Folks,
Last Sunday (August 30, 2015) an article about the new cholesterol-lowering drugs appeared in the New York Times (NYT). The article can be read here: http://www.nytimes.com/2015/08/30/health/new-alternatives-to-statins-add-to-a-quandary-on-cholesterol.html?_r=1 The article focused on the side effects of statin drugs and it questioned if doctors will prescribe the new drugs even though they are very expensive. After reading it in the NYT, my friend and colleague, Dr. Ira Goodman, called me and suggested we write a letter to the editor. Of course, the NYT did not accept our letter, but I thought it would make an interesting blog post.
DrB
To Editor at the New York Times
Re; New Drugs Add to A Quandary on Cholesterol
Your article about the new cholesterol-lowering medications focused on the side effects of this class of medications. However, you missed the most important part of these medications—do they really work? In other words, do they significantly reduce the incidence and mortality of strokes and heart attacks? The answer is a resounding “No” in approximately 99% of the patients treated. This important fact is usually withheld from patients when they are given these drugs because both the prescribing physician and the unsuspecting patient are unaware of the true statistics related to the studies of cholesterol-lowering medications.
You mention the JUPITER trial and the increased risk of diabetes. However, before talking about undesired effects of a drug, it is incumbent upon a practitioner to assess efficacy. If the efficacy is not there, then who cares what the side effects are- the drug should not be used. Efficacy trumps safety every time. No efficacy, no drug. Period. This is called informed consent which the American public does not have in most cases when these drugs are used.
Imagine a roulette wheel with 99 black slots and 1 red one. The manufacturers of cholesterol lowering drugs have managed to convince about 29% of the American public and nearly 100% of physicians that you should bet on red!! Yes these drugs will lower your cholesterol very effectively but what you are missing is that lowering cholesterol does not result in lower clinical events like heart attacks or stroke in the vast majority. Check the studies—the data is there.
In JUPITER (which was mentioned in the NYT article), 0.35% of those treated with rosuvastatin (Crestor®) suffered a heart attack compared to 0.76% in the control group. That means the absolute difference in heart attacks in those that took the rosuvastatin was 0.41%. In other words, 244 subjects would need to take rosuvastatin for 1.9 years (the length of the JUPITER study) to prevent one heart attack. In fact, 99 percent (243 out of 244) of those that took rosuvastatin received no benefit in lowering their risk of having a heart attack.
For primary prevention, preventing a first cardiac episode, the best of the cholesterol studies has shown approximately a 1% mortality benefit in taking a cholesterol lowering medication. That means that these drugs fail nearly 99% who take them. For secondary prevention—trying to prevent a second cardiac event—the numbers are not much better as the best studies show approximately a 3.5 percent reduction in mortality. Therefore, using statins for secondary prevention fail 96.5 percent who take them.
The best metric for measuring the effectiveness of a drug is the NNT or the number of patients needed to be treated with the drug to prevent 1 clinically significant endpoint. In the case of statins and presumably in the case of the new class of drug to lower cholesterol the NNT for primary prevention is between 100-500!! I would not want to take an expensive dangerous drug that is likely to increase my incidence of diabetes (which in and of itself increased heart attacks), heart failure, dementia, muscle aches, fatigue, and oxidative stress as a result of lower vitamin D and coenzyme Q10. For what? To lower my chances of an MI or stroke by less than 1%? I would rather take up jogging and eat better. I would rather bet on black.
The statin drugs have been a disaster as they don’t work in the majority of people who take them. Now, we want to spend over $14,000 per year in a new class of cholesterol-lowering drugs?
We must be out of our minds.
David Brownstein, M.D.
Ira Goodman, M.D.
I’ve got a new doctor with a new “hit me” with the statin routine. Its exhausting trying to explain even when I really don’t need to. It’s that dumbfounded look that gets me but I know that most doctors and my new one just won’t change so why try to explain. She such a nice doctor I want to take them just to help her pay for her medical school loans. 🙂
Thanks DrB for another great article. I’d like to share a Crestor story.
My husband has high blood pressure and angina, started bp lowering medication (2007) and then had a heart attack in 2012 where the doc put stents in two blocked arteries. At a follow up visit his doctor put him on Crestor and, within a week, he was in a fog and just didn’t feel well. He contacted his doctor and told him he was going to stop taking the Crestor. Of course, the doctor objected but conceded. The fog lifted and he began to remember things again. I immediately researched Crestor and did not like what I read regarding side effects and the uselessness of the drug.
So, out of curiosity I asked my husband to get his medical records and after reviewing his cholesterol levels and triglycerides and doing a quick calculation he was in what is considered the normal range. I was amazed that a doctor would recommend this medication when my husband’s cholesterol levels were within normal range. Anyway, I’ve been researching natural alternatives for about 4 years now and making some strides with diet changes and vitamins and minerals. Follow up visits and stress tests are always within normal range but his pressure is still very high even with the medications he has been prescribed (180/138). I’m going to continue my quest. I really would like my husband back and off these medications he’s taking. He is too young to be this sick (50s) and I want him around for a very long time. What is amazing is this doctor recommends statins at every visit. Is there a financial component here?
I’ve been a DrB fan for years and love his publications, blogs and newsletter. I wish he could clone himself and open a practice in our town. Still searching for a holistic doctor too. Praying I’ll find a good one.
Esther says:
Met with a very nice and seemingly intelligent cardiologist yesterday who strongly encouraged me to take statins. He then also mentioned a new drug which requires shots every couple of weeks and is outrageously expensive.
I am trying to find a natural solution to reversing calcification of arteries. Any ideas?
Esther, I was the recipient of a failed open heart surgery in 2005, the same year I was told my left and right carotids were blocked 50 and 70% respectively while my right femoral artery was 100% blocked, left common iliac in the 90 percentile range of blockage and I was a very unhappy camper. I went on to have 30 intravenous edta chelation therapies from a dr coy in punta gorda fl ( no longer there ) and went from not being able to walk to my mailbox and back to walking 8 miles one night which by itself was a miracle however a year after the diagnosis on the carotids I went back and was tested again, this time the blockage was in the 50% range and lower for the left. Unfortunately I have also been suffering with unbelievable chronic pain, originating in my neck, perhaps a vertebrae was moved during the open heart surgery ( ? ) and not back in position after they closed me up.
While I believe the open heart surgery was necessary as even there I had 100% blockage in the LAD ( widow maker ) ( was told I still had abnormal blood flow in the same place after the surgery ), perhaps if I had the edta chelation sooner, even as a preventative since heart disease runs in the family, I may have not ever had to have a surgery. We’ll never know but what I do know is I’m still here.
Please do your research, it’s not available in every state but in my opinion and if you ask my family the same question, it’s well worth doing whatever you have to do it.
Best of luck and health
Thank you, Dr. Brownstein. The cardiologist recommended the injections to me after I declined statins. And I’m even more uncomfortable with that option, since there’s no long term safety info.
The NYT is not the only news source. Have you tried other media outlets? What about working through your professional medical organizations? Or science organizations? Seems this type of information would be newsworthy especially when backed up by solid science.
Linda,
If only it were that easy. If it were, you would see headlines about the CDC whistleblower.
DrB
I have to point out here, that in my humble reading of the original article, it did not focus on the side effects of statins, but most poo-pooed them as most imaginary in their patients. This really disturbed me greatly! From my understanding most physicians don’t believe most of their patients when they say they are having side effects from drugs even when those side effects are right in the literature for those drugs and the patients didn’t have such symptoms before starting the drugs.
How long were the studies done that supposedly showed no or low side effects from statins? A couple of weeks, months? “The statin trials, which involved tens of thousands of people, found no more muscle aches, the most common complaint, in patients who took statins than in those who took placebos” Well just because both groups have muscle aches still does not address the CAUSE of those muscle aches! Muscle aches from statin intake is a whole different ball game than muscle aches from everyday work and play. Talk about a study used to cloud the issue!
The whole original article is still predicated on the belief that somehow cholesterol, a molecule our bodies were programmed to make, is bad for you. It made me sick to read it.
I must question when physicians are going to realize that lowering cholesterol is not a “magic” bullet.
Rather, it is loaded with lots of contraindications like diabetes, amnesia & muscle death.
Dr. Brownstein,
Since the criminals who run the NYT won’t print the truth, I will forward this to everyone in my email list. Thanks for all your work.
Met with a very nice and seemingly intelligent cardiologist yesterday who strongly encouraged me to take statins. He then also mentioned a new drug which requires shots every couple of weeks and is outrageously expensive.
I am trying to find a natural solution to reversing calcification of arteries. Any ideas?
Where does red yeast rice fit in this category
Sue,
Red yeast rice can be considered the same as a statin drug as it works in the same way.
DrB
My question is: How did the placebo group do in comparison?