Does a Statin a Day Keep the Grim Reaper Away?

Are Statins good or bad? It depends on who you ask.

Statin drugs, used to lower blood cholesterol, are among the most prescribed drugs in the world. In 2016, according to drug tracker QuintilesIMS Institute, the top-selling Statin in America, rosuvastatin (Crestor), brought in a whopping $4.2 billion for manufacturer AstraZeneca and atorvastatin (Lipitor), was prescribed 106 million times to top the list (it was ranked third behind only ACE Inhibitor lisinopril and thyroid drug levothyroxine). Crestor is currently among the top-selling drugs in the world, and Lipitor is the best-selling prescription drug of all time according to Forbes, raking in $148.7 billion since its approval in 1996. And while Lipitor went generic in the U.S. in 2011, manufacturer Pfizer still generated $1.76 billion in sales in 2016 with most of its sales coming from China and other overseas markets (https://www.fool.com) Any way you look at it, Statins are big business in America and around the globe.

Conventional medical wisdom suggests a direct link between high low-density lipoprotein (LDL) cholesterol and heart disease. The theory is that if you have too much bad cholesterol in your blood, it builds up in the walls of your arteries and over time causes hardening (atherosclerosis) which slows and/or blocks blood flow to and from the heart. This theory has been generally accepted for more than 100 years, culminating with the landmark Framingham Heart Study in the 1950s that among other things “proved” that factors such as smoking, high blood pressure, and high cholesterol were related to heart disease. As the science progressed, cholesterol became more understood and now cholesterol-lowering medicine is a cash cow for drug companies. This is an oversimplification, but suffice it to say there have been entire books written on the issue and we don’t really have the time or space here to delve too deeply into the research. Yet it doesn’t take a trained research scientist to type the words “does cholesterol cause heart disease” into Google and come up with hundreds of articles with conflicting conclusions. It is especially true that in the past few years the number of studies discounting the role of cholesterol in heart disease has increased substantially. Honestly, trying to understand cholesterol can give you a heart attack itself. Triglycerides. High-density lipoprotein. Low-density lipoprotein. Very-low-density lipoprotein. Apolipoprotein B.

I don’t know anymore if high cholesterol causes heart attacks. I’m not sure the medical establishment really knows. What I do know is that among the thousands of heart attack survivors in my Facebook support group, hundreds have reported that they did not have high cholesterol at the time of their heart attacks. Others used medication and lifestyle changes to lower their cholesterol and had second or third heart attacks. I had normal cholesterol and exceedingly high triglycerides prior to my heart attack, and both were under control through diet, exercise, and medications at the time of my heart attack. Had the damage already been done in my arteries? Perhaps. I don’t think I’ll ever know. I definitely have both my cholesterol and triglycerides under control now. In fact, as of this writing, my latest blood work showed my total cholesterol was 119, triglycerides 94, HDL cholesterol 41, and LDL 59. This gives me a total cholesterol to HDL ratio of 2.9. These numbers are fantastic by any measure and my primary care doctor, as well as my cardiologist, were very pleased, to say the least. How did I get my numbers to such cardiovascular-friendly levels? Well, I’ve been working on it and experimenting with various medicines, supplements, diet, and exercise. But before I tell you my secret, I must say once again that we are all individuals with different body styles, metabolisms, and, most importantly in my mind, genetic makeup. More than five years after my heart attack, I believe it was caused by years of high triglycerides. Note I used the word believe versus know. Nobody knows for sure why I had a heart attack at age 45, but given my personal history, I have come to believe that my nearly 100 percent blocked LAD was caused by a buildup of plaque due to high triglycerides in my bloodstream. Now I understand this does not account for why I only had a blockage in one artery, given that if in fact, this was the cause other coronary arteries could just as easily have been blocked. Maybe it was random. Or maybe there was something else going on, like inflammation in the LAD that gave the plaque a place to stick.

Regardless, my cholesterol levels were never very high and as you can see from my most recent numbers they are still very low. I was on a Statin prior to my heart attack, but that didn’t stop me from having a heart attack. It’s my understanding that Statins don’t do much to lower triglycerides, nor do they help raise good cholesterol (HDL). So were my doctors wasting my time by putting me on a Statin in the first place? Who knows. When I was first diagnosed with very high triglycerides I was put on a drug called fenofibrate (Tricor) to lower them, and it worked to some degree although while on Tricor they were never as low as they are now.

For the record, it’s my non-scientific belief that the combination of high levels of fish oil, moderate exercise, and a diet extremely low in processed carbs and added sugar has led to my low triglycerides and generally great blood work.

But what about Statins? If lowering LDL cholesterol is so important to the medical establishment shouldn’t we all be on a Statin? There are some doctors who believe this, perhaps most notably Dr. David Agus, professor of medicine at the University of Southern California Keck School of Medicine, who wrote in his New York Times bestselling book The End of Illness that everyone over 40 should discuss Statins with their doctor, even if they haven’t had heart problems or are at increased risk for heart disease or diabetes. Unfortunately, this strategy didn’t work for his most famous patient, Steve Jobs, who died of pancreatic cancer. Nevertheless, the anti-Statin forces are loud, so much so that some doctors are warning that the anti-Statin movement could actually be killing people.


“An internet-driven cult is attacking the safety and effectiveness of cholesterol-lowering Statins, despite mounds of clinical trial data showing the drugs work and produce minimal side effects,” 

Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, told CBS News in 2017.

The anti-Statin crowd seems to align around a different cause of heart disease — inflammation. In fact, more and more it seems the medical community is lining up on one side or another in this debate about cholesterol vs inflammation. One popular inflammation argument, championed by Scottish doctor and author of The Great Cholesterol Con Dr. Malcolm Kendrick, goes like this:


“Chronic stress leads to dysfunction of the hypothalamic pituitary adrenal axis (HPA-axis) which leads to sympathetic overdrive plus added raised stress hormones leads to metabolic syndrome (raised BP, raised blood sugar, raised clotting factors, raised cortisol, raised all sorts of things) which causes endothelial damage plus increased blood clotting which leads to plaque formation and death from acute clot formation.”

Malcolm Kendrick

Sounds reasonable, yes?

While the great cholesterol debate continues, millions of us remain on Statins and avoid high cholesterol foods, and it may not be doing anything at all to rid us of the number one cause of death in the world.

One thing we can say about cholesterol-lowering drugs like Statins is that they do in fact lower LDL cholesterol. There are hundreds if not thousands of studies to back these claims, so if you want to lower your LDL you should probably be on a Statin. I take a small dose of Crestor every day and my LDL is well below the danger zone. Common cholesterol-lowering drugs include:

  • Statins such as atorvastatin (Lipitor), pravastatin sodium (Pravachol), and simvastatin (Zocor)
  • Bile acid resins such as cholestyramine
  • Cholesterol absorption inhibitors such as ezetimibe (Zetia)

The Statin debate might be very different though if the drugs didn’t have such high reported rates of side effects. Common side effects include muscle pain and damage, liver damage, increased blood sugar or type 2 diabetes and memory loss or confusion. Perhaps these side effects are so widely reported because so many of us take Statin drugs, but perhaps they really do cause rough side effects in many people. I can tell you that no issue is more common in my Facebook support group than Statin side effects and the Internet is awash with people in chat rooms and on message boards complaining about Statin drugs.

It’s probably also worth mentioning that recently the American Food and Drug Administration approved a new type of cholesterol-lowering drug called evolocumab (Repatha) which has been hailed as a “breakthrough” to reduce LDL cholesterol without the side effects of Statins. No doubt, any advancement in cholesterol reduction is going to be big business and Repatha maker Amgen is counting on a huge windfall once the drug is more readily available. By the way, as for the side effect debate, even Amgen warns that Reptha’s side effects include: a runny nose, sore throat, symptoms of the common cold, flu or flu-like symptoms, back pain, high blood sugar levels (diabetes), and redness, pain, or bruising at the injection site.

Many of the survivors I speak to say their goal is to change their lifestyle so that they eventually can stop taking so many drugs. I have a slightly different attitude — I’m grateful for the science that led to these life-saving drugs. Yes, there are side effects and as science progresses we will likely find new therapies and maybe even debunk some current therapies. And while I agree that lifestyle changes are critical to post-heart attack health and well being, I’m fine chugging down a plethora of pills every day.

The bottom line for me is that I’m not so sure high cholesterol causes heart disease. And I definitely don’t think dietary cholesterol raises one’s cholesterol (I think sugar and carbs are the culprit). I’m all in on including healthy fat in my diet, and I have no problem eating eggs and other high cholesterol foods. That said, I don’t have any side effects from my Statin so unless the medical establishment publishes new clear-cut proof I don’t need it I’m going to keep taking it. Yep, hedging that bet a bit.

Heart Attack Survivors Should Embrace Prescription Drug Therapy

colors colours health medicine

It’s amazing to me how many people I’ve met in my life who complain about prescription drugs. They treat headaches with meditation, muscle pain with acupuncture and guzzle herbal tea for everything from indigestion to toe fungus. In America, measles is making a comeback because uninformed parents refuse to inoculate their kids because some quack on the Internet referenced a flawed study in a phoney medical journal. Yes, some “alternative” treatments have therapeutic value. But you’ve had a heart attack — it’s time to put your big boy pants on and take your meds. Former heavyweight boxing champion Mike Tyson famously said “everyone has a plan until they get hit.” That’s how I feel about people who refuse to take the life-saving drugs available today. Think about how lucky we are to live in a time when researchers have developed extraordinary medicines to keep us alive. There’s a reason why your grandfather died after a heart attack when he was 45 — all he had to treat his diseased heart was aspirin and Alka-Seltzer.

If you are one of those lucky people that has gotten through life having barely having to take even a simple Tylenol for a headache, congratulations. But if you’ve had a heart attack, that part of your life is over. The sooner you get over the fact that you have to buy one of those pill cases with the days of the week on them to keep track of all your medications the better. Seriously, what’s the big deal? Take your medicine.

Current treatment methodologies for heart attack patients have drastically reduced the risk of death from 30% in the 1960s to approximately 3–4% today. Part of this is due to medical advancements like angioplasty and stents, and part of it is due to the discovery of new medications. Historically speaking, it wasn’t that long ago that first-line treatment for heart disease included bloodletting or mercury.

In truth, it’s a glorious time to be alive. Medical advancements in the 20th century have had a significant impact on the health of humans and one need only look at life expectancy to see just how significant we’re talking about. At the start of the 20th century, according to the World Health Organization the average global life expectancy was 31. 100 years later, it is 65.6 and in some countries it is as high as 80. The reason for this dramatic improvement is multifold, but some of the key reasons include the eradication of infectious diseases like smallpox, polio and leprosy and the decline in deaths from diseases like measles. In fact, in just the past century science introduced vaccines against the six most deadly childhood killers (polio, diphtheria, measles, mumps, rubella, and chickenpox). Advances in childbirth safety made a huge impact too. Other important advancements included the use of randomized clinical trials, vitamin supplements, insulin treatment for diabetics, chemotherapy, x-rays, and of course the introduction of antibiotics. In the heart diseases realm, the past 100 years have seen the introduction of bypass surgery, heart transplants, and pacemakers to name a few. And in terms of noninvasive treatment, we’ve seen the development of numerous drugs to treat all aspects of heart disease.

All this is to say, depending on your specific condition, today’s medical professionals have a huge arsenal from which to choose to treat your heart disease. And yes, with many medications there are side effects, but the side effects are far outweighed by the success of these drug treatments. To be sure, some of us will experience a side effect that is too severe to live with, but even then there are both mainstream and alternative treatments.

I am now nearly six years post heart attack, and my heart is doing great; in fact, I suspect it’s in better shape today than it was before my heart attack. I attribute this to following a good diet, exercising, and taking my meds. Yeah, I had to buy two pill boxes to keep track of everything I’m taking (one for the morning and one for the evening) but what’s the alternative? I’ll tell you what the alternative is — dying.

A Bitter Pill to Swallow

pill_box_with_pillsOne result of my heart attack is that I now have a crapload of pills to take each day. There are two ways to look at this: on one hand, I am very lucky I live in a time when science has brought us so many amazing medicines, and on the other hand I am a little freaked out by how many foreign substances I am putting into my system each day. On top of that, during my recovery, I have done some reading and watched some documentaries that not only question the use of drugs but provide scientific evidence for natural ways to bring about the same positive results. What to do, what to do?

Here’s a little taste of what I swallow each day just for my heart:

  • Plavix — Keeps the platelets in your blood from clotting to prevent blood clots after a recent heart attack or stroke.
  • Carvedilol — Used to treat people whose hearts cannot pump blood well as a result of a heart attack. Carvedilol is a beta-blocker that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.
  • Lipitor —  Used together with diet and exercise to reduce blood levels of low-density lipoprotein (LDL) cholesterol (”bad cholesterol”).
  • Altace —  Used to reduce the risk of heart attack and to improve survival in patients with heart failure after a heart attack. Altace is an angiotensin-converting enzyme (ACE) inhibitor that works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.
  • Aspirin —  Used to prevent heart attacks in people who have had a heart attack in the past or who have angina. Also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack.
  • Warfarin — Used to prevent blood clots from forming or growing larger in your blood and blood vessels. Warfarin is also used to treat or prevent swelling and blood clot in a vein and it works by decreasing the clotting ability of the blood.

Last night I finished watching a documentary about Ray Kurzweil called Transcendent Man. Ray is the proponent of something called The Singularity, which he thinks will take place within the next 30 years. The Singularity is “a proposed advancement that will occur sometime in the 21st century when progress in genetics, nanotechnology, and robotics will result in the creation of a human-machine civilization.” Until this time, Ray is trying desperately to keep his biological body alive and as part of this process the man swallows more than 150 supplements per day. That seems like a lot of effort, but if you honestly thought it would extend your life wouldn’t you at least consider it? That’s sort of my conundrum with all the pills I’m taking. I definitely believe in science and my cardiologist is highly trained and has seen results with pharmaceutical treatment. I’d be stupid not to do what he says. I know there are some of you out there who think taking drugs is a scam and all the hype is just a way for big pharma to make money, but that’s easy to think until you are faced with a life or death situation. Mike Tyson used to say “everyone has a plan until they get hit.” That’s how I feel.

I will say this — I have made a pretty solid recovery in the seven months since my heart attack and I have to believe the reason for this is because I did the three things my cardiologist asked of me. I did cardiac rehab and continue to exercise regularly, I drastically lowered my intake of cholesterol, fat and sodium, and I’ve taken my meds. As much as it freaks me out to take all these drugs, it appears to have made an impact. Of course, if I follow this logic I will be on tons of drugs for the rest of my life. But at least I’ll have a rest of my life.