Views on cholesterol and statin therapy in the recent ABC catalyst programs
I have had a number of emails from clients asking my views on a recent two-part program which created a storm of controversy.
The first 30 minute episode had some good messages which unfortunately were buried underneath some very biased journalism. The second 30-minute episode addressing the use of statins was highly negative toward this class of drugs but without providing any factual data to back up their claims.
Cholesterol is one of many risk factors
On positive note, I agree with their premise that everyone focuses just on cholesterol, whereas in reality this is just one of several risk factors for a blocked artery.
The best way of addressing risk is to import multifactorial risk factors into a heart risk calculator, which we have been doing in every patient for the best part of a decade. This appears in our patient reports.
The biggest risk factors
The biggest risks are in fact getting older and being a male. Female risk increases post-menopause. In addition other risks are: being a smoker, having diabetes or pre-diabetes (where your body is not being able to metabolise sugar very well), raised cholesterol, raised BP and significant positive family history.
I found that the world seems to focus on just the cholesterol but it really is a combination of everything. They also made the point that there are many people treated with drug therapy that probably shouldn’t.
My practice has been increasingly looking for physical evidence of plaque build-up with some form of imaging rather than just embarking on cholesterol lowering therapy e.g. statins. I agree that not everyone with high cholesterol alone needs to be put on this medication straight away.
The seven-year rule
Statin medications do cause side-effects, rarely are lethal and have passed the seven-year rule that is 20% of all drugs accepted by the FDA in the USA are subsequently removed by the market within seven years due to major life-threatening side-effects identified subsequent to their trials. Statins have been around for more than 20 years now.
I don’t recall it being mentioned anywhere within the articles that … the death rate for coronary artery disease has fallen by about 30% over the past 30 years or so — some of this has clearly been contributed to by statin therapy.
In addition there are well published trials that also reinforce the benefits of statin therapy in primary prevention when we are attempting to stop an initial heart attack or stroke.
I think everyone agrees that if you have established arterial disease, in the context of a prior heart attack or stroke in particular, then statin therapy absolutely saves lives.