Cholesterol pills or not

Cholesterol pills or not

According to experts, there is a conflict regarding the recommendations for millions of people taking statins to prevent heart disease and strokes. A vascular surgeon explains why he feels better without them.

• Dr. Haroun Gajraj: “After closely analyzing the research, I concluded that statins were not going to save me from a heart attack and that my cholesterol levels were almost irrelevant.”

When I had a routine health check eight years ago, my cholesterol was so high that the lab thought there had been an error. I had 9.3 millimoles of cholesterol per liter of blood—almost double the maximum recommended. It was a huge scare. My primary care doctor immediately prescribed statins, the medication that lowers cholesterol and is supposed to prevent heart disease and strokes. For eight years, I faithfully took my 20mg atorvastatin pills, without side effects. Then, one day last May, I stopped taking them. It was not a decision made lightly; after studying the research more closely, I concluded that statins were not going to save me from a heart attack and that my cholesterol levels were almost irrelevant.

When I informed my doctor of my decision three months later, I was not completely honest. Instead of saying that I had my doubts about the medication, I told my doctor that I stopped taking statins because they were causing me arm pain. He didn’t blink.

The trial published by the pharmaceutical industry this month—a trial that I suspect relies heavily on industry data, as Dr. James Le Fanu pointed out in these pages last week—may suggest that side effects are uncommon, but previous studies have found that one in five people taking statins suffers from adverse side effects, including muscle pain, diarrhea, memory loss, and blurred vision.

The doctor simply suggested I try another brand of statin. The sooner, the better, he said, since I had already stopped taking my prescription for three months. “Wait,” I said. “Can you do a blood test first?” When the results came in, he was surprised to see that my total cholesterol was lower than when I was taking statins. After three months without the pills, it was 5.4 mmol/l (5.4 millimoles per liter of blood) compared to 5.7 mmol/l the previous year. The significant changes I made in my life since stopping statins are eliminating sugar (including alcohol and starchy foods like bread) and eating more animal fat.

Many experts today believe that sugar is emerging as a true villain in the story of heart disease; while after decades of demonization, saturated fat has been exonerated from causing heart disease according to a recent “meta” analysis of 70 studies from the University of Cambridge.

Generally, I was eating red meat three or four times a week and enjoying butter, whole milk, and a lot of eggs. I thought that after three months on a high saturated fat diet, my cholesterol would have skyrocketed to pre-statin levels—but no, it decreased and has remained low for seven months. And not only that, but my LDL cholesterol (also known as bad cholesterol) was also lower than when I was taking statins, and my HDL (also known as good cholesterol) to LDL ratio was below four for the first time, an excellent sign according to medical wisdom.

And it’s not that I was worried about any of this. Yes, it was the statins that initially lowered my cholesterol levels so drastically. But so what? I believe that high cholesterol has been the scapegoat for too long. Yes, it may be an indicator of heart disease in some circumstances, but there is no evidence of a causal connection.

In my opinion, high total blood cholesterol or high LDL levels do not cause more heart attacks compared to the paramedical causes of car accidents, even if they are present at the scene. Lowering cholesterol with drugs without addressing the diet and lifestyle factors that actually cause heart disease is absurd. Moreover, there are plenty of other, more reliable indicators of heart disease risk. What surprised my doctor the most was that these indicators were apparently now better than when I was taking statins. My blood pressure was low. For the first time in many years, I was slimmer, especially around the belly. My triglycerides—a type of fat in the blood with a causal relationship to heart disease—were lower than at any time in the last eight years. My fasting blood glucose was at an optimal level, whereas a year earlier it had been too high. My total white blood cell count—a marker of inflammation—was lower.

In a marker from my blood test called glycosylated hemoglobin (A1c), the high levels associated with heart disease and total mortality were exactly normal. Finally, my C-reactive protein (CRP) level—a protein that increases in response to inflammation—was very low. Therefore, biochemically, I was in excellent shape, better than when I was taking statins. “Have you started running?” my doctor asked, perplexed.

No, I have always run. For years, I have exercised three times a week, eaten a lot of fish, quit smoking, and tried to keep my stress levels low.

The only thing that had changed was my intake of sugar and animal fat. That check-up was seven months ago, and now, at 58 years old, I don’t take a single pill. My doctor is happy. I haven’t felt this good in years and, at the same time, I am deeply concerned about the proposals that still advocate for the use of statins. Until 2005, statins were prescribed only to people with at least a 30% or greater risk of having a heart attack in about 10 years.

Then they lowered it to a 20% risk. Now, the NHS project guidelines will provide for those with just a 10% risk—in other words, most men over 50 and most women over 60. I am a vascular surgeon. Before founding a private clinic in Dorset 11 years ago specializing in varicose veins, I worked in the NHS for 13 years. Back then, I did not question the medical guidance on cholesterol, and although statins were an amazing medication.

And they probably are, for men who have heart disease—not necessarily because they lower cholesterol, but because they can reduce other risks, such as the inflammation marker CRP. Exercise, weight loss, and omega-3 supplements also decrease CRP.

But what about other groups—such as women, the elderly, and people like me who have not been diagnosed with any heart disease? The evidence that we benefit from cholesterol-lowering medications is ambiguous at best. The SEARCH 2 study, one of the most extensive and recent studies, involved 52,000 men and women aged 20-74 in Norway without pre-existing heart disease, over 10 years. The results for women were clear.

The lower the total cholesterol in women, the higher the risk of death, whether from heart disease or any other cause, including cancer. These findings are reflected in previous studies. For men, high cholesterol was associated with heart disease and death from other causes. But low cholesterol was also associated—with levels below 5mmol/l. Once again, this is just an association and not a causal connection. A level of 5mmol/l to 7mmol/l was the optimal level.

Guess what? This is already the national average. Moreover, numerous studies have linked high cholesterol levels to increased longevity in older individuals. As for me, I have not been diagnosed with heart disease, and no one in my family has had a heart attack. However, my four uncles and my sister have diabetes. A study from Canada, published last year in the BMJ, has shown that statins increase the risk of diabetes, which gives me some faith. The controversy over these medications was reignited last week when Professor Sir Rory Collins from the University of Oxford warned that doctors who hesitate to prescribe them to those at risk could cost lives.

The doctor, by definition, is a generalist. They do not have time to read and analyze the data from every paper for every medical condition. Still, in a recent study from the Pulse journal, six out of ten doctors opposed the proposal to lower the risk level in patients prescribed statins. And 55% said they would not take statins or would not recommend them to a family member, based on the proposed new guidelines. If this is not evident, I don’t know what is. Best regards, Marc Bony