Cholesterol & Statin DrugsNovember 2004
By William Davis, MD, FACC
You have seen the glitzy ads for cholesterol-lowering drugs. Advocates call the statin drugs the “new aspirin,” to be taken by everyone, every day. Here is the real story.
The pharmaceutical companies are waging a war.
The battleground: treating your cholesterol. This single sector of the health care market is reaping tens of billions of dollars in revenues for these multinational companies. They must be manufacturing great drugs. Or are they?
Supporters are so enamored of statin drugs that some have even proposed putting them in the water supply. Critics object that the statins are another thalidomide story for the drug industry, with ill effects not yet fully understood.
No matter what you believe, the statins—or more properly, HMG-CoA reductase inhibitors—are a huge success story. As one investment reporter put it, statin drugs “turn cholesterol into money.” Lipitor® alone brought Pfizer $9.2 billion in 2003, more than the company earned over several years in the early 1990s.1 Industry estimates put total annual spending on statins at more than $22 billion. It is no wonder the pharmaceutical companies are hyping these drugs. The question is, what are we getting for our $22 billion?
The Science Behind Statins
It is also well established that the risk of heart attack is reduced by around 30% over five years of treatment. In the widely pub-licized Scandinavian Simvastatin Survival Study, 4,444 participants took the simvastatin drug (Zocor®) or a placebo. Heart attacks and death decreased from 28% in the placebo group to 19% in the simvastatin group.2
The Scandinavian study and similar trials solidly bolster the argument that statins reduce LDL and thereby lower the risk of heart attacks in people who have suffered prior heart attacks, as well as in people at risk for a first heart attack. Over the years, some have voiced concern that statins might raise cancer risk, but the evidence solidly refutes that notion. In studies involving tens of thousands of participants, statins did not increase the risk of cancer.3-12
Unfortunately, the statins’ success in lowering cholesterol has led many people to believe they represent a cure-all for cholesterol and heart disease risk. They are not, however, a cure-all. To get at the truth about statins, we need to dig deeper.
Statins and Side Effects
In many physicians’ practices (including my own), muscle aches and weakness occur in approximately 30% of patients who take statins. The companies and clinical investigators roundly deny this, claiming that even people who take placebo experience muscle aches and weakness at a similar rate simply because humans are prone to such ailments.
Like many of my colleagues, I have hundreds of patients who, when they take a statin agent, develop annoying, sometimes incapacitating muscle aches and weakness that abruptly stop when they discontinue use of the drug, and return when drug use is resumed. The association appears clear.
Are the symptoms progressive and will they lead to some sort of irreversible damage? While there are no data to guide us, the recent observation that muscle biopsies reveal distinct structural abnormalities lends scientific credibility to the suspicion that the muscle aches are real. This observation and early research on statins demonstrating that they deplete cellular coenzyme Q10 suggest that CoQ10 replacement may have a role in treating these symptoms.
I have found the use of CoQ10 supplementation to be indispensable for these symptoms. A daily dose of 100 mg of CoQ10, preferably in an emulsified oil base rather than powdered form, relieves the symptoms of muscle aches and weakness in four of five instances, usually within five days of starting the supplement. These views are, of course, not supported by the drug manufacturers.13-15 (Should you suffer muscle aches or weakness, always discuss them with your doctor first, in the event that they do in fact represent serious muscle injury.)
The fact is, statins are pretty good drugs, considering that they are intended for long-term use. Imagine taking an antibiotic for 10 years! Even 10 days of antibiotic treatment can leave you with stomach aches, diarrhea, and opportunistic infections that emerge after elimination of the original infectious organism. In this respect, most people who take statin drugs year after year fare pretty well.
The fundamental flaws in focusing on cholesterol and statin agents are the perceptions that cholesterol identifies hidden heart disease and that lowering cholesterol is the way to a future free of heart attacks. Both perceptions are untrue.
Do Statins Cure Heart Disease?
The answer is a clear “no.” The risks of heart attacks and death are reduced, not eliminated, by treatment. In other words, for every 100 people who participated in the Scandinavian study on Zocor®, 9 heart attacks were prevented (reducing the number of those suffering a heart attack from 28 to 19). Nevertheless, 19 heart attacks still occurred. Why does lowering LDL with statin drugs result in such limited success? Are there other ways to reduce the risk of heart attacks so that the 19 of 100 people destined to suffer a heart attack can avoid one?
We must step back for a moment and recognize that statin therapy for high cholesterol is just one piece of a bigger picture. Heart disease has many other risk factors, and there are many other ways to reduce risk and identify people at risk.
Lowering Cholesterol Naturally
For example, if you follow the American Heart Association’s diet, you might enjoy a 7% drop in cholesterol.16 That is certainly an improvement, but still not good enough. If you follow an ultra low-fat diet (deriving no more than 10% of your total calories from fat), your cholesterol may drop, but you will also reduce HDL and increase triglycerides, sometimes dramatically.17 The net effect can be an increased risk of heart disease and diabetes.
The following are some healthy strategies that truly help lower total cholesterol and LDL.
Raw almonds. A handful (1/4-1/2 cup) of raw almonds daily not only lowers cholesterol, but also lowers the dreaded genetic risk factor for coronary disease, lipoprotein(a). Almonds also blunt abnormal spikes in blood sugar after eating and help prevent diabetes. They are tremendously filling and are great for sugar addicts who need to snack, since almonds take the edge off your sweet tooth.18,19
Soy protein powder. Soy products are a source of many beneficial substances, such as isoflavones. Eating soy protein powder (sold in one-pound canisters) is a tremendous way to reduce cholesterol through soy’s tendency to suppress the liver’s production of cholesterol particles. Even the FDA, ordinarily charged with reviewing drugs, has endorsed the value of soy protein powder. Three tablespoons a day in fruit smoothies, protein shakes, or blended with yogurt or other foods will lower LDL by around 12%.20,21
Pectin. Found in apples and the rinds of citrus fruits, pectin is a natural fiber that lowers cholesterol; the same foods also provide flavonoids that yield broad health-promoting effects. Pectin is also available in powdered form (for example, Life Extension’s Apple Pectin Powder).22,23
Flavonoids. A large and diverse collection of naturally occurring substances that lower cholesterol, flavonoids provide antioxidant benefits, lower blood pressure, possess anti-inflammatory properties, and prevent cancer. Sytrinol™, a new, patented complex of citrus bioflavinoids is a convenient way to lower LDL by as much as 15% while obtaining all the other benefits of flavonoids.24-26
Tocotrienols. Isolated vitamin E, or d-alpha tocopherol, has shown disappointing results in lowering the risk of heart attacks. Yet a growing body of research suggests that the four tocotrienols (which are cousins to the vitamin E family) lower cholesterol and have potent chemopreventive effects, much like flavonoids.27,28
Soluble fibers. Among the best soluble fibers is oat bran. Containing twice as much beta-glucan as oatmeal, oat bran is a versatile source of soluble fiber that can lower cholesterol by around 10-15% while also reducing blood sugar and providing roughage for bowel health. Beta-glucan is also available as a nutritional supplement. Starchy beans such as black, pinto, Spanish, red, and kidney beans provide significant soluble fiber that can lower LDL. Consuming one-half cup of these beans each day in one or more meals is an easy way to lower cholesterol. Note that fibers like the wheat fiber found in whole wheat bread and raisin bran cereals do nothing for your cholesterol.29-31
Phytosterols. These soybean derivatives lower cholesterol by 12-15%.32,33
PGX™. A relatively small amount (one to three grams before each meal) of this highly viscous fiber blend of glucomannan, xanthan, and alginate may help lower LDL and total cholesterol. Even more important may be its ability to limit sugar absorption and the subsequent after-meal insulin spike. High after-meal blood glucose and insulin levels increase the risk of heart attacks significantly.34-43 When study subjects took just one gram of glucomannan before each meal, total cholesterol was reduced by 21.7 mg/dL and LDL was lowered by 14 mg/dL.44,45
What cholesterol levels should you aim for? There is broad consensus that, in the absence of known heart disease, an LDL level below 100 mg/dL is desirable. In our program for coronary plaque regression, once plaque is identified, we aim for an LDL of 60 mg/dL or less. We achieve this by using statins when necessary but after natural alternatives have been attempted.