July 13, 2017

expert reaction to new report on statins and the cholesterol hypothesis

A new report published in The Pharmaceutical Journal claims that the lipid hypothesis – the link between blood cholesterol levels and occurrence of heart disease – is based on ‘cherry-picked science’ and that it has misguided doctors in the prevention of heart disease.

Dr Tim Chico, Reader in Cardiovascular Medicine / consultant cardiologist, University of Sheffield, said:

“High cholesterol has been proven beyond all doubt to contribute to coronary artery disease and heart attack. For example, patients with genetic defects that cause very high cholesterol suffer heart attacks in their twenties, and their life expectancy is increased with cholesterol lowering treatment. So to say the cholesterol hypothesis is dead is simply incorrect. The discussion about how much benefit patients get from statins and who should be offered treatment is completely separate to the proven role of cholesterol in heart disease.

“The authors of this article seem to suggest many doctors do not believe diet and exercise are as important as drugs for reducing heart disease, but I have never met such a doctor. I totally agree with the authors that we should encourage everyone to take more exercise and eat a healthy diet, high in vegetables and fruit and low in “junk” foods, but this has been the position of all major medical bodies for a long time already.

“This article suggests that drug treatment or lifestyle change is an either/or proposition, when clearly it is not. If someone wants to reduce their risk of heart disease, they should certainly start by improving their lifestyle; taking more exercise, not smoking, eating a heathy diet and maintaining a healthy weight. However, in some people at high risk of heart disease, or for those who have already suffered heart problems, drug treatment can play an important role in further reducing the risk of future events such as heart attack or stroke.”

Prof. Mark Baker, Director of the Centre for Guidelines at NICE, said:

“Heart disease and stroke kill 1 in 3 of us and disable many more. To make progress in the battle against heart disease and stroke, we must encourage exercise, improve our diets still further, stop smoking, and where appropriate offer statins to people at risk. Their use in people who have established cardiovascular disease is not controversial. Their use to prevent the development of cardiovascular disease in well people is a more recent role but is equally widespread and robustly evidence-based.

“NICE’s guidance on reducing cholesterol recommends that doctors should offer statins to people with a 10% risk of developing cardiovascular disease over 10 years.  The purpose is to reduce further the numbers of people suffering heart attacks and strokes.

“But people should not take statins instead of making the lifestyle adjustments that those at risk of cardiovascular disease need to make – such as stopping smoking, being more active, drinking less alcohol, eating more healthily and losing weight.

“This debate does not affect people currently on statins.  They should continue to take them. If they are worried, they should talk to their GP.”

* ‘The cholesterol and calorie hypotheses are both dead — it’s time to focus on the real culprit: insulin resistance’ by Demasi et al. published in The Pharmaceutical Journal on Thursday 13th July.

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/tag/cardio-heart/

Declared interests

Prof Mark Baker: No conflicts of interest.