The Stubborn Myth of Statins and Cholesterol

My total cholesterol was measured at over 300mg/dL last month. (This would be 7.8mmol in the UK). Normally this is not an issue at all as I’ll get into, but it happened to be assessed as part of a life insurance underwriting medical. Now that I am self-employed and no longer covered by the excellent group employee benefits I enjoyed for the last 25 years I have to figure out these realities.

I’ve also been looking into some sort of health coverage and even though we don’t use the conventional medical system other than for annual check-ups, in the US it’s wise to have some sort of emergency coverage just in case. We started the process with a Christian healthcare-sharing ministry but they also applied a standard algorithm and wanted to impose a surcharge on our monthly contributions as I was deemed high risk. I gave them all sorts of other test results showing I was normal weight and had a cardiac calcium score of zero (no plaque on my arteries at all) but they insisted their guidelines were fixed.

This is frustrating for two reasons. Firstly the original guidelines on cholesterol levels indicating cardiac risk were based on flawed conclusions from the Framingham Heart Study (FHS) originating in 1948 and have since been superseded by new studies and a better understanding of cholesterol’s role in the body but the myth persists. And secondly the pervasive prescribing of Statins, a class of drug invented to lower cholesterol levels that is one of the best examples of doing more harm than good for most people. The marketing machine of Big Pharma is exploiting the first myth earning billions in the process and will ride the train as long as they can get away with it.  

This is a long post but important to touch on three aspects of this issue for a full understanding.

Critical Functions of Cholesterol in Your Body

• Every cell in your body is made of cholesterol. It is needed to maintain the integrity of cell membranes

• Your most vital hormones are synthesized from cholesterol including cortisol and the sex hormones such as testosterone, progesterone and estrogen.

• Cholesterol is nature’s repair substance. It is used to repair wounds including any micro-tears or irritations in your arteries. A fact that explains one mis-understood connection of cholesterol in arteries, it is likely there to help not hinder. The problem in heart disease is plaque made from calcium deposits.

• Cholesterol is essential to the proper functioning of the brain and nervous system

• Bile salts needed for proper digestion are made from cholesterol ensuring the absorption of vitamins and minerals from food.

• Vitamin D is formed through the action of sunlight on the cholesterol in your skin. Vitamin D is one of the most important compounds in your body for bone health and immune health to name just two. It actually acts like a hormone involved in many different processes. We will discuss the crucial role of Vitamin D in later posts.

• Separate to the Vitamin D connection, cholesterol helps us fight infections and is part of our very complex immune system.

This is just a sample of what we know of cholesterol’s role in good health. There is much we don’t understand. What is clear is that 80% of our cholesterol level is just down to our genetic makeup. Only 20% is affected by our lifestyle including our diet but is also heavily affected by how much we exercise and how much stress we are under. Heart disease is definitely affected by what you eat but it’s sugar, processed foods full of hydrogenated vegetable oils and lack of nutrients that’s the problem not cholesterol.

Just 4 months ago I had a test as part of my regular annual physical and my total cholesterol was 260mg/dL (6.7mmol). I think I was actually eating more meat 4 months ago than I was more recently, and I was definitely exercising less previously than I am now. Our human bodies are immeasurably complex so I’m not going to worry about this one number when all other signs are that I am perfectly healthy.

Just for the record my LDL (so called “bad” cholesterol) was 170. This is the number a statin was designed to affect but in fact on closer examination of even the FHS data, a more accurate risk assessment would look at the ratio of Total Cholesterol to HDL (so called “good” cholesterol). In my case 266/87=3.05. Less than 4 is desirable, less than 3 is even better. I’m good!

Statin drugs are arguably the most successful pharmaceutical to ever come to market. Pfizer’s Lipitor generated over US$12 billion in the year 2006 (that’s with a “B”). It has since lost its patent so generic versions are available. In 2022 it generated only US$2 billion in sales for Pfizer – still worth fighting to protect such a robust revenue stream! They were touted to reduce “bad” cholesterol and in most people they do just that. You might have to switch around the several different name brand statins available to find one you can tolerate but if your objective is a score on a blood test you can get there. The only problem is this won’t make you any healthier.

The Myths About Cholesterol and Heart Disease

MYTH: People with high cholesterol are more prone to heart attacks

TRUTH: 70% of people who have a heart attack have cholesterol levels below 200mg/dL (5.2mmol). There is a slightly higher risk shown for young men who have levels above 350mg/dL (9mmol) but for older men and women of all ages high cholesterol is actually associated with a longer lifespan.

MYTH: Cholesterol and saturated fat clog arteries

TRUTH: There is very little cholesterol in arterial plaque (and what is there is probably beneficial as mentioned above). Most of the material is a calcium deposit (a bit like limestone) and most of the fatty acids are unsaturated.

MYTH: Eating saturated fat and cholesterol-rich foods will cause cholesterol levels to rise and make people more susceptible to heart disease.

TRUTH: There is no evidence that saturated fat contributes to heart disease. The evidence is pointing more closely to the substitute fats invented such as hydrogenated vegetable oils and trans fats as well as sugar and ultra processed foods. 

MYTH: Cholesterol-lowering drugs have saved many lives

TRUTH: The original studies cited to link cholesterol levels with cardiac risk showed a dubious association at younger levels and over age 50 mortality actually went up as cholesterol levels dropped. More recent studies have looked at the randomized control drug trials for several statins and proved there is no clear correlation with cardiac risks.

The Dangers of Statin Drugs

• Statins work by inhibiting the enzyme that enables you to form cholesterol in the liver. Other brand names beyond Lipitor are Zocor and Crestor. There are many others.

• Given the number of functions cholesterol is involved in it is no surprise that taking statins results in a myriad of side-effects. Some are felt right away usually resulting in a switch to a different statin drug in the hopes of better tolerance (they each work slightly differently). But most side effects take months or even years to become noticeable and are then dismissed as a new/separate ailment.

• Weakness and muscle wasting are the most common side effects resulting in muscle aches and pains, back aches and even slurring of speech due to the interaction of statins with the production of Coenzyme Q10 which is an important compound involved in metabolism and muscle function helping to generate energy in the cells.

• Heart failure is also a side effect of statins (!) as the heart is a muscle that depends on a good supply of Co-Q10.

• Cognitive impairment including memory loss and brain fog. The studies connecting statin use to formal diagnoses such as Dementia and Alzheimers are still unsettled with some showing a heightened risk and others showing some benefit, which may be due to the anti-inflammatory and anti-clotting properties of statins rather than their effect on cholesterol.

There is more to the story of statins, cholesterol and heart disease than I’ve been able to cover here. So I encourage you to explore further. And of course make sure to discuss with your healthcare professional before stopping a statin that you are already on.

I’ve provided a couple of links – firstly to a paper published in the British Medical Journal that analyzed 19 different studies on the topic. And then to the website of Dr Aseem Mulhotra, an award-winning cardiologist in the UK who is outspoken on this issue. He has appeared on TV, in documentaries and written a helpful book called A Statin Free Life. You may also like the book The Great Cholesterol Con by Dr Malcolm Kendrick.

Back to my underwriting issue, I will continue to search out more enlightened policy providers who understand the true risks and avoid propagating the myth that encourages too many people to get on a statin drug which is only going to add to their future healthcare costs and even potentially increase mortality risk.