Does Cholesterol Really Matter?

by Julian Whitaker, MD

I'd like to shine the spotlight on one of medicine's sacred cows- the belief that lowering cholesterol with drugs protects against heart attacks and premature death. Our obsession with cholesterol began in the 1950s when studies linked high consumption of animal fat with high rates of heart disease. This opened the door for clinical trials that laid the foundation of a new paradigm: the cholesterol theory of cardiovascular disease.

This theory has had profound ramifications. It changed the way we eat (fats bad, carbohydrates good) and contributed to our problems with obesity and diabetes. It wormed its way into "clinical practice guidelines"- cholesterol management has become a "standard of care" that doctors are expected to follow. It spawned the invasive heart surgery industry, based on the presumption that cholesterol-laden blockages must be bypassed or propped open. And it led to the creation of the best-selling class of medications in history: cholesterol-lowering statin drugs, which generate more than $15 billion in worldwide sales every year.

But it's all a house of cards. No matter what you've been led to believe, a high cholesterol level is not a reliable sign of an impending heart attack. In fact, growing numbers of experts question whether cholesterol matters at all. As for statin drugs, for most of the 40-plus million Americans recommended to take them for the rest of their lives, they're an ineffective, expensive, side effect- riddled fraud.

Statin-Free Zone

When a patient taking Lipitor, Zocor, or another statin drug comes to Whitaker Wellness, we discontinue it at once. "But my cholesterol level is 240." "My doctor told me I'll have a heart attack if I don't take this drug."My father died of heart disease, so I have to take it." I've heard all these justifications and more, and I still recommend that my patients get off statins. Here's why.

First, they're not very effective. These drugs do lower cholesterol, but so what? We're not treating lab numbers. We're treating patients, and the ultimate goal in cholesterol management is to reduce risk of cardiovascular disease. Except for a very limited number of people, there is absolutely no evidence that statins protect against heart attack or premature death.

Are you over age 65? Not a single study suggests you'll receive any benefits, even if your cholesterol goes down substantially. A woman of any age? Same story. A man younger than 65 who has never had a heart attack? Ditto, no help at all. For middle-aged men who have had a heart attack, statins may lower risk of a repeat heart attack, but that's the extent of it.

I know this is hard to buy in light of the multiple drug advertisements and glowing endorsements from doctors. But keep in mind that pharmaceutical companies do a superb job of pulling the wool over the eyes of consumers and physicians alike by withholding unfavorable study results and making false, misleading, and often deceptive claims.

A Statistic We Can Understand

That's why I want to step around confusing statistics and tell you about an easy-to-understand measure that you'll never hear about in drug ads. It's called "number needed to treat," or NNT, and it describes the number of patients who would need to be treated with a medical therapy in order to prevent one bad outcome. Experts consider an NNT over 50 to be "worse than a lottery ticket."

Lipitor ads claim that it reduces risk of heart attack by 36 percent. Sounds pretty good until you look at the fine print, do the math (which John Carey did in a great article in Business Week), and figure out that the drug's NNT is 100. This means that 100 people must be treated with Lipitor in order for just one heart attack to be prevented. The other 99 people taking the drug receive no benefit.

To put this into perspective, the NNT of antibiotics for treating H. pylori, the underlying cause of stomach ulcers, is 1.1. These drugs knock out the bacteria in 10 out of 11 people who take it, making them a reliable, cost-effective therapy. At the other end of the spectrum are statins, which as a class have an NNT of 250, 500, or higher depending on the study you look at. What a deal for drugs that can cost more than a thousand bucks a year and are almost guaranteed to cause problems.

Goodbye Drugs, So Long Symptoms

Statins lower cholesterol by suppressing the activity of an enzyme in the liver involved in the production of cholesterol. But this enzyme has multiple functions, including the synthesis of coenzyme Q10. CoQ10 is a key player in the metabolic processes that energize our cells. No wonder statin users often suffer from fatigue, muscle pain and weakness, and even heart failure- the cells are simply running out of juice.

The second most frequent adverse effects of statins are problems with memory, mood, suicidal behavior, and neurological issues. Other common complaints include sexual dysfunction, and liver and digestive problems. Symptoms range from minor (achiness, forgetfulness) to serious (complete but temporary amnesia, permanent memory loss) to lethal (congestive heart failure, rhabdomyolysis or complete muscle breakdown). One statin drug, Baycol, was taken off the market a few years ago after it caused dozens of deaths from rhabdomyolysis. Several studies have also linked statin drugs with an increased risk of cancer.

Because physicians rarely warn of these side effects, few patients suspect their drugs may be the reason they begin feeling bad- and it's often a revelation when they put two and two together. Simply discontinuing these medications can result in tremendous improvements in health and well-being. Texas cardiologist Peter Langsjoen, MD, published a study showing that when symptomatic patients got off their statins and started taking 240 mg of CoQ10 per day, they had significant decreases in fatigue, myalgias (muscle aches), dyspnea (shortness of breath), memory loss, and/or peripheral neuropathy.

Not a Drug But a Program

As you can see, we need to shift away from this myopic focus on statin drugs and lowering cholesterol, and take a more holistic view. Folks, you don't need statins- you need a program that addresses all the known risk factors for heart attack, stroke, and other cardiovascular disorders.

Inflammation, not high cholesterol, is the primary cause of heart disease. Harvard researchers have discovered that a high blood level of C-reactive protein, a marker of inflammation, is more predictive of heart disease than cholesterol.

In short, do what you can to manage your cholesterol, but don't worry about it if your level is particularly stubborn. The average cholesterol of people who have heart disease isn't much higher than the level of those who don't. If high cholesterol runs in your family, concentrate on what you can control, and remember, numbers aren't everything.