What Your Doctor Might Not Tell You About the New Statin Drug Guidelines

In case you didn’t hear, two of the biggest and most mainstream medical organizations in the world—the American Medical Association and the American College of Cardiology—recently released new recommendations for who should be on a statin drug.

And if the guidelines become accepted practice, I’d recommend calling your broker to invest in the drug companies, because there’ll be a doubling of the number of people on statin drugs.

For years, the guidelines for statin treatment revolved around cholesterol numbers. But, as cardiologist Stephen Sinatra, MD and I point out in our book, “The Great Cholesterol Myth”, LDL cholesterol is a poor predictor of cardiovascular disease. Several studies show that over half the people admitted to hospitals for heart disease have normal cholesterol levels.

The cholesterol believers argue that’s because “normal” is too high, and should be even lower! They simply can’t bring themselves to contemplate that they’re looking at the wrong marker. And that we need a whole new paradigm about the real promoters of heart disease.

The current advice—lower your cholesterol as much as possible– didn’t work out very well and evidence is tissue-thin that all that cholesterol lowering saved any lives. Perhaps that’s why the new guidelines recommend that doctors stop using cholesterol numbers as a guide to statin treatment. Instead, they’ve come up with even broader reasons to treat, reasons that would include darnned near anyone on the planet.

Which is great news if you manufacture statin drugs. Not so good news if you’re prescribed one that you really don’t need.

So here are some of the things that are wrong about the new guidelines. And keep reading, because I’ve saved the best for last.

The new guidelines fail to distinguish between men and women. “For women”, says Dr. Sinatra, “the data fails to demonstrate that the benefits of statins outweigh the risks—including breast cancer and diabetes”. Sinatra adds that the only women who should be on statins are those with advanced coronary artery disease who continue to deteriorate despite lifestyle interventions. “I believe that less than 1% of women with coronary artery disease fall into this category”, he says.

The new guidelines also recommend that everyone with diabetes be on a statin. This is particularly problematic since last year the FDA began requiring statin manufacturers to put a diabetes warning on their labels, as a number of studies have shown a disturbing increase in diabetes among those treated with statins. “Giving statins to people who already have diabetes doesn’t make sense”, says Dr. Sinatra.

The side effects of statin drugs can be far more serious than you might think, and are undoubtedly more common than you’ve heard. How do I know that? Because a study by Dr. Beatrice Golumb showed that approximately 65% of doctors don’t report the side effects of statins that patients commonly complain about. That’s because the docs don’t believe them. Some of the side effects of statin drugs- like memory loss and muscle and joint pain—are common in older people, so the doctors simply think their newly reported symptoms are coming from “something else”.

According to the Harvard Health Blog, as of 2011 fully half of men ages 65-74 and 39% of women ages 75 and older are on statin drugs. That’s a pretty staggering number, and likely to double if the new guidelines become accepted practice. Even if the percentage of people with dangerous or uncomfortable side effects was less than 10%– (it’s probably more, but let’s just say)—that’s still millions and millions of people with side effects, and many of those people don’t really need to be on statins in the first place.

And how do I know that?
Well, I told you I’d save the best for last, so here it is: The guidelines call for putting someone on a statin if their risk of having a heart attack is “greater than 7.5% over a 10 year period”, whatever that means.

But on Nov. 17, the New York Times reported that the “risk calculator” used in the guidelines was flawed. How flawed you ask? It overestimated risk by between 75% and 150%.

I’ll pause for a moment to let that sink in.

Listen—I’m not anti-statin. Statins have a modest benefit in middle-aged men with existing heart disease. They thin the blood and are anti-inflammatory. But before we start putting half the world on them, let’s try and remember that heart disease is not a Lipitor deficiency. Better that we use statin drugs as a last resort—certainly not as the first order of business.