Dagens Nyheter Debate: “High cholesterol is not dangerous for women and healthy men”
April 26, 2011
Doctors and researchers: The truth begins to emerge. Over half a million Swedes are taking drugs for elevated cholesterol, in vain. The cholesterol-lowering medicines – used by over half a million Swedes – reduces the risk of dying from heart attack. But the reduced risk only applies to men who previously had a myocardial infarction. The effect is also modest. What most people don’t know is that no experiments with this group of drugs (so-called statins) have managed to prolong the lives of healthy people. But now the truth begins to come out. An extensive analysis by the Cochrane Collaboration shows that statin therapy only has a trivial effect. On the contrary, there is reason to warn about the side effects that an uncritical use of statins may provide, write the authors.
Each cell produces its own cholesterol, and if that isn’t enough the liver produces it. We produce 3-5 times more cholesterol than we eat. If we eat too little the body’s production increases, if we eat a lot of the cells takes a break. This explains why it’s difficult to influence cholesterol levels through dietary changes.
The idea that cholesterol is dangerous came from Framingham, a small town outside of Boston. Here, researchers began in 1948 to screen people. When they repeated the examinations a few years later, they discovered that the cholesterol in those who meanwhile had a heart attack had been a little higher than normal. The researchers then claimed that high cholesterol was a risk factor for myocardial infarction.
The idea was immediately spread in the scientific community. But no one reacted when the Framingham residents were examined 30 years later. It then turned out that high cholesterol only was a risk factor for men up to age 47, and not for older men or women at all.
As if that wasn’t enough - more men had died of heart attack among those whose cholesterol had decreased. The authors wrote: “For every milligram percent cholesterol had decreased, cardiovascular mortality and total mortality increased by fourteen and eleven percent.”
Since then there have been numerous similar reports published, and most of them have confirmed the Framingham researchers’ results. For a few high cholesterol was a risk factor even in 70-year-old men, but most have found that high cholesterol is not a risk factor for older people. More than twenty studies have even shown that older people with high cholesterol live the longest.
The main thing that has kept the the cholesterol hypothesis alive is studies of people with hereditary high cholesterol, known as familial hypercholesterolemia. For many years it was thought that most die young of heart attacks. When British researchers began to study large populations, they discovered that people with this abnormality in average live as long as others. A few more die from heart attack, but fewer are dying of cancer.
It is not cholesterol that is dangerous. The risk is the same whether it is a bit higher than normal or if it is 2-3 times higher. This have been concluded by several research groups, however, without drawing the natural conclusion of their discovery.
There are other signs that the villain isn’t cholesterol. ENHANCE was an experiment with cholesterol-lowering statins, which only included people with hereditary high cholesterol. Half received Simvastatin, the other half also received a new cholesterol-lowering drug. Although cholesterol decreased most in the intensively treated group, atherosclerotic increased most in this group.
The cholesterol-lowering statins reduce the risk of dying from heart attack, but only for men who had a previous infarction and the effect is modest. The probability that a sixty-year-old male infarction patient is alive in five years is about 90 percent, and if he takes a statin tablet daily the probability increases to 92 percent.What most people don’t know is that no statin experiments have been successful in prolonging the lives of women or healthy men. The truth, however, begins to seep out.
The Cochrane Collaboration (The Cochrane Library 2011, Issue 1) recently reported an analysis of all published statin experiments on healthy people, a total of more than 34 000 individuals.
According to the report, statin therapy only has a trivial effect on people with healthy hearts. Several of the published experiments were according to the researchers also flawed in one way or another – a number of heart patients had been included in some, and in others the reports of side effects were incomplete.
The Cochrane-report has been lively commented on in international media. “Millions are taking statin needlessly” was the headline in The Telegraph. The editor of Time was more cautious: “Statins May Not Prevent Heart Disease in Healthy People”.
In an BBC interview said Fiona Taylor, a member of the UK Cochrane Group: “This analysis stresses that our knowledge of the effect of statin treatment in people who have never had a cardiovascular disease is highly incomplete.” (“This review highlights important shortcomings in our knowledge about the effects of statins in people who have no previous history of cardiovascular disease.”)
We find that the warnings against an uncritical use of statins are well founded. It is not safe to lower cholesterol. The most common side effect is sore and weak muscles. The official figures say that the frequency is less than 1 percent, but independent researchers can tell you that 25 percent is closer to the truth.
Others have found that about 20 percent of male heart patients become impotent after a few months of treatment. The study was funded by Pfizer, but the website for their cholesterol-lowering agent Lipitor is silent on this. Pfizer obviously has a solution to this problem – it’s named Viagra.
The many reports of memory loss, aggression, insomnia, nightmares, depression and suicidal thoughts is not surprising either, given that the brain is the organ richest in cholesterol and that normal brain function requires a continuous local production of cholesterol.
Serious birth defects have been reported, and also damage to peripheral nerves resulting in burning pain and weakness of muscles in the legs. But how many people read the small print on the package insert?
Perhaps the most serious side effect is cancer. In three studies of statins the cancer frequensy increased with statistical certainty. This is explained away with the argument that a merging of all statins experiments haven’t found an increased occurrence, even after ten years. Ten years of smoking is as we know not enough to get lung cancer.
Also, skin cancer was not reported, the cancer that is detected only if exposed to carcinogens. This since the number of cases of skin cancer increased in the first two experiments with Simvastatin.
It’s also worrying that a Japanese monitoring of statin-treated patients found that cancer was three times more common in those whose cholesterol dropped the most.
Today, the number of statin-treated people in Sweden long ago passed half a million, and a large proportion of these are healthy people whose only “illness” is high cholesterol. Time to take science into account?
Uffe Ravnskov, PhD, Associate Professor, Independent Researcher, Lund
Karl E Arfors, Professor, previous exploratory research director Pharmacia AB
Christer Enkvist, Former county chief, a former member of the SBU
Tore Scherstén, Professor, former chief secretary of the National Medical Research Council
Ralf Sundberg, Associate Professor
Jørgen Vesti Nielsen, chief physician