It is crucial to exercise caution regarding medical claims made by individuals who profit from radical allegations, even if they have a popular platform like the Joe Rogan podcast. Many of these individuals, who may be medical professionals, commit the fallacy of appealing to authority by dismissing decades of medical research and promoting their views as the only valid ones. In the case of the cholesterol debate, some doctors claim that high cholesterol levels are not a concern for heart health, but such claims contradict decades of research findings and clinical outcomes. These individuals may be promoting books or alternative health practices lacking mainstream evidence to support their claims. While they may provide some evidence, it’s essential to consider the entire body of research and seek guidance from trusted healthcare providers. Ultimately, individuals have the right to choose their healthcare path, but it’s crucial to be well-informed and aware of the risks associated with alternative or unsupported medical advice.
One area of debate on such shows regards statin medications and their role in cardiovascular health. Here is what to know about this topic and how our providers can help at the Men’s Clinic for Wellness and Vitality.
What is Cholesterol?
Cholesterol is a type of fat found in all human and animal cells. It is an essential component of cell membranes and necessary for producing certain hormones and bile acids. However, high cholesterol levels in the blood have been linked to an increased risk of cardiovascular disease (CVD), including conditions such as heart attacks and strokes.
The Importance of Reproducibility in Research Studies
There has been significant debate within the medical community regarding the role of cholesterol in the development of CVD and whether lowering cholesterol levels can reduce the risk of such conditions. To address this question, researchers have conducted numerous studies over the years. The best medical evidence available suggests a link between cholesterol and CVD. The fact that many studies have reproduced the same findings regarding the relationship between cholesterol health and cardiovascular health is crucial in this debate. It highlights the importance of taking a single study and trying to reproduce its findings in another, validating the results and increasing confidence in the conclusions drawn. In the context of the cholesterol and cardiovascular health debate, numerous studies have confirmed the link between high LDL cholesterol levels and an increased risk of CVD. Hence, individuals who persist in framing cholesterol-lowering medications as harmful or ineffective lack credibility. Understanding the significance of reproducibility in research is crucial to make informed decisions based on reliable evidence.
What the Research Tells Us
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death globally and in the US. Reducing apoB particle number, estimated by LDL cholesterol (LDL-C) concentrations, effectively decreases the risk of ASCVD mortality. The relationship between the duration of lower apoB levels and a reduction in ASCVD events is believed to be significant. Studies have repeatedly shown that high levels of LDL cholesterol, also known as “bad” cholesterol, increases the risk of developing cardiovascular disease (CVD) while reducing LDL cholesterol can decrease this risk. One of the most notable studies in this area is the Framingham Heart Study, which tracked over 5,000 participants over several decades. Recent studies, including large clinical trials, have confirmed the effectiveness of lowering LDL cholesterol in decreasing the risk of major cardiovascular events. Statin medications, commonly used to lower LDL cholesterol, have been shown to reduce the risk of heart attacks and strokes in people with high cholesterol levels.
Some of the largest and most influential clinical trials investigating the effect of lowering LDL cholesterol on the risk of CVD include the 4S Trial, the Heart Protection Study, the IMPROVE-IT Trial, and the ODYSSEY Outcomes Trial. In the 4S Trial, more than 4,400 patients with a history of heart attack or angina were randomized to receive either a statin medication called simvastatin or a placebo. The patients who received simvastatin had a 30% reduction in LDL cholesterol and a 42% reduction in the risk of major coronary events (such as heart attacks) compared to the placebo group. The Heart Protection Study included more than 20,000 high-risk patients randomly assigned to receive either a combination of simvastatin and ezetimibe or a placebo. The combination therapy reduced LDL cholesterol levels by 1.0 mmol/L and reduced the risk of major vascular events (such as heart attacks and strokes) by 22%. The IMPROVE-IT Trial included more than 18,000 patients who had recently experienced an acute coronary syndrome and found that a combination of simvastatin and ezetimibe reduced LDL cholesterol levels by an additional 24% compared to simvastatin alone, resulting in a 6.4% reduction in major cardiovascular events. Finally, the ODYSSEY Outcomes Trial included more than 18,000 patients with high LDL cholesterol levels despite taking maximum doses of statin therapy. Those who received alirocumab, a medication that inhibits a protein that regulates cholesterol metabolism, had a 15% reduction in LDL cholesterol levels and a 15% reduction in the risk of major cardiovascular events compared to those who received a placebo.
How Much Does Lowering Ldl-C Affect Mortality?
Randomized clinical trials (RCTs) have shown that LDL-C lowering drugs, such as statins, ezetimibe, PCSK9 inhibitors, and bile acid sequestrants, reduce the risk of major ASCVD events by up to 24% for every 1 mmol/L (38.7 mg/dL) reduction of LDL-C after one year of follow-up. Statins and other LDL-lowering medications have their largest effect in the first year of treatment, with an average reduction of 39 mg/dL LDL-C. The difference between LDL-C in the intervention and control groups decreases with each subsequent year.
Long-Term Benefits of LDL-C Lowering Medications
A recent meta-analysis by Wang et al. pooled 21 RCTs to evaluate the relationship between lipid-lowering drug exposure duration and the risk of major cardiovascular events. The meta-analysis was limited to large, long-term RCTs of at least three years and the equivalent of 1000 patient years of follow-up time. For each year of study, the average LDL-C concentration of the control and treatment groups were pooled to show the absolute differences in LDL-C levels over time. Hazard ratios and 95% confidence intervals for each year of follow-up were extracted from published survival curves to assess the effect of duration on ASCVD risk reduction.
The analysis found that lipid-lowering medications cause the greatest drop in LDL-C levels in the first year, and the difference between treatment and control groups diminishes with every year of follow-up thereafter. However, the hazard ratio decreased with each subsequent year of treatment with lipid-lowering drugs. One year of treatment was associated with a proportional risk reduction of 12%, compared to a risk reduction of 23% after 5 years and 29% after 7 years. The relative protection afforded by LDL-lowering medications compounded with longer durations of use, such that the difference in CVD risk between treatment and control arms widened with each successive year – at least up to year seven, the longest study duration in the analysis.
Overall, these clinical trials have shown that high LDL cholesterol levels increase the risk of developing CVD while lowering LDL cholesterol can reduce this risk. Statin medications such as simvastatin and ezetimibe effectively reduce LDL cholesterol levels and the risk of major cardiovascular events, as well as alirocumab in patients with high LDL cholesterol levels, as demonstrated by the ODYSSEY Outcomes Trial. These findings provide strong evidence that reducing LDL cholesterol can help prevent cardiovascular disease,
Despite this evidence, some still argue that cholesterol is not a significant risk factor for CVD and that other factors, such as inflammation, may be more important. However, the vast majority of medical experts agree that high cholesterol levels do increase the risk of CVD and that lowering cholesterol through lifestyle changes and medication can help to reduce this risk.
In conclusion, the best medical evidence suggests a clear link between cholesterol and CVD and that lowering cholesterol levels can reduce the risk of these conditions. While there may still be some debate in the medical community about the role of cholesterol in CVD, the weight of evidence supports interventions to lower cholesterol levels in people at risk for CVD.
“Side Effects” of Statins
Statin therapy is a crucial tool for managing healthy cholesterol and reducing the risk of heart disease. However, despite its proven effectiveness and safety, some in the media have given statins a lousy reputation. Consequently, some may avoid this medication for fear of largely unfounded side effects. Many medicines have side effects, and it is common for people to report adverse reactions after taking them. Compared to other drugs, the number of people who report side effects from statins is relatively low. For example, studies show that up to 20% of people who take antibiotics can experience side effects such as diarrhea, nausea, or allergic reactions. Similarly, some antidepressants can affect up to 30% of patients with side effects such as weight gain, sexual dysfunction, and drowsiness. In contrast, the reported incidence of side effects from statins is typically less than 5%, and most of these are mild and easily managed.
While statins can have side effects, they are generally mild and manageable, and few people experience them. The benefits of statin therapy far outweigh the risks, particularly for those at high risk of heart disease. Unfortunately, despite the low incidence of side effects, some individuals and groups continue to propagate the notion that statins are harmful, creating a nocebo effect that deters people from taking medication that could help them manage their health conditions. The nocebo effect is a real phenomenon where people imagine or believe they are experiencing side effects purely due to negative expectations, even if the medication is not causing harm. Some unscrupulous healthcare professionals have also capitalized on the fear surrounding statins, spreading misinformation without adequate evidence. This can be dangerous as it can prevent people from receiving the necessary treatment to manage their cholesterol and prevent heart disease.
In conclusion, it is important to recognize that statin therapy is safe and effective for most individuals, with manageable side effects that are typically mild. People mustn’t shy away from taking this essential medication, especially those at high risk for heart disease and for whom statins can be a lifesaving tool. It is crucial to dispel any myths about statins and educate the public on their safety and effectiveness to ensure that those who can benefit from this medication receive the necessary care to manage their cholesterol and prevent heart disease. Furthermore, it is important to note that LDL-C reduction achieved through lipid-lowering medications, particularly statins, effectively reduces the risk of major ASCVD events. The duration of treatment is a crucial factor, as the relative protection offered by LDL-lowering medications increases with longer periods of use.
Heart and Vascular Health Optimization
At the Men’s Clinic for Wellness and Vitality, our team can discuss your heart health and ways to slow or prevent the progression of CVD. To schedule an appointment with our providers, contact us online or call us at (520) 488-2404.Back to All Blogs