Study Casts Doubt on Value of Cholesterol Drugs
Hundreds of millions of people worldwide take cholesterol-lowering drugs, like statins, but now a new review suggests that many folks don't benefit from these medications.
The researchers said the review of 35 randomized controlled trials failed to show a consistent benefit in lowering the risk of heart attack or stroke, or for preventing deaths.
"Normally, when you have a theory that says something is beneficial, it should be beneficial all the time, but not all of these studies show the benefit," said study author Dr. Robert DuBroff. He's a clinical professor of medicine in the division of cardiology at the University of New Mexico's School of Medicine in Albuquerque.
Does this mean DuBroff thinks patients should dump their cholesterol-lowering drugs?
"I think it's a decision between a patient and a provider," he said.
But, DuBroff added, "Don't be misguided into thinking that you can take a statin and then not pay attention to other risk factors. Don't underestimate the benefits of lifestyle changes: Keeping body weight at a desired level, eat healthy foods like in the Mediterranean diet, exercise regularly and don't smoke."
While the American Heart Association also emphasizes the importance of a healthy lifestyle, the heart group also recommends that certain people take cholesterol-lowering medications.
Dr. Donald Lloyd-Jones, president-elect of the American Heart Association (AHA), thinks the latest research relied on questionable studies and remains a proponent of cholesterol-lowering drugs.
"Statins are very effective at lowering LDL cholesterol [preventing it from developing into plaque that deposits on blood vessel walls]. Statins are also very effective at stabilizing the plaque that is already there, and are extremely effective at lowering the risk of heart attacks and strokes. They are also inexpensive. They're a huge win for preventive medicine," Lloyd-Jones said.
The AHA says that high-quality evidence from large randomized controlled trials have shown that statins are effective at bringing LDL levels and heart risks down. The drugs are usually well tolerated and have a low risk of side effects.
While the latest research first looked at 35 randomized controlled trials of cholesterol-lowering drugs, only 13 of the studies lowered LDL (the "bad" cholesterol) levels enough to be included in the review. Of these 13 studies, only one saw a reduced risk of death. Five reported a reduction in heart attacks and strokes.
DuBroff said that the researchers found that the degree of reduction in LDL cholesterol didn't have any correlation with decreasing heart attacks, strokes or death.
If the benefits of lowering cholesterol aren't clear, why are so many people taking these drugs?
"Our analysis is perhaps more comprehensive than those done in the past. But we're not the first to raise these concerns. We tried to objectively look at all of the evidence, not just those studies we favored," DuBroff said.
He noted that most experts agree that LDL cholesterol plays a critical role in the development of plaques that stiffen blood vessels.
However, that's where DuBroff diverges from the American Heart Association and the American College of Cardiology.
"It's a leap of faith to think that if you lower LDL, it will bring down your cardiovascular risk and mortality. LDL is just one component of the cardiovascular disease process," he said, adding that just correcting LDL may not be enough to make a difference in the risk of heart disease, stroke and death.
DuBroff said he thinks the guidelines for using cholesterol-lowering medicines may "need to revisit some of this negative or contradictory evidence. Maybe we've all been brainwashed a bit into thinking that we need to take a pill and we'll be safe from cardiovascular disease."
But Lloyd-Jones wasn't convinced by the research. "I don't think the review's conclusions are supported by science. If you have questions or concerns about cholesterol medications, there are better-designed studies to answer these questions. The Cochrane Reviews -- known for superb methodology -- found that the more LDL-lowering we get, the better the outcomes for the groups that are treated," he said.
If you have any concerns about your cholesterol medication, both DuBroff and Lloyd-Jones recommended speaking with your doctor.
Lloyd-Jones said if you have a high risk of heart disease or stroke, it's important not to just stop taking statins and other cholesterol drugs. "This is not like an antibiotic where you can treat for a week and then stop," he said.
The review was published online Aug. 3 in BMJ Evidence-Based Medicine.
Learn more about cholesterol from the U.S. National Heart, Lung, and Blood Institute.
SOURCES: Robert DuBroff, MD, clinical professor, medicine, division of cardiology, University of New Mexico School of Medicine, Albuquerque; Donald Lloyd-Jones, MD, ScM, president-elect, American Heart Association, and chair, department of preventive medicine, Northwestern University's Feinberg School of Medicine; Chicago; BMJ Evidence-Based Medicine, Aug. 3, 2020, online