Olmsted County, MN
A recent paper in the Archives of Internal Medicine should give pause to those dispensing statins like candy. According to some fairly persuasive autopsy data, it appears that the rate of heart disease may be back on the rise after being in a slow decline over the past 40 years.
In Olmsted County, Minnesota, home of the Mayo Clinic, autopsies are much more common than in other parts of the country. So much so that the autopsy records of this county are often used in scientific inquiry as a surrogate for the country as a whole. Autopsies used to be more common nationwide but had fallen in 2003 to only 8.3 percent of deaths. Autopsies are conducted in Olmsted County at rates an order of magnitude greater than they are throughout the rest of the country.
Autopsy studies are terrific for gathering data because you don’t have to guess what disease someone had, you can actually see it. But, great as autopsy studies are for gathering data on a given person, they can be less than stellar when looking at the larger picture. Since autopsies are done on people who have died and were presumably not in very good health right before they died, it’s often difficult to extrapolate the findings to the living, breathing, more healthy population. The researchers at Omsted County got around this problem.
From 1981 through 2004 3,237 people in Olmsted County aged 16-64 years died of all causes. Of these, 515 died of ‘unnatural’ causes, defined as suicide, accidental, homicide or a manner that could not be determined. Of these 515, 493 (96%) were autopsied. The fact that these subjects died of unnatural causes is what gives the data its validity. Were these patients who died in the hospital after lengthy illnesses, it would be hard to apply the findings to citizens at large. The subjects of this study, however, died not of illness but of some other more violent cause. Assuming they were representative of the rest of the ‘healthy’ people walking around, what their coronary arteries showed would be of interest. Of these 493 subjects who died of unnatural causes, 82 had their coronary arteries graded during autopsy. (Coronary anatomy grading is an analysis based on degree of coronary artery plaque adjusted for age and sex that basically describes the severity of atherosclerosis in the coronary arteries.)
From the start of the study in 1981 until 1997 the autopsy data showed a slow decline in the number of people with evidence of coronary artery disease and in the number of people with high-grade (bad) coronary artery disease. The autopsy data pretty much mirrored the national data showing a slow, steady decline. Then right after 1997 things changed.
From 1997 through 2004 there was a steady increase in the number of people with signs of coronary disease. Beginning in 2001 the number of people with high-grade disease began increasing. You can see this graphically in the chart below.
The authors of the study conclude that
Declines in the prevalence of CAD at autopsy over the 1981-2004 period taken as a whole reinforce the argument that 4 decades of declines in heart disease mortality largely reflect reductions in disease incidence (ie, reductions in CAD incidence more than offset any rise in prevalence from improved survival among persons with CAD). Our finding that temporal declines in the grade of CAD at autopsy have ended, together with suggestive evidence that declines have recently reversed, provides some of the first data to support increasing concerns that declines in heart disease mortality may not continue.
What do they think is causing this increase?
The extent to which recent trends are attributable to the epidemics of obesity and diabetes mellitus awaits further investigation.
If you look at the graph below you can see that deaths from heart disease peaked in about 1950 and leveled off for a few years until around 1968 when they started a much steeper decline. In 1966 the surgeon general issued the famous warning that is still on all cigarette packages. Even before that drastic step was taken there was much in the news about the dangers of smoking and people began to quit. Most experts consider the decline in incidence of heart disease (which mirrors the graph below but lags behind it) as a consequence of the fall off in the number of people who smoke.
Now let’s look at all this data and put on our thinking caps. We know – everyone knows – that smoking is a major risk factor for heart disease. We know that smoking is on the decline and so has been heart disease, which makes sense. We also know that doctors every where have been prescribing statin drugs like crazy to anyone with even a tiny elevation of serum cholesterol levels. The paper tells us that virtually all the people in Olmsted County – including the ones who died of unnatural causes – are patients of the Mayo Clinic. The Mayo Clinic is a hotbed of statinators.
So, we can reasonably conclude that many of these people dying unnatural deaths were probably on statin drugs. (The average age of the subjects was 36 years with a standard deviation of 14 years, meaning that plenty were middle aged and ripe for statin prescriptions.) And the reversal in the many-year-long decline in heart disease occurred just about the time that the statinators really got going.
What we can tell from our calculating is that people are smoking less, taking statins and developing more heart disease. I’m not saying that the statins are necessarily causing heart disease, but I certainly don’t think they’re doing a whole lot to prevent it either. And since we know that statin drugs consume a huge portion of national medical bill, why do we continue to take them by the handful?
The authors of this study sort of backhandedly blame the increase on the increasing rates of both diabetes and obesity. But most people who are diabetic and obese are middle aged, and what statinator worth his/her salt wouldn’t have one of these patients on a statin? It would seem to me that if statins have even a fraction of the power to prevent heart disease that most statinators believe they do, these figures showing the extent of coronary disease would still be going down and not up. It certainly makes one wonder.
>>>”The paper tells us that virtually all the people in Olmsted County – including the ones who died of unnatural causes – are patients of the Mayo Clinic. The Mayo Clinic is a hotbed of statinators.
So, we can reasonably conclude that many of these people dying unnatural deaths were probably on statin drugs.”<<<
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Sorry Doc. I’m not buying this one. You are normally obsessive about sticking to the facts, but you’re drawing some irrationally unquantifiable conclusions here.
Tell me what percentage of all Mayo patients are taking statins? “Hotbed of statinators” isn’t science. where’s the double-blind with placibo here? You’re much better than this, Doc.
..Todd
The Mayo Clinic is as mainstream as it gets. Take a look at the affiliations of many of the people out there promoting statins – you don’t need a double-blind study for this one. I can assure you that prescribing statins us de rigeur.
Cheers–
MRE
One would think that with the many years now of treatment with statins that we would see an overall reduction in the need for angioplasty, stents, and CABG. And certainly so in those treated for a long period of time. My personal observation is that there are more interventional procedures, not fewer.
Your observation is on the money.
Is the third chart from the same study?
Not to detract from your evaluation, and I’m no expert in statistics, but I notice in the third chart that there are drops in death from heart disease during WWI, the depression, WWII, and Korean War. I presume that during those times the average all cause death rate was slightly higher so more people were dying of other causes, for instance in battle, from influenza and malnutrition before they could die from heart disease.
So my question is, by looking at this chart how do we know that the steady decline in heart disease death isn’t because of an increase in other cause mortality like the increase violent death in cities, on going military conflicts and traffic fatalities? Or is this 3rd chart only reflective of deaths in Olmsted Co.? If so then the decline in death rate could be that people were dying elsewhere because of the wars and the depression.
The slight dips to which you refer are just that – slight dips. The overall trend didn’t change. The chart shows the national statistics of deaths from heart disease. Since heart disease is and has been for years the number one killer of people in this country, it’s unlikely that the downward trend seen since about 1950 is caused by increases in other causes of death.
Interesting. A contributing factor for the small increase could also be the increased acceptance of suicide among the terminally ill (this is even legal in Oregon now).
I suppose, but most suicides in the terminally ill population are people who have cancer. Most people don’t consider having heart disease as being terminally ill.
I wonder if this data also has to do with the whole low-fat craze of the late 80s and 90s. We’re seeing the results of that diet on these people’s arteries.
Remember Atkins and Scarsdale were popular in the 70s… so the effect of that low-carb lifestyle may have shown up in the decrease in deaths during the 60s-80s.
Could be, but it’s hard to tell from the data.
Of course we know from Gary Taubes book that the increase in heart disease from 1900-1950 was due to: 1) an increase in the ability to detect/diagnose heart disease (where prior to this the cause of death for many folks with heart disease was listed as “unknown”), 2) A dramatic increase in the American life-span, specifically where the number of people aged >60 doubled – an age when most heart disease occurs.
I would think that a more likely cause of the most recent increase in heart disease could be blamed on the effects of the low-fat, high-carb diet widely adopted in the 1990’s.
My employer contracts with Mayo. I get a monthly newsletter from them telling me how to stay healthy. They’ve mentioned statins. But it’s not an every-issue kind of thing. OTOH, with every mailing they try to get me on a high-carb, low-fat diet.
You’ll have a hard time separating the effects of the Mayo Statinators from the Mayo Carburetors.
I’ve always found that Statinators and Carburetors (great term, BTW) are one and the same. First it’s the carburation, which never works, then it’s the statination.
Cheers–
Carburetors is brilliant beyond belief, and I hereby nominate it for Epithet-in-Chief!
Agreed!
Well, the CBS Evening News (I know, I know – probably the first time I’ve watched it years) tonight told us again how ineffective Vytorin is.
The really interesting part, however, is that they said patients that were also taking Actor, a drug that treats INSULIN RESISTANCE, showed slowing of plaque buildup!!!
Of course, they still don’t get the link. The diabetes “expert” they interviewed had the following to say:
“So, while I try and get my patients to have perfect blood sugars, I’m more concerned that their blood pressure is perfect, and that their cholesterol is lowered with a statin,” said Dr. Stuart Weiss of New York University Medical Center.
Jesus, as you say, wept.
http://www.cbsnews.com/stories/2008/03/31/eveningnews/main3984588.shtml
Statins aside… wasn’t it in the early to mid nineties when mcdonalds switched from tallow to trans fat oil for their fries? That would fit in nicely with the timeline.
Just a thought…
Dude, we’re all terminal. So far.
I receive 4 health news letters from alternative doctors, and one of the newer things talked about is the affect of vitamin K2 on the deposition of calcium in the body. As K2 is manufactured by intestinal bacteria, and we love to use antibiotics for everything, could this be a factor? My cholesterol has regularly run 240-250, since 1974. I’ve only taken statins for maybe a total of 2 weeks in perhaps 1980 or so, and have had a cat scan as recently as 2001 that showed only one small pixal of ca in the aorta. I’m 67, and avoid prescription drugs with a passion. I follow your diet about 60% of the time, but for years have avoided sugar and high carb snacks. I think several things, highfructose corn syrup, hormones in foods, and overuse of antibiotics, are affecting people greatly, and there are no magic bullets (pills) that will solve the problem. Only dieting will power.
It looks like the side effects of statins may be starting to get the attention necessary to shed some light on the dangers of their wholesale disbursement.
I am one who had a terrible experience with side effects from a statin. During the course I did a lot of research and came across a web site for USCSD (University of Cal. San Diego) who was doing a research study on negative side effects of statins. I filled out an online survey.
To my pleasant surprise I just received the following e-mail with 3 massive questionnaires attached seeking in depth information into how the statin affected my memory, neuropathy and muscles. I am so glad that at least someone is putting forth the effort to get to the bottom of the statin disasters.
(the email)
You generously filled out a questionnaire related to your experience on statins in January 2008. Thank you so much for the time and information you provided! We are writing to you now because you reported symptoms that are among the most common problems reported by statin users (e.g.
loss of memory or lowered thinking ability, muscle pain or fatigue, and neuropathy). Because so many people report these particular problems, and ask us questions about them, we are directing studies specifically in these areas. We hoped we might once again appeal to you for information on your own experience.
Attached are questionnaires that ask specific questions regarding muscle, memory, and neuropathy symptoms. We hope you might be kind enough to help once more, so that we have better information with which to answer questions by persons who experience these problems. If you prefer to have these surveys mailed to you, please e-mail us back your return address and we will immediately send them to you with a postage-paid envelope. **
Please e-mail the completed questionnaires to statinstudy@ucsd.edu (if applicable) or mail to:
UCSD Statin Effects Study
9500 Gilman Drive, Dept. 0995
La Jolla, CA 92093-0995
Please be reassured that any identifying information will be kept confidential within the study group. The “Notice of Privacy Practices”
booklet can be accessed through the following website:
http://health.ucsd.edu/hipaa/hipaa.asp.
If you have questions, or for more information, do not hesitate to call us at (858) 558-4950. Your contribution will help advance our understanding on the potential adverse effects of statin use.
Thank you again for your kind participation. We look forward to hearing from you.
Sincerely,
Stephanie Cham
UCSD Statin Effects Study
P.S. If you know of someone else who has any experience on or with statins, we would greatly appreciate it if you would provide them with our contact information (statinstudy@ucsd.edu or (858) 558-4950) and let them know that their input can be of great help to us.
Hey Doug–
Thanks for providing this info for us all. I appreciate it. I wasn’t aware this study was going on.
Best–
MRE
Not in response to statins, but a fascinating brief article in NYT saying that overweight children have fewer cavities:
http://well.blogs.nytimes.com/2008/04/02/overweight-kids-have-fewer-cavities/
I read this, too. Interesting.
Very interesting and timely podcast on BBC Radio 4 about the over prescribing of statins in the UK:
“The Investigation: Statins
Statins are a modern wonder drug – routinely praised for their ability to lower cholesterol levels and prevent heart attacks. Over 3 million people in Britain are taking them. They are the most widely prescribed drug in the world. This week the Government announced a policy of heart check ups in England which according to the NHS’s national heart director will mean 7 million people taking statins for the rest of their lives. But is there any point? Only a tiny percentage of these people will ever benefit. In the “The Investigation” this week, Simon Cox asks are we are putting too many people on statins?”
http://www.bbc.co.uk/radio/podcasts/fileon4/?focuswin
Anne
Thanks for the great link.
I am trying to reach Dr. Eades. I apologize if this isn’t the best way to reach you.
In April 2007 my friend, Eric Schultz, was sworn in as a Police Officer for our local Police Department and bought a house with his girlfriend. For the next six months Eric assumed everything in his body is working great. He was wrong. In October 2007 he was diagnosed with bone cancer, six months later the doctors decided to amputate his right foot. Now he has 4 more months of chemo treatments.
I am trying to get the message across that his diet is what put him in the hospital in the first place. I want him to understand that fat is good and grains are bad. I want him to understand that his never ending supply of “Fresca” is killing him and the aspartame is acting as a catalyst for his cancer that, according to his doctors, is being killed off by chemo. I have enlisted the help of Scott Kustes, Robb Wolf, Art DeVany, and Dr. Cordain. As you know they are all strong advocates of the paleolithic style diet and/or are against processed grains if any. My plan is to combine all the feedback that each of you brilliant people are willing to give me into one short, factual, and straight to the point document for my friend to read. All in effort to provide the facts of our side and present it in an organized manner for which Eric can use to make his own decision and not one based on the FDA’s food pyramid from grade school.
He is a victim of years of brainwashing making him believe that his doctors know what they are talking about, his Subway sandwich “Jared style” is good for him and that fat=high cholesterol=overweight. I am on a mission to prove him wrong and help him see the light. I need your help to bring the information to him in the same way that has reformed so many other “healthy” people from their once “healthy” ways. Unfortunately for us he doesn’t like to read..imagine that someone in his position not willing to put forth the time and effort to be properly educated…perhaps another epidemic in our country. Well too bad for him. If I have to force feed him this stuff I will.
Please, if you have anything to add, or have dealt with a similar situation I am completely open for suggestions. He thinks he has beaten cancer. He thinks that since it was in his foot and his foot is gone then he doesn’t have cancer anymore. So do all our friends! I am alone and I am determined to make sure I am not isolated completely. I am not giving up on them without a fight.
I would like to thank you in advance for your time and consideration. I look forward to hearing from you soon,
Zach
— i am sorry if the format seems generic as i am using it for everyone i am contacting
Hi Zach–
I understand your plight, but it’s been my experience that bombarding people with information about a specific point of view that is counter to what they believe is not a good way to persuade them. Most, when confronted by this approach, will simply say that there are a lot of ‘experts’ out there who believe the opposite. In other words, their confirmation bias kicks in.
If coming down with cancer and losing a foot isn’t enough to make someone sit up and take stock of the situation, I don’t think a barrage of info from me or anyone else will do the trick.
Plus, who knows why he really got cancer? Tons of people eat atrocious diets and never get cancer, so who’s to say his came from his diet? I couldn’t really make that call.
I do know that cancers use glucose for fuel and that providing a lot of sugar gives cancer food to grow on, so to speak. There have been several studies in the literature showing good results in cancer patients by keeping them on ketogenic diets. You can read one such study here.
I wish you well in dealing with your friend.
Best–
MRE
Thanks for answering my earlier questions.
About the article that overweight children have fewer cavities. It appears from the article that the researchers used growth percentile charts to determine which children were overweight. In my experience this is as inaccurate a measure of obesity in children as the BMI is in adults, maybe even less accurate. My oldest son always ranked in the 95th percentile from birth and he was never overweight, he was just a big boy fed good protein and healthy fats and little sugar — low carb for his teen years, most of the time. He also had never had cavities until after he started driving and was able to stop at the convenience store after school. He went on a Mountain Dew binge for a couple of months. Between 6 month dental checkups he developed 5 cavities. Needless to say he learned his lesson and and immediately stopped the daily consumption of soda pop.
On another thought, I read this article yesterday about the analysis of human coprolites found in an Oregon cave.
http://news.yahoo.com/s/ap/20080404/ap_on_sc/fossil_feces;_ylt=AgEKjnMR47JRZznvm1YZy0lxieAA
A quote from the article “While the analysis is not yet complete, he said there are bones of squirrels, bison hair, fish scales, protein from birds and dogs and the remains of plants such as grass and sunflowers.”
What! No carbs? Imagine that.
Hey … what happened to the Random Blog-feature on your page, Dr. Eades? IMO that was a gem of a feature, and I am sure others utilized it as well to learn from your wellspring of knowledge.
Please re-instate the feature.
kr
Michael
Thanks for the heads up. That feature got left off when we upgraded to the most recent version of WordPress. It should be fixed now.
I’ve been meaning to ask you about your thoughts on the early ending of the JUPITER trial regarding rosuvastatin; i.e., they stopped it because “plaque was down in patients using the drug.” Something seems too good to be true here.
Sooo, today I came across a blog entry on Pharmalot about many trials being stopped early (as soon as the researchers see a good result). While I agree that a drug that is beneficial should get to patients as soon as possible, I can’t help wondering about the machinations of the drug companies…..
I agree with you that the method of stopping a study as soon as the results start looking good for your drug is irresponsible. But, we’ve got to keep selling those drugs…
Stopping short is very irresponsible! Do the drug companies think that they can continue to get away with fudging results and details? Oh wait, they do seem to be getting away with it. Unbelievable…..
Dr. Eades
I guess it had to happen sooner or later…
Cholesterol Drugs for Kids
http://well.blogs.nytimes.com/2008/07/07/cholesterol-drugs-for-kids/
I read this in this morning’s Times. Unbelievable!
Dr. Eades
I hope that you blog on the recent study that claims that statins delay memory problems. My personal anecdotal evidence is the opposite. I stopped Lipitor early this year and my decline in memory stopped. Is there any hypothesized mechanism for the statins improving memory.
These kinds of studies have been surfacing over the past few years. Then better studies come along and refute them. And since memory loss is a well-documented side effect of statin use, I don’t think the possible reward is worth the pretty certain risk.
“Very informative article – I hope there’s even more 🙂
If you’re willing to share, which theme is being used here? I would like to know if it’s a free one.”
The theme is: Freedom – Green and Widgetized And it is a free one.
Very interesting!by looking at this chart how do we know that the steady decline in heart disease death isn’t because of an increase in other cause mortality like the increase violent death in cities, on going military conflicts and traffic fatalities? Or is this 3rd chart only reflective of deaths in Olmsted Co.? If so then the decline in death rate could be that people were dying elsewhere because of the wars and the depression.
These kinds of studies have been surfacing over the past few years. Then better studies come along and refute them. And since memory loss is a well-documented side effect of statin use, I don’t think the possible reward is worth the pretty certain risk.
Its not important whether statins drugs are directly leading to increase in heart diseases or there some other reasons to blame, what’s more important is to make sure that the root causes. in the form of various addictions are eradicated. Thanks for drawing our attention towards this issue.
My god! that is a very seroius finding. I think this article can play an eye opener for all and it should go a far way in discouraging the intake of statin drugs.
I’ve only taken statins for maybe a total of 2 weeks in perhaps 1980 or so, and have had a cat scan as recently as 2001 that showed only one small pixal of ca in the aorta. I’m 67, and avoid prescription drugs with a passion.As K2 is manufactured by intestinal bacteria, and we love to use antibiotics for everything, could this be a factor? My cholesterol has regularly run 240-250, since 1974.
How can you “avoid prescription drugs with a passion” yet “use antibiotics for everything”?
I think you misread Twitter Apps. He (if he is a she, sorry) was not saying that he uses antibiotics for everything, he was saying that because modern medicine prescribes a lot of antibiotics (for everything), and antibiotics kill off the intestinal bacteria that manufacture K2, and K2 is heart protective, antibiotics may be a factor in the resurgence of CAD.
I am not endorsing the logic, but wanted to offer a reading of his post that I think would make more sense.
Thanks. Maybe I did misread.