Statin medications, used to lower cholesterol have been the best selling drugs over the past two decades. Sales revenue has been in the tens of billions of dollars. They are effective at lowering cholesterol.
Of course nobody dies of cholesterol, which is a component of each and every cell in the human body. The assumption on which they have been marketed is that lowering cholesterol will reduce rates of heart disease and increase life expectancy.
You might think that over 25 years such an assumption would have been tested. You might think that governments, which claim to have concerns about the health budget, would want some solid evidence that money is well spent.
Last month, a review was published in the BMJ, which the authors noted was the “first study ever to systematically evaluate statin trials using average postponement of death as the primary outcome”.
The results are staggering! In primary prevention (people with no heart disease) death was postponed 3.2 days and in secondary prevention (those with heart disease) death was postponed by 4.1 days.
The authors noted that this was the “ first study ever to systematically evaluate statin trials using average postponement of death as the primary outcome”.
This study is remarkable for two reasons. First, that in 25 years of widespread use, such an evaluation had never been done. And secondly, that the benefit in terms of life expectancy is non-existent!
How can this be?
It comes from the confusion of proxy health outcomes with actual health outcomes. As noted last week, times of birth and death are recorded and are difficult to fudge. Someone is either dead or alive. Thus life expectancy (or postponement of death) is a “hard” measure. So is whether someone has had a heart attack or not.
Cholesterol, weight and even blood pressure are proxy measures. Nobody dies of them. They are risk factors. Treating them gives everyone a warm fuzzy feeling. But treating risk factors is not treating illness. We hope we are preventing it, but this is not necessarily the case either.
The role of cholesterol has been overstated. It is a minor risk factor for heart disease. Lowering it is not an end of itself. Yet it is regarded as such by many in medicine. Thus we saw the hysteria two years ago when a TV program challenged the medical orthodoxy on use of statins.
As with all studies, this recent one can be criticized. It only considered life extension over a six-year period (the length of the trials it examined). Yet lets be generous and treble it to 20 years. This would at best lead to a postponement of death by 12 days. And it would be likely less than that as the longer you live the more possible it is you die of some other cause.
Previous work has shown that lowering cholesterol and blood pressure (proxy measures) had little effect on the progress of atherosclerosis (artery narrowing).
In Australia last week there was much debate over needless tests and procedures and the cost to the health system. The cost of statin medications has been enormous but has not been mentioned.
Lowering of thresholds for what is “raised cholesterol” together with the confusion of proxy measures with real measures has led us to this point.
We see the same problem in lowered threshold for high blood pressure and even raised blood sugar. And the worst of all is the BMI of 25 being the cut off for being overweight.
All this leads to over diagnosis and over treatment.
Healthy people are reclassified as having a condition needing treatment. That treatment is generally medications and it has cost and side effects.
There are only two reasons why one should treat any condition in medicine. That is to improve the quality of life or extend life. Treatments, which do neither of these, in my opinion, cannot be justified.
Lowering cholesterol does not make people feel better. The fact that it does not increase life expectancy calls their widespread use into serious question.
Do not expect to see this reported in the media as it goes against the narrative of the powers that be in health. Big dollars and reputations are at stake.
Questioning of health “authorities” and foundations will have to come from an informed general public.
This article first appeared on www.drjoetoday.com