David Diamond: The effectiveness of statins

Regarding the Aug. 6 Point of View “People’s Pharmacy guest dispenses bad advice on statins” by Dr. Ann Marie Navar: On the podcast with Dr. Steven Nissen, we discussed research on diet, heart disease, cholesterol and statins. Navar said that I made “dangerous claims about cholesterol and heart disease” and that the “misinformation” I conveyed to patients “will increase their chances of having a heart attack or stroke.”

The first issue critics raise is whether I am competent to provide a scholarly perspective on cardiovascular disease. I am a scientist with a Ph.D. in biology and over 100 publications in medical journals.

Ten years ago I was at high risk for developing heart disease because I was overweight, my triglycerides were at astronomical levels and my HDL (“good cholesterol”) was dangerously low. My doctor urged me to go on medications, including a statin. Instead, I decided to study the medical literature on diet and heart disease to understand why my blood lipids were abnormal.

My excess weight and abnormal lipids were caused by excess carbohydrate consumption. By reducing consumption of high glycemic foods, such as sweets, bread and potatoes, I reduced my triglycerides by 75 percent, doubled my HDL and lost weight, without medication.

I have shared what I have learned with online lectures, in hospital grand rounds and in invited lectures at international medical conferences. I delivered the keynote lecture on statins and heart disease at the World Congress on Diabetes & Obesity in Riga, Latvia. My lecture on statin research was so well received that the clinicians honored me with their award for “outstanding contribution to science.”

In a paper in a peer-reviewed medical journal, my 16 co-authors (all of whom were M.D.s and/or Ph.D.s, including cardiologists) and I provided a rigorous assessment of the hypothesis that people over age 60 with high levels of LDL-C would have a higher rate of death from heart disease and all causes. To the contrary, we found that elderly individuals with the highest levels of LDL-C had an equivalent or, in most cases, a lower rate of death than elderly people with the lowest levels of LDL-C. It was on the basis of our findings that I stated on the program that high levels of LDL are associated with greater longevity, which is simply a restatement of a fact.

In a second paper, I and a colleague described the deceptive approach statin advocates have used to exaggerate the appearance of the effectiveness of statins in reducing coronary events. Navar stated that “statins can reduce the risk of cardiovascular events between 20 and 30 percent.” The actual benefit produced by statins is only a 1 percent reduction in coronary events compared with placebo-treated subjects. I discussed on the program how statin advocates transform the 1 percent effect into a larger effect using statistical manipulation of data.

Navar stated as a fact that “studies of hundreds of thousands of adults confirm the safety of statins.” Her statement misrepresents research findings on statins. The risk of developing type 2 diabetes can be five times as great as the benefit of taking statins.

Paraphrasing a colleague, it must be difficult to accept that belief that cholesterol causes heart disease is wrong.

The length limit was waived to permit a fuller response to the Point of View.

This story was originally published August 15, 2016 at 4:51 PM with the headline "David Diamond: The effectiveness of statins."