Statin Drugs, Cholesterol and Heart Disease: Myth versus Reality

We’re delighted to introduce our first ever guest ‘post’, from By Dicken Weatherby, N.D. and Donald R. Yance, MH, CN. Dicken will be speaking at the upcoming BANT seminar we are hosting on 29th October, read on for a taster of what to expect!

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Pfizer and Merck are continuing their efforts to have the commonly prescribed Statin medications Lipitor and Mevacor approved for over the counter use. Currently these drugs are made available in the US only with a physician’s prescription. In the US, the Food and Drug Administration or FDA has turned down three times Merck’s application to make Mevacor, one of the first statin drugs, available without a prescription. The panel that made this decision the third time raised concerns that patients would turn to statin drugs instead of seeking a physician’s care. It’s good news that the FDA isn’t giving the green light to widespread over-the-counter drug use despite the heavy sway of advertising that would have people believe statin drugs are a safe panacea for preventing cardiovascular disease. We know most of you reading this already understand the misinformation being foisted on the public regarding statin drugs, but we thought we’d take this opportunity to review some the myths and the realities behind this issue so you can properly consult with your patients and clients.

Dispelling some of the myths regarding statin drugs, cholesterol and heart disease:

MYTH 1

“High cholesterol (and LDL) is the number-one cause of heart disease in the West.”

Wrong. High cholesterol is among the risk factors for heart disease, but is not the leading risk factor. The most prevalent risk factor is low HDL, along with small LDL particles, which commonly occur together. In fact, of every 100 people with coronary heart disease, 60-70 will have low HDL and small LDL particles, but fewer than 30 will have high LDL. If this is the case, why do we not hear more about low HDL and small LDL particles? The answer is simple: because treating these is not as profitable for drug companies. But just wait—when a profitable drug becomes available to treat this more prevalent risk factor for heart disease, we can expect to hear about an “epidemic” that will justify billions of dollars in new drug expenditures.^1-4

What qualifies as low HDL? National guidelines say it is a level of less than 40 mg/dL for men and less than 45 mg/dL for women.⁵ In fact, a level of less than 60 mg/dL is probably very significant.⁶ HDL is already a standard measure in everyday cholesterol panels. Small LDL particles, on the other hand, need to be measured specifically. The medical world focuses on statin therapy for LDL, while the most prevalent risk factor for heart disease goes untreated in the great majority of cases.

MYTH 2

“If I take a statin agent, I won’t have a heart attack.”

This is simply untrue. Lowering cholesterol (even to rock-bottom levels) reduces, but does not eliminate, the risk of heart attacks. Many heart attacks still occur in people with low cholesterol levels, whether or not they take cholesterol-lowering drugs.⁷ We must consider that there are other risk factors for heart disease besides cholesterol, such as small LDL particles, low HDL, high fibrinogen, high homocysteine, and high insulin levels. Results from the most recent National Health and Nutritional Survey show that 47 million US adults have metabolic syndrome (low HDL, high triglycerides, high blood pressure, excess abdominal fat), which substantially heightens the risk of heart disease even in the presence of low cholesterol levels.⁸

MYTH 3

“I feel fine and my stress test was normal. My doctor says I don’t have heart disease.”

This is among the most widely propagated fallacies spread by many primary care physicians and even cardiologists. First, lack of symptoms should not be reassuring, as most heart disease is silent—without symptoms and undetectable by conventional means such as electrocardiograms and cholesterol testing. Second, stress testing is a miserable failure for screening asymptomatic people. Most future deaths and heart attacks, in fact, occur in people with normal stress tests (when symptoms are not present). The net result of this misperception is that most future heart-attack victims are walking around feeling fine and unaware of their risk.⁹ Cholesterol can be high, low, or in between, but all too frequently fails to shed light on this murky situation.

Cholesterol: the lipid with a bad reputation

Hyperlipidemia refers to elevated blood levels of lipids (fats), including cholesterol and triglycerides. Most people with hyperlipidemia have no symptoms. However, hyperlipidemia is a contributing factor associated with an increased risk of coronary heart disease (CHD), a thickening or hardening of the arteries that supply blood to the heart muscle. CHD, in turn, can result in angina pectoris (chest pain), a heart attack, or both.  Although hyperlipidemia is considered a risk factor to heart disease, it is one of many risk factors and what actually causes hyperlipidemia is a debatable issue.  It not as simple as foods that contain cholesterol, elevate lipids.

Another important risk factor, which has been largely overlooked, is the oxidation of low-density lipoprotein (LDL) cholesterol caused from a lack of antioxidant-rich foods, herbs, and nutrients and/or a large intake of foods and chemicals that contains damaging free radicals.  Chronic inflammation also contributes to oxidative stress and an increase in CHD.  When LDL cholesterol oxidizes, it promotes atherosclerosis by a process referred to as the macrophage-foam cell mechanism, particularly in the presence of stressors, like cortisol and insulin.  Cortisol and insulin together act as a dynamic duel causing all kinds of disruptions including an increased oxidative and inflammatory state.  These are the real underline causes to chronic disease.  Inflammation is also involved in the process of LDL oxidation and contributes to the development of vascular disease. ^10-13 Ideally LDL levels should be kept under 120 mg/dL and you should monitor your patients for oxidative activity, especially lipid peroxidation.

The production of C-reactive protein is an essential part of the inflammatory process, and the measurement of this substance reflects the level of inflammatory activity deep within the body. It appears that certain conditions create a state of excessive inflammation within the circulatory system. High C-reactive protein levels are evidence of this type of inflammation. ^14-17 Ideally it is best to keep C-reactive protein levels below 0.55 mg/L in men and 1.5 mg/L in women. Please note that the reference ranges above refer to the High Sensitivity CRP or hs-CRP test.

Multiple risk markers for atherosclerosis and cardiovascular disease act in a synergistic way through inflammatory pathways.  The following lists the different factors that have been identified as risk factors for CHD and arterial damage:

1. Elevated CRP
2. Elevated LDL
3. Excess Insulin
4. Low HDL
5. High Glucose
6. Nitric Oxide Deficit
7. Excess Triglycerides
8. Low Free Testosterone
9. Excess Fibrinogen
10. Excess Homocysteine
11. Hypertension
12. Low Vitamin K
13. Excess Cholesterol

There are many key inflammatory biochemical risk markers for cardiovascular disease; in particular, the role of three basic cell types affected by these risk markers (endothelial cells, smooth muscle cells, and immune cells), the crucial role of inflammatory mediators, nitric oxide balance in cardiovascular pathology, and the use of nutrients (flavanoids, carotenoids, sterols, vitamin C and E, Omega 3 fatty acids etc.) to circumvent several of these inflammatory pathways. Most of the above risk markers for cardiovascular disease have a pro-inflammatory component, which stimulates the release of a number of active molecules such as inflammatory mediators, reactive oxygen species, nitric oxide, and peroxynitrite from endothelial, vascular smooth muscle, and immune cells in response to injury. Nitric oxide plays a pivotal role in preventing the progression of atherosclerosis through its ability to induce vasodilation, suppress vascular smooth muscle proliferation, and reduce vascular lesion formation. Nutrients such as arginine, antioxidants (OPCs, vitamins C and E, lipoic acid, selenium, glutathione), and enzyme cofactors (vitamins B2 and B3, B6, B12, folate, zinc) help to elevate nitric oxide levels and may play an important role in the management of cardiovascular disease. Other dietary components such as DHA/EPA from fish oil, tocotrienols, vitamins B6 and B12, and quercetin contribute further to mitigating the inflammatory process.  ¹⁸

Within the broad range of cholesterol levels from 180 to 240 there is little to no evidence that this alone correlates with heart disease. Below 180 there is increased risk of hemorrhagic stroke, depression, and suicide. Above 240 there is increased risk of cardiovascular disease and ischemic stroke. Over age 70, elevated cholesterol and cardiovascular events no longer correlate. All told, total serum cholesterol alone is a poor indicator of cardiovascular disease. Half of all heart attack patients have normal total cholesterol levels.

So, not only do statin drugs have their inherent drawbacks, but in some ways they are treating a fabricated problem based on misunderstood and misrepresented “research”. As natural health care providers, we know that we must be wary of the current cholesterol hysteria, we must be able to explain the real evidence, and we must help our patients understand the facts so they can make educated health choices.

Dicken Weatherby, ND is originally from Oxfordshire in the UK and is based in Ashland, Oregon USA. A graduate of the National College of Natural Medicine, Dicken is author of the bestselling book Blood Chemistry and CBC Analysis-Clinical Laboratory Testing from a Functional Perspective. He has self-published seven other books in the field of alternative medical diagnosis, has created numerous information products, and runs a number of successful Web sites including http://www.FMTown.com, an online membership community for practitioners interested in Functional Medicine and Functional Diagnosis. Dr. Weatherby is the creator of the “Foundations of Functional Diagnosis Training Program” at www.FunctionalDiagnosis.com and the “Foundations of Functional Blood Chemistry Analysis” Training Program at www.BloodChemistryTraining.com.

 

Donald R. Yance, CN, MH, RH is an internationally known herbalist and nutritionist. He is the founder and medical director of the Centre for Natural Healing in Ashland, Ore. Through extensive research and clinical practice, he has developed his Triphasic system, which forms the cornerstone of his clinical approach. Donald is the founder and formulator of Natura Health Products, and founder and president of The Mederi Foundation, whose programs promote health education and clinical research on the use of natural medicine, with an emphasis in the field of integrative oncology.

This article was also published in the BANT newsletter September 2011

 

 

 

References

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