Do not stop cholesterol meds based on one study

It is safer to stick to statins while experts debate reliability of new research:

Bold claims that statin medications may have little positive impact on the heart health of people over 60 have stimulated lively debate among cardiovascular researchers and doctors.

A recent study published in BMJ Open medical journal and led by Dr Uffe Ravnskov of the University of Lund, Sweden, argues that high levels of low-density lipoprotein (LDL) cholesterol are not linked to higher rates of death from cardiovascular diseases in people older than 60 years of age.

“Essentially, the study argues that people over 60 with high LDL cholesterol levels do not benefit from taking statins, a commonly prescribed medication category that reduce the amount of ‘bad’ cholesterol your body produces,” explains Dr Jacques Snyman, director of product development at Agility Health.

“As Agility Health, we are concerned that some members of the public may read about the claims advanced by this study and decide to stop taking their cholesterol medicines without consulting a medical professional. We would like to caution against this; conflicting studies are published all the time, and this is just a single study that has had its methodology called into question.”

The body itself produces LDL cholesterol, and statins work by inhibiting the enzyme that is involved in the formation of this dangerous type of cholesterol. “A number of studies have, indeed, implied that high cholesterol alone is not a firm predictor of heart disease. However, in combination with other risk factors – such as smoking, being overweight or a genetic predisposition to heart disease – high cholesterol levels are a cause for concern,” Dr Snyman explains.

“Excessive cholesterol in the blood tends to cause a build up of cholesterol plaque in the arteries. As a consequence, the arteries get narrower and narrower, and this residue causes the hardening of arteries. If the plaque build up ruptures, your blood’s natural repair mechanism will start to form a clot on the area and potentially cause a blockage. This could starve the heart muscle of oxygen and result in a heart attack.”

Dr Snyman adds that the blood clot may also form in the arteries of the brain, causing a stroke. “In this scenario, the clot limits or cuts off the supply of oxygen-rich blood to the brain. This causes brain cells to die and may result in irreparable brain damage,” he notes.

“It is important to contextualise the recent Ravnskov et al research findings by stating that other peer-reviewed studies have supported the efficacy of statins in reducing heart attacks and strokes. Notably, a 2003 study by MR Law et al that was published in BMJ, found that through lowering LDL cholesterol, statins effectively reduced the incidence of cardiac events by approximately 60%, and lowered the risk of stroke by up to 17% in the long term.

“We would therefore urge those who have been prescribed statins to not react to this latest piece of research without first consulting their doctor.

“The Ravnskov et al study itself concludes by saying that more research is needed into the causes of cardiovascular disease and a re-evaluation of medication used to treat cholesterol-related conditions.

“Differences of opinion and robust academic debate are very important to advancing medical science. The public should therefore not feel compelled to change their treatment based on any single paper. Rather, allow the leaders in the field to reach broad consensus grounded in the advances derived from the entire spectrum of research before taking any potentially life-altering decisions regarding your health,” Dr Snyman concluded.

Practical lifestyle tips for a healthier heart:

• Have your cholesterol levels regularly tested from the age of 20 onwards;
• Get plenty of exercise, but consult your doctor before embarking on a new exercise regime;
• Eat plenty of fresh vegetables, whole grains and fibrous foods;
• Limit total fat intake to less than 30 percent of total calories consumed daily;
• Saturated fatty acids should account for less than 10 percent of total calorie intake;
• Polyunsaturated fat intake should be no more than 10 percent of total daily calorie intake;
• Limit cholesterol in your food to no more than 300 milligrams per day;
• Do not consume more than 3 grams of sodium per day;
• Quit smoking and consume alcohol in moderation.

References and further reading:

• British Heart Foundation “Flawed cholesterol study makes headlines”. Available at https://www.bhf.org.uk/heart-matters-magazine/news/behind-the-headlines/cholesterol-and-statins
• Law MR, Wald NJ, Rudnicka AR (June 2003). “Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis”. BMJ 326 (7404): 1423. Available at http://www.bmj.com/content/326/7404/1423.full
• Ravnskov U, Diamond DM, Hama R, Hamazaki T, Hammarskjöld, Hynes N, Kendrick M, Lansjoen PH, Malhotra A, Mascitelli L, McCully KS, Ogushi Y, Okuyama H, Rosch PJ, Schersten T, Sultan S and Sundberg R (June 2016) “Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review” BMJ Open Volume 6, Issue 6 2016. Available at http://bmjopen.bmj.com/content/6/6/e010401.short?g=w_open_current_tab

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