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Coronary heart disease is the most common cause of death in the US. But the reasons for this, along with effective solutions, have been hotly debated for decades. At the heart of the controversy is a frightening question: Do statins kill or cure?

While various institutions including the American Heart Association, American College of Cardiology, and medics at Harvard Medical School persist in recommending statins for those at risk of having stroke or a heart attack, there is no doubt that lifestyle changes are more effective than statins. The only issue is that not everyone believes in exactly the same lifestyle changes, particularly when it comes to diet.

That said, as long ago as 1956, the three major risk factors for cardiovascular disease (CVD) had been identified as high blood pressure; increased serum cholesterol levels; and smoking.

Recommended Lifestyle Changes

After their comprehensive review of various trials, Sultan and Hynes were convinced that the best way to prevent primary cardiovascular problems and approach regeneration programs was to make lifestyle changes, including abstinence from smoking tobacco. This, they concluded, had “enhanced clinical efficacy” and improved quality of life more than any pharmaceutical or other so-called “conventional” intervention was capable of.

While the British Heart Foundation continues to promote statins, it does (somewhat casually) warn against potential side effects. It also advises that there are other ways to lower cholesterol – which is, of course, why doctors prescribe statins (see below). You can do this, they say, by:

  • Eating a balanced and healthy diet
  • Maintaining a healthy weight, taking your body mass index (BMI) and waist circumference into account
  • Making sure you do physical exercise regularly

The Mayo Clinic, which appears to be as pro statins as the institutions mentioned above, state that “doctors are far from knowing everything about statins.” However they also state unequivocally that, “lifestyle is still key for preventing heart disease,” and promote the fact that lifestyle changes are vital to reduce the risks of heart disease. Their recommendations are very similar to those of the British Heart Foundation:

  • Eat a healthy diet
  • Maintain a healthy size – specifically in terms of “waist girth.” This, they say should be less than 35 inches (about 89 cm) in women and 40 inches (not much more than a meter) in men
  • Exercise regularly, sit less, and generally ensure you are physically active
  • Stop smoking and be sure to avoid “secondhand smoke.”

Reliable dietary recommendations remain contradictory, especially in terms of high fat versus low fat, and the value versus potentially harmful effects of grains. Generally, though, it is now agreed that carbohydrates should be limited, and sugar largely avoided.

Cholesterol and Statins: How It All Started

American physiologist, Dr Ancel Keys established a link between dietary cholesterol and atherosclerosis and cardiovascular disease more the 60 years ago. He blamed dietary saturated fat, and blazed a trail for low-fat diets and the development of drug therapy that eventually led to the launch of statins in the 1990s. He believed that lipids (essentially various forms of fat) needed to be decreased in the human body, but also advocated a healthy lifestyle (albeit one that included minimal fat) along with regular exercise.

Nicknamed “Mr Cholestrol,” Keys began studying a link between diet and cardiovascular disease after World War II when he realized that food shortages in Europe seemed to correlate with a drop in coronary artery disease (CAD.) This culminated in his famous (infamous to some) Seven Countries Study that found, amongst other things that a typical Mediterranean diet resulted in low blood cholesterol and hardly any heart attacks. It also found that where fat was generally a major component in meals (especially in the US and Finland,) heart-attack death rates and blood cholesterol levels were highest. 

The first trials looked at drug therapy and/or diet and its effect in preventing CVD. Dietary modification was largely focused on reducing total (and more specifically saturated) fat content, with some trials looking at using soybean and corn instead of the usual oils (sunflower, canola and so on.)

From mid 1990, mega-trials started focusing on statins that could lower lipid levels. Sultan and Hynes refer to this as the “statin saga,” which is what they label a “marketing trap” that has really only benefited middle-aged men who were already suffering from CHD. Ironically, though, statins aren’t even proven to be the best form of primary prevention for them either. Aspirin, they say, has proved to be a better form of primary prevention. Also, they reveal that high cholesterol has been found to protect the health of heart failure patients and the elderly.

As they point out, the statin industry and spin-offs are (or were when the study was published in 2013) worth 20-billion a year (the currency is not specified, but presumably they mean £20 billion.) Furthermore, this is part of what they describe as the “utmost medical tragedy of all times.”

As Sultan and Hynes’ paper states, it isn’t just that the healthcare industry has managed to “inadvertently” induce potentially fatal nutrient deficiencies in millions of people who were otherwise healthy. It is also the fact that the industry has not reported on all the negative side effects that result from taking statins, and there has been active discouragement in terms of publication of the many negative studies that have been done.