The Statinator Paradox
Pity the poor lipophobes and statinators. They’ve just taken another grievous wound to their favorite theory and haven’t even got sense enough to know it. In fact, not only do they not have sense enough to realize they’ve taken the hit, they’re actually crowing about it.
The current issue of the Journal of the American Medical Association (JAMA) has an article titled Trends in High Levels of Low-Density Lipoprotein Cholesterol in the United States, 1999-2006 that puts another major dent in whatever validity remains of the lipid hypothesis of heart disease.
I’m going to start categorizing the types of findings published in this paper under the rubric of The Statinator Paradox. I find it interesting that whenever scientists discover data that shows the opposite of what their hypotheses predict, they don’t conclude that their hypotheses might be wrong; instead they deem the contradiction a ‘paradox’ and bumble on ahead with their hypotheses intact.
The lipophobes hold the hypothesis dear that saturated fat causes heart disease. When the data began to surface that the French eat tons more saturated fat than do Americans yet suffer only a fraction of the heart attacks, the French Paradox was born. Nothing wrong with our hypothesis, it’s just those pesky French people who are somehow different. It’s a By God paradox, that’s what it is.
Same thing happened with the Spanish. Researchers looked at the food consumption data in Spain and discovered that Spaniards had been eating more meat, more cheese and more dairy while decreasing their consumption of sugar and other carbohydrate-rich foods over a 15-year period. And, lo and behold, during this same period, stroke and heart disease rates fell. Can’t be. Saturated fat causes all these things. But the data show… Thus came the Spanish Paradox.
Statinators and lipophobes believe with all their little fat-free hearts that LDL-cholesterol is bad and is the driving factor behind heart disease. So whenever I come upon data that gives the lie to this notion, I’m going to start calling it the Statinator Paradox.
This JAMA paper is a classic case of the Statinator Paradox.
Researchers using the NHANES data looked at the change in the prevalence of elevated LDL cholesterol and found that it fell substantially from 1999-2000 to 2005-2006. In a period of about six years the prevalence of high LDL cholesterol dropped by a third, which is a lot of drop in a fairly short period of time.
And since everyone knows that high LDL cholesterol causes heart disease, it should go without saying that during this same time period there occurred a significant decrease in the prevalence of heart disease. Right? Uh, well, no, not really. If anything, the prevalence of heart disease actually increased. But not to a statistically significant degree. So statistically there was no difference in the prevalence of heart disease during a time in which high LDL cholesterol levels were falling. But if high LDL cholestrol causes heart disease…? It’s the ol’ Statinator Paradox writ large.
It was fun reading this paper because a basically fairly simple project was cloaked in all the regalia of academia and academic speak.
It starts out with a great opening sentence that is a paragon of academic weaselry:
High total blood cholesterol is recognized as a major contributing factor for the initiation and progression of atherosclerosis.
Recognized? What does that mean?
I could substitute words in this sentence and come up with the following:
The policies of Barrack Obama are recognized as a major contributing factor in the initiation and progression of socialism in America.
What does that mean? Depends upon whom you say it to. If I were to shout this sentence at a Sarah Palin campaign event, I would be cheered loudly. If I said it at a Nancy Pelosi event, I would be tarred and feathered. Since the ‘truth’ of the sentence is a function of the bias of the person hearing it, it’s not a meaningful sentence. As written, the sentence doesn’t mean squat, which makes it perfect for academic writing.
The authors, I’m sure, are believers in the lipid hypothesis but just can’t muster the gumption to write ‘high total blood cholesterol IS a major contributing factor…’ Instead they use the word ‘recognized,’ which makes the sentence meaningless and lets them off the hook should the lipid hypothesis ever blow up in their faces.
In setting up the study, the researchers went through a lot of rigmarole to allocate subjects to three different categories depending upon their degree of risk for developing heart disease. In determining this risk, researchers used the Framingham risk equation, which relies to a great extent on cholesterol levels to allocate that risk. Which is strange since the Framingham Study has never shown elevated cholesterol to be a risk factor for heart disease.
Once subjects were divvied into these three groups, the researchers measured LDL-cholesterol levels and calculated what percentage of subjects in each group had high LDL-cholesterol levels. The threshold as to what was high varied as a function of the risk level of the group as a whole. The bar for what was high was lowest in the high risk group and highest in the low-risk group. In other words, if subjects had multiple risk factors, then an LDL-cholesterol level of anything over 100 mg/dl was considered ‘high,’ whereas in subjects in the lowest risk category, an LDL-cholesterol level over 160 was considered ‘high.’
Researchers calculated as a percentage the number of subjects who had high LDL-cholesterol in each risk group and did the calculations again six years later.
The weighted age-standardized prevalence of high LDL-C levels among all participants and among participants in each ATP III risk category decreased significantly during the study periods.
Which is what they were crowing about. Our therapy dramatically decreased the number of people at risk for heart disease.
But as for heart disease itself:
No significant changes were observed in the prevalence of CHD or CHD equivalents from 1999-2000 to 2005-2006.
So what did our researchers conclude from the fact that there were one third fewer people with high LDL-cholesterol yet there was no decrease in heart disease?
They concluded the obvious. There were still two thirds of people with LDL-cholesterol levels that were too high. And, no doubt, these people were not on statins.
Don’t believe me? Here it is in their own words.
However, our study found that almost two-thirds of participants who were at high risk for developing CHD within 10 years and who were eligible for lipid-lowering drugs were not receiving medication.
So, let me see if I’ve got this straight. This study shows no evidence that lowering LDL-cholesterol levels decreases the prevalence of heart disease. And what we conclude from this data is that we simply need to treat more people. Brilliant!
As I was reading this paper online, I got a bing alerting me that I had an email from Medscape bringing me the latest in mainstream medical thought. I opened the email and began scrolling through the various articles displayed when my eye fell on one titled “Lipids for Dummies.”
I clicked on it, and what opened was a video of a statinator of the deepest dye interviewing an alpha statinator about how to best deal with the risk of heart disease.
It was unbelievable.
Here in a short interview is everything that is wrong with mainstream medicine today. We have two influential doctors at the pinnacle of their academic and clinical prowess – no doubt on the payrolls of multiple pharmaceutical companies – who are absolutely full of themselves blathering on about expensive treatments that have no true scientific grounding. And their BS is being disseminated to practicing doctors everywhere. Instead of ‘Lipids for Dummies’ this interview should have been called Dummies for Statins.
Watch and just shake your head.
These guys aren’t really talking about reducing the risk for heart disease or early death; they’re discussing how to use extremely expensive medications that are not particularly benign to treat lab values. As I’ve written countless times, statins can quickly and effectively treat lab values, but there is little evidence they treat much else. So if you want to have lab values that are the envy of all your friends, statins are the way to go. But if you want to really reduce your risk for all-cause mortality, you might want to think twice before you sign up for a drug that will cost you (or your insurance company) $150-$250 per month, make your muscles ache, diminish your memory and cognition, and potentially croak your liver.
If you wonder who underwrites these kinds of interviews, take a look at the actual Medscape link in which the video is embedded. See if you, like Sherlock Holmes, can figure it out.
This link requires requires free registration.
(If I weren’t so pleased with a nice Sous Vide Supreme review we got today, this kind of nonsense would make me contemplate seppuku.)
[...] of scientists, Dr Michael Eades has an exceptional post on why recent research helps show that saturated fat doesn’t cause heart disease. Dr Mike also makes some fantastic points about how the researchers, despite having their [...]
Here’s the latest on statins. According to the article in the link below statins are now effective in the treatment of H1N1. Apparently there are no limits to the miraculous benefits of statins.
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/oct2909idsa2.html
Dr. Eades,
If you compare the numbers from 1999 to 2005 as shown in the Table 2 in the paper, it shows that there WAS a significant increase in:
- coronary heart disease (from 2.8% to 3.7%)
- strokes (from 2.0% to 2.9%)
- diabetes (from 7.8% to 10.3%)
I posted a video showing these numbers in the paper.
I also included your comments in this video and posted it on YouTube so that more people will become educated about this.
The link is shown below.
Larry Hobbs
larryhobbs@fatnews.com
Here is the link to the video showing details of the paper.
http://fatnews.com/index.php/weblog/comments/4201/
Larry Hobbs
larryhobbs@fatnews.com
Dave,
Do you have a link to the vegan site that you were talking about in your post?
I would like to check some out and see if they make sence.
Cheers
GoEd
great Blog. Reading Tabes GCBC’s. Known as the diet delusion in Aus. Facinating. (I don’t think I’ve ever said that about anything…ever…appart from sarcastic effect.) Thanks for your great insights looking forward to reading more
So, NHANES showed ‘bad’ LDL is going down in the U.S. and thus total cholesterol. Have a look here: in 150,000 white folk in Austria, being in the lowest 25% for cholesterol predicts early death, repeat early death. In WOMEN over age 50, that increased risk equalled the risk of [life long] smoking!!! Why would more people with low cholesterol be good if statistically that means earlier death?
http://www.ncbi.nlm.nih.gov/pubmed/15006277?dopt=Abstract
From http://www.health-heart.org/cholesterol.htm here’s some perspective:
http://www.health-heart.org/CRESTOR-rosuva_JUPITER-in-perspective.gif
A superb cartoon that NAILS it better than any scientist or MD
http://www.health-heart.org/NoBadCholesterol.jpg It’s not how much cholesterol, it’s how clean that particle: has it got enough omega-3, enough CoQ10, vitamin E or carotene-like stuff [carotenoids] or too much tans fats and heat burnt cholesterol or heat damaged polyunsaturates?
Comment Highlight: Jake, Art DeVany, & Cartography…
Better maps do exist.Art DeVany’s upcoming book will be one such epistemocratic map (and I look forward to reading and reviewing it).I want to thank Jake for chiming in to my previous post and spurring this installment of Comment Highlight:
Jake said….
So does anybody have a substantive response to NP’s post?
“Statins do reduce all-cause mortality. A meta-analysis published in the BMJ by Brugts et al. (2009) showed that for primary prevention in patients with cardiovascular risk factors, all-cause mortality was reduced significantly by 12% (ARR: 0.6%) over an average follow-up period of four years. A meta-analysis published by Wilt et al. (2004) in the Archives of Internal Medicine showed that for secondary prevention, all-cause mortality was reduced by 16% (ARR: 1.8%). This translates to a number needed to treat of 167 for primary prevention, and 56 for secondary prevention to prevent one death from any cause, give or take.”
Never mind. I found substantive rebuttals here (the wonders of google): http://www.proteinpower.com/drmike/cardiovascular-disease/the-statinator-paradox/comment-page-1/#comment-242276
Yesterday I started having chest pains and ended up in the cardiac unit at the local hospital. I opened my tray this morning and low and behold a low fat/low salt “heart healthy” breakfast of six pieces of white toast, a big pile of potatoes, and about two tablespoons of egg beaters.
Dr. Eades I would be interested to hear what you have to say about calcium scores in a more detailed fashion. My calcium score is 45 but I’m not sure exactly what that means. My HDL’s are 114, LDL’s are 67, triglycerides are 72, overall is 195. Blood pressure is 116/68 and pulse is 65 bpm. The cardiologist here says these are decent scores but I’m worried about the chest pains. I exercise regularly and although I do eat low carb, high protien, I also eat a ton of saturated fat. So with this pain I’m wondering more than ever which direction to move as far as diet. Supposedly a calcium score of 45 puts me in the 90th percentile of males 30-41 years old which sounds pretty ominous.
I guess you mean LDL 114 and HDL 67. People would “die” to have those numbers as per conventional wisdom. How about 1 gram fish oil/day and use canola for omega-3 and make sure you get enough electrolytes, especifically magnesium, both antiarrhythmics.
Has anyone ever checked your homocysteine level? Its only remedy a fairly high dose multivitamin pill. I have rarely seen heart problems when that number is near 7, near 11 is probably average and above 16 is a stroke / heart attack waiting to happen. That stuff is one genetic factor that OVER TIME causes artery damage but lowering it is no quick fix.
Statins don’t lower calcification rate either and with your lipid numbers, few conventional doctors would put you on a statin [unless they're afraid getting sued for not doing so].
I’m not sure about vitamin D but that also could be a factor but that’s not nearly as clear as is homocysteine.
One risk of being in a cardiac ward is that you may be surrounded by people making a carreer out of putting stents into arteries, something that all agree does not prevent the next heart attack or make you live longer — if this is done in a planned fashion.
If the cardiogram was clear and troponin was zip, I’d take a cab out (for better food) but that is your decision after you’ve studied all the charts and discussed all the options. If there was troponin, I’d take it easy for at least a month; that is a sign of heart damage. Something else than heart? Best of luck, E.V., a non-MD
A long long time ago, I think I asked you if there was anything approaching the truth at all to the animal-fat-is-bad-for-you meme that has taken hold of the world. I believe your response was none at all. (I may be mistaking you with somebody else.)
I have recently been thinking about ways to convert others to my way of nutritional thinking that people will take seriously. In order for this to happen for most people, I think my views have to be stated in a way that doesn’t invoke any cognitive dissonance. So I think the following has to be true of my argument:
1) it can’t suggest that the conventional wisdom is COMPLETELY wrong
2) it can’t suggest that conventional wisdom researchers are COMPLETELY incompetent
3) it can’t make reference to a self-interested cabal of researchers validating each others work, because that makes me sound like I’m suggesting a conspiracy which makes me the loony person
4) it can’t suggest that the listener is a fool for continuing to believe the conventional wisdom
I’m wondering if you’d agree with the following, in respect to the facts:
Early measurements and studies on LDL cholesterol suggested to many researchers that increased LDL cholesterol was linked to heart disease, so they recommended behaviors such as avoiding avoiding animal fat consumption, which is known to increase LDL in many individuals. However, more precise, more recent studies measuring subtypes of LDL strongly suggest that small, dense LDL (typically increased by carbohydrate and most vegetable oil consumption) is a better marker of heart disease risk than total LDL. So earlier recommendations to reduce animal fat consumption and increase carbohydrate and vegetable oil consumption may have been a reasonable recommendations to make based on the earlier studies, but the newer studies suggest that those recommendations actually increase heart attack risk.
Sounds good to me except for the vegetable oil part. I’m not sure that vegetable oils make LDL particles smaller; I think that comes primarily from carbohydrate and lack of fat.
[...] de hormoni, reglarea glicemiei. Doctor Eades are pornita o adevarata cruciada(cum ar fi aici sau aici) impotriva statins-urilor (Zetia, Lipitor etc.) insa nu multi doctori stau cu urechile [...]