Rafe Issues Challenge to Statin Industry
I have been trying to get the straight scoop on whether statins actually decrease mortality and morbidity in a significant way and I haven’t been able to find any real evidence that they do.
If you ask a cardiologist it’s clear that they believe unequivocally that statins work, mostly because they see what statins to do blood cholesterol levels. But remember, cholesterol numbers in and of themselves do not matter. They are a proxy variable for cardiovascular health. Plaque buildup matters. At one time blood cholesterol numbers were the only non-invasive indicator we had of plaque buildup, but that’s not true anymore. However, drug companies are highly incentivized to prove that statins improve health. So they fund lots of studies.
Notwithstanding the systemic bias when there are profit motives and publication motives, we can turn to these studies and see if statins actually work. The best way to remove bias is to look at large-scale meta-analyses, like this one. If you simply read the conclusion you see “statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.” However, if you decode the numbers you see that “significant” means that, for example, at age 65 you improve your changes of dying within the next four years from 8% down to 7% [hat tip to Kevin for helping me decode the numbers]. Now, is that really significant?
If my cardiologist told me I needed to take statins and I said “prove it” and he produced that study above, I would absolutely not take them. For one, there are known deleterious side effects (which could possibly account for the small overall mortality risk decrease). For another, the average length of followup was only 4 years, whereas I am told that I am to take these drugs indefinitely. How do I know that the long-term side-effects won’t overrun the long-term benefits sometime after the four year mark and thus increase my overall mortality risk?
On the other hand, some small scale studies done by well-respected physicians indicates that you can reverse even advanced heart disease, as measured by the number of cardiac events (i.e. what really matters) through diet and exercise alone.
You can object all you want to the statistical significance of small scale studies. The real issue is, given the evidence, what would YOU do if you were diagnosed with heart disease or were at high risk of heart disease as measured by your cholesterol numbers?
Since I’m not such a candidate, I made a friendly wager with a good friend of mine about a year ago who is. He has been under a physician’s care for years because he has abnormally bad cholesterol numbers, and it runs in his family. His doctors told him that he couldn’t control it with diet and that statins are the only way to go. Problem is, he has a hard time tolerating statins (i.e. deleterious side effects). Despite being on various statins, his numbers had barely budged. The wager was designed to test the hypothesis that through dietary changes and exercise he could improve his numbers, a proposition that he claimed was impossible because he’d changed his diet in the past but it didn’t work. My claim was that he was misinformed about what he was supposed to be eating and what he was not. He got some advice from another friend who knows the literature. Here is the result:
Been on about an 80%ish vegan diet, taking 2 meds (that I’ve taken before to little effect) that are pretty mild as far as lipid management,my cholesterol on a recent test came back lower than it’s ever been:
total chol = 165, hdl = 40, ldl = 110, triglyc = 80
my LDL level was 270 less than a year ago, and my total chol was 350.
Still kind of stunned, and I expect the results are at least somewhat anomalous, but even if they prove to be outliers to my normalized levels it will represent a bigger improvement than I could have ever had taking super-dosage statins.
Here’s my challenge to the medical establishment: produce a meta-analysis of statins that shows absolute age-adjusted mortality rate decrease of greater than 10% over 20 years.*
In the mean time, I’ll be eating healthy, exercising regularly, and making money from people who want to take the same bet as my friend.
* Statins were commercially available in the U.S. starting in 1987, so the underlying data should exist. And remember, going from 8% to 7% is a 12.5% relative decrease but only a 1% absolute decrease. Since we care about human lives, not publishable results, isn’t it time that we start demanding absolute improvement from the medical community?