Crowd

A fortnight ago I wrote about how the role of cholesterol in heart disease was being challenged. There was also a challenge to the widespread prescribing of statin medications. And to cap it off we saw a near hysterical reaction of some health authorities to this.

The story has continued to grow and has taken new twists.

The most notable development has been the release in the USA of new guidelines for the use of statin medications. Thus far their role has been to lower cholesterol and in particular LDL or “bad cholesterol”. These were issued by the American Heart Association and the American College of Cardiology

The new guidelines may increase the number of people prescribed these medications. It removes the need to lower cholesterol and focuses on “total risk”. This is a calculation considering all risk factors including smoking, weight, family history, blood sugar and cholesterol. This is fine in theory but all computer models and algorithms have major limitations. Plus some 40% of people who have a heart attack have no risk factors.

The new recommendations are to consider a statin in anyone with a 7.5% chance of having a heart attack in the next ten years. The flip side of this is the same people have a 92.5% chance of NOT having a heart attack in the next ten years. And even if the risk calculation was fully reliable (which it is not) this means that for every 1000 people taking medications for ten years, 75 may get a benefit.

Keep in mind that taking the tablets does not mean you can’t have a heart attack!

Which is where this gets really serious. There is no conclusive evidence that for people who do not have heart disease that taking statins provides any benefit. There is benefit in those who have had a heart attack.

Plus there are a significant number of people who will get side effects.

Over the last few weeks even I have been surprised to hear patients describe how much better they feel after stopping statins. They report having more energy and less muscle soreness. Their quality of life has been improved.

Hidden in the fine print is a move away from setting targets for cholesterol levels. It has been recommended that people are treated (often with increasing doses of medication) until their blood levels are at a certain figure. Yet the evidence has never been there for this approach.

Indeed trials have shown that medications, which lowered LDL, did not reduce cardiovascular disease or death.

Yet we know that following a Mediterranean type diet and doing regular exercise DOES reduce cardiovascular disease and death. They do not come from a pill and cannot be patented.

Daniela Drake writing on The Daily Beast best described it thus; “…what conventional medical care really offers (is) a lot of pharmaceutical treatment for a lot of dietary diseases”.

And unfortunately it gets worse. Some 40% of the doctors on the panels, which determined these guidelines, had current financial ties to drug companies. To quote John D Abramson of Harvard and Rita Redberg of University of California writing in the NY Times; “ The American people deserve to have important medical guidelines developed by doctors and scientists on whom they can confidently rely to make judgements free from influence, conscious or unconscious, by the industries that stand to gain or lose”.

Here in Australia the backlash against those who question “experts” has continued.  A survey by a drug company found “huge numbers” of people had stopped taking their tablets. This was described by a spokesperson from the Heart Foundation as “frightening”. A medical association has run a full-page newspaper ad warning people about stopping tablets.

Given that sales of these drugs are worth billions a backlash is not surprising. My call for the Heart Foundation to declare its own interests and those of any doctors associated with it has gone unanswered.

So here is the bottom line. After 40 years whilst the role of cholesterol in heart disease is unclear it is far less than we have been told. New guidelines whilst potentially widening the number of people, who can be prescribed statins, concede that lowering cholesterol is not important.

Guidelines and protocols so loved by academics and governments are in a word-tainted. We can have little or no faith in them.