Martin Schoenbeck: Do you really need to take Statins?

Statins are one of the most frequently prescribed drugs in the UK. They are a class of drugs that lower cholesterol, which is thought to be involved in the formation of fatty plaques in the arteries, leading to heart attacks and strokes. Interestingly, we actually need cholesterol to function healthily, for example our brains are made up largely of cholesterol. The medical profession is in debate as to healthy levels, and to complicate things further, there is low-density lipoprotein (LDL) cholesterol (often labelled bad) and high-density lipoprotein (HDL), or good cholesterol. The bar for total cholesterol has been set quite low at 5.0 or below, but the ratio of HDL/LDL is important, and therefore if you have more HDL cholesterol, you can safely be higher than 5.0. The question I am most often asked in my clinic is how effective Statins are and “do I really need to be taking these?”

A seemingly simple question, but it is not surprising that patients are confused when they have such a high level of medical endorsement from government-backed authorities. Our own National Institute for Health and Care Excellence (NICE) suggests that these drugs could save 50,000 lives a year if every British male over the age of 60 and female over 65 took them regularly. High praise indeed. As a result of this kind of publicity, GPs are encouraged to prescribe these drugs to their older patients, regardless of whether or not they have had cardiovascular incidents or indeed are even at heightened risk. The cost to the UK taxpayer is enormous — the bill for these drugs runs to some £450 million per year and worldwide revenues for the drugs is estimated to be some £20 billion. Little wonder then that the research (funded by the drugs companies themselves) is so heavily weighted in favour of the efficacy of these pills. 

It is very interesting to note some independent research carried out in 2015 at the University of Liverpool. Results were clearly at odds with these NICE guidelines when this newer research indicated that only 750 lives per year could be saved with Statin drugs. What was interesting was that more research carried out at multiple centres across the UK noted that cardio-vascular deaths had fallen by 38,000 between 2000 and 2007, but that only 1,800 of these fewer deaths could be directly attributable to Statin use by patients. The vast majority of the fall in numbers of deaths was due to improvements in diet, exercise and lifestyle.

Many physicians are becoming increasingly concerned about the seemingly inexorable drive to get ever more older members of the population taking these Statin drugs. Just last month Dr. Kailash Chand (Honorary Vice President of the British Medical Association) voiced his concerns about these drugs in an open letter signed by many leading physicians calling for a full review in to the use of these drugs. He stated that he was “calling for a full parliamentary investigation into Statins”. In response, the recipient, Sir Norman Lamb MP, chair of the science and technology committee, wrote to chief medical officer Dame Sally Davies, calling for a review. The call was based on the lack of clarity on the real benefits of the drug and true incidence of side effects. 

Dr Chand doesn’t end his concerns there. In an open access article for GP magazine PULSE he states  “In the hands of pharmaceutical industry propagandists, outsider studies have become powerful weapons of misinformation. GPs have no problem using high-dose Statins in patients who have already had a heart attack or stroke, as they’re at very high risk of further episodes, and there is some evidence of benefitting that group. Despite this, the data on an individual basis is quite underwhelming. According to non-transparent industry-sponsored studies taken religiously for five years, heart attack patients can at best expect a one in 83 mortality reduction and a one in 39 chance of preventing a non-fatal heart attack.” Dr Chand says that prescribing these drugs without a clear explanation of the risk / benefits to patients, is both unscientific and unethical. 

Side effects

What kind of side effects are being reported? Again, it depends which studies you believe. The pharmaceutical industry’s own data (accepted by NICE) suggests that only 1/100 people get the most common form of side effect – which is muscular myalgia. This flies in the face of other independent research in New Zealand which puts the figures closer to 1/10 people who experience this therefore some ten times higher.

Other side effects from these drugs, according to the NHS, include: nose bleeds, headaches, sore throats, runny nose, feelings of nausea, digestive issues from constipation to diarrhoea, an increased risk of T2 diabetes.

It is also well documented that Statin use robs the body of CO-Q10  enzymes, which are integral to cellular energy production and have also been found to protect against cardio-vascular disease. A reduction in CO- Q10 has been linked to the muscular myalgia many patients experience, yet this essential nutrient is not recognised by mainstream medics of being any value in symptom reduction.

What alternatives are there?

It is clear from studies that the biggest impact by far is from eating a healthy diet, based on the Mediterranean diet. Raw extra virgin olive oil over 30 ml a day on your salad and eating 50g per day of mixed nuts can reduce your risk of cardio vascular incident by a third – significantly beating the success rates of statins.

Losing weight can significantly reduce your risk of developing cardiovascular (CV) diseases, and also reducing the risk of developing T2 diabetes. 26.2 % of the UK population were classed as clinically obese in 2018.  Lack of exercise and smoking are significant contributory factors driving mortality. Taking statins as a substitute for tackling these issues is clearly counter-productive and of limited impact.

Other biopsychosocial factors are important drivers of CV disease. Both loneliness, isolation and stress are mentioned by Dr Malcom Kendrick who published The Great Cholesterol Con (John Blake 2007). Loneliness has increased enormously in the elderly population with the rise of the nuclear family, and modern long term stress from money worries, a bullying boss, racist abuse and relationship breakdown are all examples cited in the book as contributions to an early death from CV disease. Clearly anything that addresses these issues can help – joining an evening class, going to a gym, seeking counselling for stress can all play an effective role in reducing risk. 

Finally, there are safer supplement alternatives. Plant based stanols and sterols which are widely available in products such as Benecol have been shown to reduce cholesterol by 10% in just three weeks.

Another powerful alternative is Red Rice Yeast (Monascus Purpureus), A natural source of statins, but unlike pharmaceutical products, it provides a mix of these compounds rather than a single one. The complex mixture interacts with the body more smoothly and is less likely to cause toxicity. These are only recommended for patients who are at significant risk of CV disease and whose cholesterol levels remain high despite dietary interventions. 

— Martin Schoenbeck BSc (Hons) M.N.I.M.H. is a consulting medical herbalist and nutritionist working in Lincoln

Disclaimer: Do not stop taking any medication without fully discussing your health with a trained medical professional. Medical Herbalists are all qualified to degree level and offer safe advice on alternative and complementary medicines. You can find your nearest practitioner here: www.nimh.org.uk