If you go to your doctor and you’ve got raised blood pressure or a cholesterol level above 5 (2)  or you are over 55 there’s a good chance you’ll be recommended a statin drug every day, probably for the rest of your life (3). Here’s a few points you might like to consider. Statins are taken to reduce high cholesterol (4), yet 50% of heart attack patients have normal cholesterol . Another marker for heart attack risk that is as accurate as cholesterol is your level of an amino acid called homocysteine. The way to reduce it is with B vitamins. Few doctors every recommend them.

Entire male population of Norway at risk of heart disease
But quite apart from whether statins work or not, what is really astounding is just how many people, according to current guidelines, should be taking them. A recent Norwegian study that found that, applying the latest medical guidelines, 85.9% of Norwegian males were classified as being at high risk of cardiovascular disease at the age of 40. What’s more, three out of four Norwegians aged 20 or older are classed as in need of counselling because of high cholesterol or blood pressure levels(5).  As the authors dryly comment: “When guidelines class most adults in one of the world’s longest living and healthiest populations as at high risk and therefore in need of maximal clinical attention and follow up, it raises several scientific and ethical questions.”

What is going on here is what’s called “diagnostic creep” - the tendency to classify more and more people as in need of medication because they exceed some guideline. In the US 70% of the UK population is taking medicines to treat or prevent ill health or to enhance well being (6). Now you don’t have to be too cynical to view diagnostic creep as a brilliant marketing tool. The best-selling statin, Lipitor, pulls in $11 billion on its own. So it has to be relevant that the majority of members of the committees that set the guidelines that make these levels of profit possible have financial links with the companies making the drugs. Eight of nine authors of the most recent set of guidelines setting lower cholesterol targets had financial links with statin manufacturers, as did nine of the eleven members of the committee that set lower levels for hypertension in 2001(7).

The fact is that dietary and lifestyle changes work much better. A study in Norway over twenty years ago took 1200 men who didn’t yet have heart disease, but who smoked and had high cholesterol, and just gave half of them advice about cutting back on saturated fats  and not smoking. After 10 years there were 44% fewer cases of heart disease among the ones who got nutrition counselling. In another study people were recommended to eat a Mediterranean diet. Those that followed the advice had 70% less heart disease. That is three times better than the usual risk reduction in similar patients given statins. Treating 250 diabetic patients with statins would prevent one death. Getting 250 diabetic patients to take exercise saves four times as many lives(8). Supplementing niacin, vitamin B3, is far more effective at raising the good cholesterol, HDL, than statins, as well as lowering the bad LDL cholesterol, but doctors rarely prescribe it. B vitamin called ‘niacin or vitamin B3 is the most effective way to raise HDL cholesterol levels. A recent review in the New England Journal of Medicine reported that niacin increases HDL levels by 20 to 35 percent (9).  It also also lowers LDL cholesterol by up to 25 percent. One of the authors of this study was cardiology expert Roger Blumenthal, an associate professor and director of the Ciccarone Preventive Cardiology Center at The Johns Hopkins University School of Medicine and its Heart Institute. Statins, by comparison only raise HDL by between 2 and 15 per cent.

As with statins, an awful lot of people have to take hypertension drugs, for just one person to benefit. One study found that 95% of patients who dutifully take their tablets for five years will be no better off(10). You’d probably be better off eating more pumpkin seeds, high in magnesium, and supplementing an additional 200mg, although doctors rarely recommend this. Is it really a rational system for so many people to be defined as sick, and all that implies, taking vastly expensive medication for so little return?

Andrew is a case in point. At the age of 35, Andrew was overweight, drank too much and had a high cholesterol of 8.9. That was more than enough reason for his doctor to prescribe the statin drug Lipitor. That was about all he did. Andrew wasn’t told much about his diet, about alternatives such as niacin, or the contribution that his high intake of alcohol, reliance on caffeine and stress and anxiety might be having.

After three months the his cholesterol had decreased to 8.7. He wasn’t impressed and stopped the drug.Instead he decided it was time to take his health into his own hands and came to one of my weekend ‘100% Health’ workshops. There he learnt what a healthy diet really means, how to balance his blood sugar levels and eat foods such as oats, beans and lentils, high in plant sterols that lower cholesterol and how niacin and omega 3 fats works better than statins. Armed with enthusiasm he cut right back on alcohol, reduced his caffeine to virtually nothing, took multivitamins, two omega 3 fat 1,000mg capsules, ‘no-flush’ niacin (500mg x 2) and vitamin two 1,000mg vitamin C supplements. Three weeks later his cholesterol tested 4.9mmol/l. The ideal is below 5. His new regime wasn’t only good for his heart. His energy soared, his stress and anxiety vanished and he lost 9 lbs as well.

Unlike statins, which can cause heart muscle dysfunction and, occasionally death (never take statins without 90mg of Coenzyme Q10 – see www.patrickholford.com/statins) , there are no known side-effects to his nutrition regime. So it’s more effective and safer.

So why aren’t more doctors giving you this kind of advice instead of prescribing more expensive, less effective, and potentially dangerous drugs as if they were God’s gift to our arteries? It’s a good question.

1.CBC news, 11 Apr 2005 reporting on Toronto's Institute for Clinical Evaluative Sciences, (ICES), which had looked at Canadians aged 18 to 74, between 1988 and 1992, who were considered at low risk for heart disease but who qualify for statin therapy under current guidelines, to estimate how many such people would need to take the drugs to save one life.
2.Confusingly the UK and the USA measure the amount of cholesterol you have in your blood in different ways. In the UK we use ‘millimoles per litre’ abbreviated mmol/l, while the American use ‘milligrams per decilitre’ abbreviated mg/dl. But it’s quite easy to translate them; 1mmol/l =40 mg/dl)
3.This is because statins are recommended if you have a mild to moderate risk of having a heart attack; a risk of between 1/7 and 1/10. It’s not hard to show up as having a moderate risk – factors include simply being male and 55 or over; being 45 and male and having one risk factor like smoking; being female and over 55 and having one risk factor.
4. “Before the Heart Attacks: a revolutionary approach to detecting, preventing and even reversing heart disease” by Dr Robert Superko  (Rodale 12.99),. This is a fascinating book by  a Fellow of the American College of Cardiology who has developed a treatment plan for heart patients that combines drugs, food, vitamins and exercise. “My key message is that cholesterol is not the most common cause of heart disease,” he asserts. We’ve known for 20 years that 50% of people with heart problems have the same cholesterol levels as those who don’t. 
“Of course very high levels are dangerous and should be brought down” he continues “but within the normal range, cholesterol level is a poor predictor of risk.” So lowering it isn’t that effective at reducing risk either. “Statin-type drugs reduce risk by about 25%, which is not good enough. What’s worse is drug company publicity has persuaded people that low cholesterol equals low risk. That is deceptive and unfair. ”  (From an interview by JB The Times, 24 January 2004,)
5. L. Getz et al., Estimating the high risk group for cardiovascular disease in the Norwegian HUNT 2 population according to the 2003 European guidelines: modelling study, BMJ, vol 331, pp. 551 (2005) {29}
6. I. Heath, Who needs health care—the well or the sick?, BMJ, vol 330, pp. 954-956 (2005) {43}
7. Seattle Times ibid
8. E. W. Gregg et al, Relationship of Walking to Mortality Among US Adults with Diabetes, Archives of Internal Medicine, vol 163, pp. 1440-1447 (2003)
9. M. Dominique Ashen, Ph.D., C.R.N.P., and Roger S. Blumenthal, M.D ‘Low HDL Cholesterol Levels’N Engl J Med 2005;353:1252-60.
10. R. E. Ferner, Is concordance the primrose path to health?, BMJ, vol 327, pp. 821-822 (2003)