A Statin Nation

1. The cholesterol hypothesis is fundamentally flawed

As you can see, with men, as the cholesterol level rise, the rate of IHD falls a bit, then goes up a bit. Nothing very dramatic. But for women, as cholesterol levels got higher, the rate of death from IHD fell by 40 per cent and pretty much stayed there, even when the total cholesterol level was above 7.0mmol/l.

The cholesterol myth debunked. For decades, we've been told that high cholesterol causes heart disease. However, extensive research reveals a more complex picture. In many studies, higher cholesterol levels are associated with lower mortality rates, especially in women and the elderly. Countries with high average cholesterol levels often have low rates of cardiovascular disease (CVD), such as Switzerland and France.

LDL may not be the villain. The focus on lowering LDL (low-density lipoprotein) cholesterol has been misguided. LDL plays crucial roles in the body, including immune function and hormone production. The idea that LDL simply clogs arteries is oversimplified and not supported by evidence. In fact, LDL may have protective effects against infections and other health issues.

Rethinking cardiovascular risk factors. Instead of obsessing over cholesterol levels, we should consider other factors that may have a more significant impact on heart health:

• Inflammation
• Blood clotting tendencies
• Endothelial function (health of blood vessel lining)
• Stress and mental health
• Nutritional status, particularly vitamin D levels

2. Statins may not work as we think they do

My comment to patients now is that: 'Statins add fifteen years to your life? No, they don't make you live fifteen years longer, they just make you feel fifteen years older.'

Statin benefits overblown. While statins are widely prescribed to lower cholesterol and prevent heart disease, their actual benefits may be much smaller than commonly believed. Studies show that statins may only extend life expectancy by a few days after years of use. The relative risk reduction often touted in studies (e.g., 36% reduction in heart attacks) translates to a much smaller absolute risk reduction.

Side effects underreported. Statin side effects are more common and potentially severe than often acknowledged. These can include:

• Muscle pain and weakness
• Cognitive issues ("brain fog")
• Increased risk of diabetes
• Liver problems
• Potential nerve damage

Alternative mechanisms of action. The benefits of statins, where they exist, may not be due to cholesterol lowering at all. Instead, they may work through other mechanisms such as:

• Increasing nitric oxide production
• Anti-inflammatory effects
• Mild blood-thinning properties

3. Diet has little impact on cardiovascular disease

The simple fact is that there is absoutely no relationship between cholesterol levels in various countries and the rate of death from CVD.

Diet-heart hypothesis debunked. The idea that saturated fat in the diet leads to high cholesterol and heart disease is not supported by evidence. Countries with high saturated fat consumption often have low rates of heart disease (e.g., France). Attempts to lower cholesterol through diet have shown little to no benefit in reducing cardiovascular events or mortality.

Carbohydrates may be the real culprit. Excessive carbohydrate consumption, especially refined carbs and sugars, may be more harmful than fats:

• Raises triglycerides and small, dense LDL particles
• Promotes inflammation
• Leads to insulin resistance and diabetes
• May contribute to obesity

Focus on whole foods. Rather than obsessing over specific nutrients, a more beneficial approach may be to focus on eating whole, minimally processed foods. The "Mediterranean diet" benefits may have more to do with lifestyle factors (social connections, relaxation, sunshine) than specific foods.

4. Sunshine exposure is crucial for overall health

There is almost nothing that is better for you than sun exposure. Not only that, it is free and enjoyable. Who could ask for anything more?

Sunshine benefits beyond vitamin D. While vitamin D production is a crucial benefit of sun exposure, sunlight offers numerous other health benefits:

• Increases nitric oxide production, improving cardiovascular health
• Regulates circadian rhythms and improves sleep
• Boosts mood and reduces depression
• May lower blood pressure
• Potentially reduces risk of certain cancers

Sun avoidance risks. Avoiding sun exposure may be as harmful as smoking in terms of overall mortality risk. Studies show that sun avoiders have shorter lifespans and higher rates of various diseases compared to those who get regular sun exposure.

Balanced approach needed. While excessive sun exposure and burning should be avoided, moderate, regular sun exposure is beneficial for most people. Gradual tanning and spending time outdoors without sunscreen (for short periods) can help optimize health benefits while minimizing risks.

5. Social connections and mental health significantly impact lifespan

Health, I must emphasise, is a combination of physical, psychological and social wellbeing. Three overlapping sets. The holy trinity. You must get them all right or nothing works.

Social isolation kills. Loneliness and lack of social connections are as detrimental to health as smoking or obesity. Strong social ties are associated with:

• Lower rates of cardiovascular disease
• Improved immune function
• Better mental health
• Longer lifespans

Stress and mental health matter. Chronic stress, depression, and other mental health issues can significantly impact physical health and lifespan. People with serious mental illnesses may have lifespans 10-20 years shorter than average.

Community and purpose. The "Blue Zones" (areas with high concentrations of centenarians) all share strong social connections and sense of purpose as common factors. Fostering supportive relationships, engaging in meaningful activities, and being part of a community can have profound effects on health and longevity.

6. Exercise and avoiding smoking are key to longevity

If you smoke 20 a day, you reduce lifespan to 94. If you smoke and take no exercise, you reduce lifespan to 89.

Smoking's devastating impact. Smoking remains one of the most significant modifiable risk factors for early death and disease. It can reduce lifespan by 6-10 years and increases risk for numerous cancers, heart disease, and respiratory problems.

Exercise as medicine. Regular physical activity provides numerous health benefits:

• Reduced risk of cardiovascular disease
• Improved mental health and cognitive function
• Better weight management
• Enhanced immune function
• Increased lifespan (potentially 3-5 years or more)

Dose-response relationship. While any amount of exercise is beneficial, more is generally better (up to a point). Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week, with additional benefits seen at higher levels of activity.

7. The medical research system is deeply flawed

'The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.'

Publication bias. Positive results are much more likely to be published than negative ones, leading to a skewed perception of treatment effectiveness. Many studies with unfavorable results are never published or are deliberately hidden.

Conflicts of interest. The pharmaceutical industry heavily influences medical research, often funding studies and paying researchers. This can lead to biased results and suppression of unfavorable data.

Statistical manipulation. Researchers often use various statistical techniques to make results appear more significant than they are:

• P-hacking (analyzing data multiple ways until a significant result is found)
• Changing endpoints after a study has begun
• Selective reporting of outcomes

Replication crisis. Many published studies, even in top journals, cannot be replicated when attempted by other researchers. This calls into question the validity of much published research.

8. Vitamin D deficiency is a major health concern

Women with higher UVB exposure had only half the rate of breast cancer. Men with higher UVB exposure had only half the rate of fatal prostate cancer. Men and women with higher vitamin D levels had one quarter the risk of developing colon cancer.

Beyond bone health. While vitamin D is crucial for calcium absorption and bone health, its importance extends to numerous other bodily functions:

• Immune system regulation
• Cancer prevention
• Cardiovascular health
• Mood and mental health
• Muscle function

Widespread deficiency. Many people, especially in northern latitudes, are deficient in vitamin D. Risk factors include:

• Limited sun exposure
• Dark skin
• Obesity
• Older age
• Certain medical conditions

Supplementation may be necessary. While sunlight exposure is the best way to increase vitamin D levels, many people may need supplementation, especially during winter months. The optimal blood level and supplementation dose are still debated, but many experts recommend levels higher than traditional guidelines suggest.

9. High-fat, low-carb diets may be beneficial for some

If you eat carbohydrates → blood sugar rises → insulin rises → blood sugar drops → hungry → eat, rpt: → fat trapped → obesity → type 2 diabetes → CVD

Carbohydrate-insulin model. Excessive carbohydrate consumption, especially refined carbs and sugars, may drive obesity and metabolic dysfunction through hormonal mechanisms:

• Raises insulin levels, promoting fat storage
• Creates a cycle of hunger and overeating
• May lead to insulin resistance and type 2 diabetes

Benefits of low-carb diets. For some people, especially those with insulin resistance or obesity, a high-fat, low-carb (HFLC) diet may offer benefits:

• Improved weight loss
• Better blood sugar control
• Reduced triglycerides
• Increased HDL cholesterol

Not one-size-fits-all. While HFLC diets can be effective for some, individual responses vary. Some people may thrive on higher carbohydrate intakes. The key is finding an approach that works for your individual metabolism and lifestyle.

10. Blood clotting plays a crucial role in cardiovascular disease

Essentially, it is a disease of the blood vessels themselves, consisting of thickened areas called atherosclerotic plaques. The final event is, usually, a blood clot forming on top of an already existing plaque.

Beyond cholesterol. While traditional views focus on cholesterol buildup in arteries, the role of blood clotting in cardiovascular disease is often underappreciated. Atherosclerotic plaques may develop as a response to injury or inflammation, with blood clots playing a key role in their formation and growth.

Thrombosis and heart attacks. The final, often fatal, event in many heart attacks and strokes is the formation of a blood clot (thrombosis) on top of an existing plaque. This suggests that factors affecting blood clotting may be as important, if not more so, than cholesterol levels in preventing cardiovascular events.

Implications for prevention and treatment. Understanding the role of blood clotting in CVD has important implications:

• Anticoagulant and antiplatelet medications may be more important than previously thought
• Lifestyle factors that affect blood clotting (e.g., exercise, stress reduction) may be crucial
• New treatments targeting the clotting process could be developed

Last updated: October 6, 2024