dietary fat. Science. 2001 Mar 30;291(5513):2536-45. (Full text)
• 2) Building drug sales on false premises:
  Stehbens WE. Coronary heart disease, hypercholesterolemia, and atherosclerosis. I. False premises. Exp Mol Pathol. 2001 Apr;70(2):103-19. (Abstract)
  Stehbens WE. Coronary heart disease, hypercholesterolemia, and atherosclerosis. II. Misrepresented data. Exp Mol Pathol. 2001 Apr;70(2):120-39. (Abstract)
• 3) Don't do cholesterol drugs, and don't try to reduce your cholesterol levels if you're a woman:
  Hu FB, Stampfer MJ, Manson JF, Rimm E, Colditz GA, Rosner BA, Hennekens CH, Willett WC. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med. 1997 Nov 20;337(21):1491-9. (Abstract) (Full text)
• 4) ... it's much better to just ditch trans-fatty acids, instead of reducing total fat intake if you're a woman:
  Willett WC, Stampfer MJ, Manson JF, Colditz GA, Speizer FE, Rosner BA, Sampson LA, Hennekens CH. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet. 1993 Mar 6;341(8845):581-5. (Abstract)
• 5) The famed Framingham study... :
  Kannel WB, Castelli WP, Gordon T. Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the Framingham study. Ann Intern Med. 1979 Jan; 90(1):85-91. (Abstract)
• 6) ... was badly skewed in favor of the cholesterol myth:
  Castelli, W. Concerning the Possibility of a Nut. . .. Archives of Internal Medicine, Jul 1992, 152:(7):1371-1372. (Editorial, no abstracts to be had)

Castelli is the doc who took over after Kannel.

• 7) Kannel continued to harp on the "blood cholesterol is an excellent indicator of heart attack risk" even after Castelli let the cat out of the bag:
  Wilson, PW, Kannel WB. Hypercholesterolemia and Coronary Risk in the Elderly: The Framingham Study. Am J Geriatr Cardiol. 1993 Mar, 2(2):56. (Abstract)

There are many reports based on the Framingham study in medline; take into account that the researchers had to massage their raw input quite a lot to get the results they desired, and take the lot with a large grain of salt.
• 8) Check the absolute total mortality of this one, not the heart mortality touted in the abstract:
  Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA, 1982 Sep 24;248(12):1465-77. (Abstract) (Full text)
• 9) The very first cholesterol-reducing drug article. They studied middle-aged men who had cholesterol levels 95 % above normal, found nice relative (not absolute) heart (not total) mortality numbers, and went on to happily recommend lowered cholesterol to anybody, nevermind sex, age, or starting cholesterol levels:
  The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA. 1984 Jan 20;251(3):351-64. (Abstract)
• 10) I quite like this pair: First a 39-year follow-up of naturally low-cholesterol young male white-collar workers ...:
  Strandberg TE, Strandberg A, Rantanen K, Saloma VV, Pitkälä K, Miettinen TA. Low cholesterol, mortality, and quality of life in old age during a 39-year follow-up. J Am Coll Cardiol 2004;44: 1002-8. (Abstract) (Full text)
• 11) ... and then a commentary on it:
  Criqui MH, Golomb BA, Editorial Comment: Low and Lowered Cholesterol and Total Mortality. J Am Coll Cardiol. 2004 Sep 1;44(5):1009-10. (Full text)
• 12) Do have a look at total side effects in the statin vs. placebo groups:
  Newman CB, Palmer G, Silbershatz H, Szarek M. Safety of Atorvastatin Derived from Analysis of 44 Completed Trials in 9416 Patients. Am J Cardiol 2003;92:670-6. (Abstract)

Scary, innit?

• 13) Somebody said it in 1998, but did anybody listen? No:
  Kmietowicz Z. Cholesterol screening is not worth while. BMJ. 1998 Mar 7;316(7133):725. (Abstract)
• 14) And the parade example of how to show nicely pro-cholesterol-lowering-med numbers:
  Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, Macfarlane PW, McKillop JH, Packard CJ, for the West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med. 1995;333:1301-1307. (Abstract) (Full text)

They all do this: if you actually read the full research paper (not just the abstract), you'll find a total absolute reduced mortality of 0.9 % over 5 years, not the 22 % lower relative total mortality they mention in the abstract.
Nice... not.

---

Also read "The Oiling of America".

And Ravnskov. While he's very much anti-anti-cholesterol, he is actually getting quoted in that bastion of nutrition science papers, The American Journal of Clinical Nutrition, these days. Good show!

---

The whole thing is rather depressing once you really start to look into things: money is everything, nevermind all the lives the pharmacogiants are ruining.

--
Related entries: Statins and cholesterol - Syndrome X.
Comments are closed.