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Edition: 2023-12-31
This article was written as a link target, so that I don’t have to re-state my position on statins every time I post to a thread on that includes that topic. For the official program position, skip down to Excerpts: Dr. Davis on Statins
Ad hominem: I have had a physician suggest that I take statin, and declined.
My basic position is that, for people who have embraced the Infinite Health or 2014+ Wheat Belly/Undoctored lifestyle, statins may have some net benefit in narrow situations, but everyone facing the choice needs to do their own double-checking of the science, and of the countermeasures needed to mitigate statin hazards. If I were a middle-aged male who had just had an MI, I might consider it. I’m not, and never have been in that situation. If I had a difficult lipidemia, I’d give it a hard skeptical look.
For those still on typical (SAD) or USDA/AMA/AHA official diets, statins may have net benefit in more scenarios, but my bet is that most if not all of that benefit vanishes, or even goes negative, once diet and various nutrient and micronutrient deficiencies are corrected.
Those who have corrected diet, including getting ample Omega 3 DHA&EPA, from supplements or food, need to contemplate what appears to be a material interference between statins and ω3 benefits (2013 Blog post by Dr. Davis, cited 2013 paper; newer 2015 paper).
During 2016, Dr. Peter Attia spoke in several places about when to consider a statin. If I can find this posted anywhere, I’ll link to it, but the following is from taking notes during his segment of the 2016 Fat Summit 2.
The presentation must be: elevated ApoB or LDL Particle Number (particle size matters too).
He identifies 4 drivers:
His posture is that if an MD is prescribing you a statin, and “If they can’t explain the four mechanisms by which apoB is elevated, they should not be treating it.”. Plus, typical MDs are “…not understanding ‘residual risk’ and therefore not knowing how to customize the LDL-P target.”
Where the situation responds to nutritional and lifestyle interventions, obviously statins are not needed. Peter does encounter cases where SFAs need to be dialed-down, and replaced with MUFAs.
Statins are one pharmaceutical in his tool box, but he points out that statins interfere with cholesterol synthesis, cholesterol cannot cross the BBB, so reducing that synth in the brain is a long term neurological hazard.
As you might imagine, the percentage of patients that are run through this protocol, and might benefit from a statin, is tiny compared to rate at which they are actually prescribed. But there are some who need to weigh the comparative hazards of statin side effects vs. consequences of raging untreated hyperlipidemia.
There is precious little non-industry science on all-cause mortality for statin use. There’s a particular problem for trials prior to 2004.
The most prominent non-industry trials (ALLHAT-LLT, and more recently, HOPE-3) showed no net benefit for statins per se. I have a separate article on HOPE-3.
ALLHAT had material confounding factors. Raw data from published industry trials is generally not available for independent analysis (see the email exchange in this article about the ABC Catalyst scandal). Then there is the question of studies left entirely unpublished; what were the results, why they were left unpublished - not even a paper full of industry spin. However, even if the industry-funded data is otherwise credible, it’s all seriously confounded as well, due to diet.
When researchers do conduct deep dives in the lit., they may come up with conclusions like: ERCP: Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and ‘heme A’, and thereby ATP generation. Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress. An impairment of selenoprotein biosynthesis may be a factor in congestive heart failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency. Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated.
Statin skepticism is not unique to the present program: Review of statins needed
There is of course no data (outside of what a few rogue doctors might have in their case files) on all-cause outcomes for statin use on an enlightened ancestral diet: a whole food, low net carb, grain-free, low-inflammatory, optimized microbiome lifestyle. We will probably never get formal papers on that (due to obstructive IRBs), which leaves everyone on their own. You are your own case manager.
Do statins drive down certain common lipid lab numbers? There’s little doubt of that, but:
It’s clear that statins shove around the mythical LDL-C number, but that apparently does not translate to leverage over all-cause mortality for unspecified phenotypes. The HOPE-3 trial, reported in April 2016 showed ~30% reduction in LDL, but only ¼% reduction in mortality (over 7 years).
CETP inhibitors also drive ‘LDL-C’ down, and raise HDL, and they are being abandoned by the drug industry as failures. Statin evangelists have characterized this outcome as a “paradox”, but only because they are utterly blind to black swans.
Put another way, these drugs might have benefit, but that benefit does not amount to a US$30 billion market, which is what it is today. Statins are being pushed to all and sundry (including children), based on the scientifically unsupported Lipid Hypothesis. The money is a huge problem. A lot of it gets kicked back to doctors, both above and below the table. A lot of it is used to fund "independent" consultants who champion the defective dogma at every opportunity. The money is of course also used to lobby for wider use of these drugs.
The other, more serious problem with statins is how they are being pushed. Many of the readers following Dr. Davis’ programs are carefully considering their options, supplementing intelligently, and monitoring their health using tests that are actually informative. That’s not the case for most people.
The more usual clinical scenario is that:
The above bullet list is the Standard of Care for statins.
I have another description for it: malpractice.
I have no problem with a fully-informed patient electing to take a statin. The fully informed scenario is exceptionally, depressingly, rare. Who might be a candidate for statins? For temporary use: ♦ a middle-aged male who has just had a heart attack. For extended use, when the key metrics don’t respond to diet, such as in some forms of familial hypercholesterolemia.
Anyone then choosing to take a statin needs to seriously look at the known side effects. One of the most vocal statin skeptics, Dr. Duane Graveline (spacedoc), died in 2016 from peripheral neuropathy caused by statins. Insofar as I have considered the matter, CoQ10 and Vitamin K supplementation would be the minimum countermeasures. ConsumerLab has separately reported that statins interfere with Vitamin D, so monitoring titer is important for dialing-in daily supplementation. The statin producers, by the way, are very far from ignorant about CoQ10.
The whole statin industry may be a huge house of cards, with too much money and liability at stake for anyone making or pushing these drugs to dare question the dogma. Tom Naughton’s Older Brother put it this way: “Statins are this generation’s thalidomide.” That may be over-stating the case, but not by a lot, particularly if statins are in fact being prescribed to children. And not just children - consider this proposal to extend statins to expectant mothers.
The future looks equally grim. Official deadly diets have yet to shift. The Lipid Hypothesis is still at large. Statins are now almost all off patent (despite gaming of the patent system to extend them, such as use by children). PCSK9 inhibitors were approved with ZERO outcome data (not even questionable industry data), based on the dogma (drives LDL-C lab result down, therefore must be beneficial). PCSK9i’s are astonishingly expensive, so the industry and their professional association lackeys are already lobbying to re-define FH in order to dramatically expand the pool of patients that simply must have them, whether or not they provide net benefit. Forcing insurance to cover them is expected to raise everyone’s insurance premiums by US$124 per year.
My view of PCSK9i’s is that they may be beneficial, possibly in more scenarios than statins, but as Peter at Hyperlipid put it: “We’ll have to wait to see the body counts.” In late 2016, one of the first PCSK9 inhibitors was abandoned. As of 2019, the outcome data was still inconclusive, because the trials did not have arms on PCSK9i alone. Statins were always used.
More ominously, a PCSK9 inhibitor vaccine is being developed. Vaccines for infectious diseases are already mandatory in many places. Ponder that: the principle of mandatory vaccination is in place. With healthcare costs spinning out of control (growing faster than GDP), it is easy to predict that the economics will give rise to proposals to mandate vaccines that purport to contain costs, even if the vaccine is just countering some of the consequences of the catastrophic consensus diets (and has horrible effects for people on sane diets, and that’s entirely aside from whatever issues are inherent to vaccines). You can stop taking an oral statin. A vaccine may be irreversible.
While I was originally composing this article, this MPT article arrived: CMS: 2014 Saw Spike in Healthcare Spending “Policy needs to be focused on trying to keep heath [sic] spending from growing faster than it needs to...”, Guterman stated.
There is no case for statin benefit, and that’s according to the JACC, although they managed to avoid reaching that conclusion. See my remarks on Statins and CAC: What is This Paper, Really?
MedPageToday (2017-05-23): Analysis: No Statin Primary Prevention Seen for Seniors Post hoc analysis turns up no benefit at ages 65-74 … Seniors don’t get a cardiovascular or mortality benefit from taking a moderate-dose statin for primary prevention, according to a post hoc subgroup analysis of ALLHAT-LLT. … In the 65- to 74-year-olds, the mortality rate was 15.5% on pravastatin and 14.2% with usual care (HR 1.08, P=0.55). For adults 75 years and older, the trend actually neared significance in the wrong direction (24.5% pravastatin vs 18.5%, HR 1.34, P=0.07). … Open-access full-text at JAMA Network: Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults
For some odd reason, those all-cause outcome numbers in the MPT article were reported as “no benefit” instead of as the usual “relative risk” (RR) numbers. Perhaps this is because, using RR, the MPT headline would need to have been: 9% or 32% greater chance of dying for seniors on statins.
Dr. Davis’ most recent statement (2017-09-18) on statins might be this one, from the UIC forum (members can view it here): “If [person’s initials and list of standard program strategies collapsed] Given the above, is there any incremental benefit to taking a statin over and above these strategies? Note that these efforts without statins typically yield FAR superior values to that achieved with statin alone. We do not have a large clinical trial conducted over many years to demonstrate reduction in cardiovascular events. But, judging by our surrogates for risk, such as small LDL, LDL particle number, hsCRP, coronary calcium score, etc. this program is magnificently effective as it stands without statins.…”
And here’s Kendrick on why we’ll never get objective trials.
PCM: WBB: The Statin Drug Tragedy PCM: WBB: How To Get Off Statins PCM: WBB: The Four Dangers of Stopping a Statin Drug PCM: WBB: Ten ways to reduce or eliminate heart disease risk PCM: WBB: Why you should have a CT heart scan PCM: UdB: What is better than a CT heart scan? PCM: UdB: Do statin drugs slow or stop the increase in heart scan scores?
___________ Bob Niland [⎆disclosures] [⎆topics] [⎆abbreviations]
Scary stuff.. Sad that millions of statin takers will never hear of this, much less the so called professionals that are writing the scrips...