They have now, officially, all gone mad?

The Mad Hatter: ‘Have I gone mad?’

Alice: ‘I’m afraid so, you’re completely bonkers, but let me tell you something, the best people usually are.’

Alice in Wonderland

I find myself quoting Alice in Wonderland more and more these days. I now think it was never a children’s book, it was an accurate scientific analysis of human behaviour.

As many of you are aware the American medical authorities have come up with the latest guidelines to reduce cardiovascular risk. A major part of the guidelines is now to inform us all that we should forget about lowering cholesterol (LDL) levels, and just take a statin…. no matter what¹.

This is how the New York Times put it:

First, the guidelines have moved away from achieving target cholesterol levels.
Americans have long been urged to focus on their laboratory numbers. Many people are obsessive about checking their cholesterol levels and pursuing even better numbers. Doctors have been told to focus on these numbers and, in some cases, the quality of their care was assessed by the percentage of their patients with low cholesterol levels.

Those days are over. The new guidelines recognize that for patients who have exhausted lifestyle efforts and are considering drug therapy, the question is not whether a drug makes your lab tests better, but whether it lowers your risk of heart disease and stroke. Studies over the past several years have shown that improving your lab profile with drugs is not equivalent to lowering your heart risks².

One of the most influential cardiologists in the world, Steven Nissen, had this to say:
“The evidence was never there” for the LDL targets, he said. Past committees “made them up out of thin air,” he added.

Past committees made them up out of thin air….. Let me try that statement again…. Past committees made them up out of thin air. Exactly. Ex-bleedingly-zactly.

So, ladies and gentlemen, you have been conned. Utterly, completely and barefacedly conned, for the last thirty years. Your cholesterol level has absolutely no impact on your risk of cardiovascular disease. You think not? Well, that is precisely what they are saying in these guidelines. If not in quite such plain words.

But, of course, I am not being entirely fair to them. The level of LDL may actually matter after all – according to the same guidelines. For, as the New York Times article goes on to say.
There’s one exception to the numbers rule. People with very high levels of the harmful cholesterol known as LDL still need to worry about targets. The new guidelines set that LDL level at 190 milligrams per deciliter – but the principle is that if people have very high cholesterol levels, then their cardiovascular risk is so high that it is likely that treatment to reduce the levels would offset any risks of the drug treatment.

So, your LDL level doesn’t matter in the slightest, unless it is a very high level. Then the level does matter a great deal. Please explain, oh great cardiologists, does LDL, or does it not, cause cardiovascular disease.

Well, it seems that it both does, and does not, simultaneously. Amazingly, we have achieved a quantum state with LDL. It simultaneously exists as a molecule that can both cause – and not cause – CVD. Which means, of course, that the levels must be both lowered, and not lowered. Yes, well, this makes perfect sense. At least it would to a lunatic.

Perhaps if we open the box with the ‘at risk cat’ in it, we will find that this new version of Schrodinger’s cat died of a heart attack caused by LDL. Alternatively, it did not. Before opening the box, it exists in both possible states. It is an interesting variation on a theme.
The most astonishing thing is not that these people are now talking the most complete gibberish. They have been doing this for years. The most astonishing thing is that the vast majority of the population will still listen to what they have to say – and follow their advice.
Well, good luck with that all you billions of mad people, following the advice of these mad scientists Good luck with that indeed. I salute you. Meanwhile I shall attempt to find the answer to a far more important question than what causes heart disease.

“Why is a raven like a writing desk?”

1: http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437740.48606.d1
2: http://well.blogs.nytimes.com/2013/11/12/3-things-to-know-about-the-new-cholesterol-guidelines/

82 thoughts on “They have now, officially, all gone mad?

    1. Maree Bradshaw

      Suggest you go onto Utube and watch Dr Robert Lustig about the dangers of fructose and sugar! He seems to understand cardiovascular disease and that statins are totally useless. Really worth watching this video

      Reply
  1. Donna Worley

    As I glanced through my newspaper first thing this morning and saw the headlines “Millions more will be advised to take statins”, I found I was shaking my head in utter disbelief that this theory is still being perpetuated. My next thought was “I wonder what Malcolm (sorry to be so familiar!) will have to say about this.” You did not disappoint.

    As this is the first time I have put fingers to keyboard to comment on your site, I would like to thank you for all the information you provide us with — both here, in newspaper articles and in your books. Having very briefly (a mere 3 doses) tried statins years ago, long before they were actually referred to as statins, I knew they were not for me. I had resisted initially and then finally gave in to pressure from my doctors. Never again will I not listen to my gut feelings! I felt it wasn’t right and now it seems I was even more right (is that grammatical?!) than I ever realised.

    Reply
  2. Bruno

    Thanks dr kendrick for the good work you do, firs o all.
    After reading the statement you’ve quoted from Steven Nissen I’ve mad some research on him 0n wikipedia and there’s a study published in 2006 that I’ll forward:
    ‘In 2006, Dr. Nissen and his co-investigators reported on The ASTEROID trial (A Study to Evaluate the Effect of Rosuvastatin On Intravascular Ultrasound-Derived Coronary Atheroma Burden). The study concluded that intensive use of statins resulting in a decreased LDL and increased HDL can reverse the build-up of plaque in coronary arteries, as measured by IVUS.[10]’
    Now, is your quote something more recent?
    Thank you in advance
    Mr Bruno Stella

    Reply
      1. Susan

        Isn’t this the same Dr. Nissen who’s been a major cheerleader for the cholesterold theory for many years? Reminds me of Gilda Radner’s old Emily Littella skits from Saturday Night Live, when she would ramble on about some perceived problem, then, once corrected, she would simply say, “never mind!”

      2. Allen F Jackson

        Many thanks Dr Kendrick to the poor unintelligent male seeking to find sanity in an insane world thanks, Statinisation is all about financial gain and more control of people. They are always correct even when they are wrong

    1. cafemoi

      Making conclusions on surrogate-endpoint studies like this is partly how we got in this mess in the first place. Somebody thought they showed cholesterol was associated with CHD. Somebody else decided that saturated fat caused cholesterol rises. Yet nobody has ever shown saturated fat [or actually cholesterol] causes CHD. This study is similar. It tests lipids and atherosclerosis but not CHD events. In the end it did not show a reduction in CHD events; they actually increased.

      Reply
  3. Robert Kingsbury

    I wouldn’t wish to appear in the slightest bit cynical but there is some strategic logic in ramming statins down our throats, especially here in the UK. A massive elderly population with a pension bill we can’t afford, superdrugs endorsed and vigorously promoted by “independent” medical “experts”….such generosity from our political leaders and such a caring attitude too. I guess the few £billion it costs the government for statins is peanuts compared to the reduction in pension costs from bumping us all off a few years early. It must just be my cynical mind because politicians aren’t devious are they ?

    Reply
  4. Chmeee

    You want me to really spoil your day ? Your mention of Schrodinger reminded me of the Many Worlds interpretation of quantum mechanics. So there would be an infinite number of universes with Steve Nissens / members of the One True Church of Statins in them. Still, looking on the bright side, there would also be an infinite number of universes in which your view held sway and Nissen denounced statins as an agent of Satan.

    Fell better now ? No, I thought not. Strangely, I don’t either.This is madness squared, though sadly I’m not surprised. Plus ça change, plus c’est la même chose.

    And people wonder why cynics exist…….

    Thanks

    Reply
  5. Dave Seibert

    Thanks Doc!
    I was watching PBS News Hour last night and saw this similar issue:
    ***** Leading heart organizations issued new recommendations for the way doctors prescribe cholesterol-lowering statin drugs. Hari Sreenivasan talks to Dr. Harlan Krumholz of Yale School of Medicine about how a new risk calculator could help doctors shift their focus from lab results to more holistic thinking about who might benefit.**** (From PBS News Hour Website)

    I was biting my tongue to stop yelling at theTV and was hoping someone like you would respond to the overall issue. I was also saddened that PBS didn’t have the other side in the issue. We need to get you on PBS!

    Reply
    1. celia

      I also caught a bit on USA TV. The suggestion seemed to be that higher more aggressive dosing was recommended for those identified as being at risk (whatever their LDL numbers). Then the business program which followed the PBS News hour reported on patents running out, how much money statins were making, and a new drug on the horizon…

      Reply
  6. Annie

    Thank you for this, and all that you have written. The article in the Telegraph filled me with horror, as these stories do, so I much appreciate your thoughts on the subject. I wonder that so few people question the idea of mass medication… we do indeed live in a strange world.

    Reply
    1. JustMeInT

      Annie … mass medication….. akin to the vaccination of the herd….. Baaaaaa
      my husband suggests ‘enemas for everyone…. starting with Dr. Nissen’ – would be just as effective as mass Statin Prescriptions, with less side effects!

      Reply
  7. Sallywags

    Love this Dr M, going to print it off when I go with my 50 year old husband to once again tell his cardiologist why he is not going to ever take statins.

    Reply
  8. Eddie Mitchell

    When I was diagnosed a type two diabetic, over five years ago, I bought four books to gain knowledge on the control of my newly acquired chronic disease. One of the books was Dr.Malcolm Kendrick’s The Great Cholesterol Con. As with most diabetics my healthcare team recommended statins very heavily. A year later two stents and angioplasty for atherosclerosis and my cardiologist gave me the impression without statins, I was a dead man walking. I resisted statins, Malcolm’s book and other information had convinced me statins would make little if any difference to my length of life. I figured with little if any benefits and a whole raft of possible complications and side effects, my decision to refuse statins was logical.

    Well, I hope Malcolm has been walking around with a smile from eat to ear over the last few days, because I certainly have. What a complete and utter fiasco has been revealed to us over the last week or so. The latest information from The American College of Cardiology and The American Heart Association demonstrates their complete confusion and ineptitude regarding cholesterol. Remember, we are not talking about a bloke in a shed blogging his ‘feory’ we are talking out world leaders in the field, or are they?

    The tragedy in all this is millions of people will carry on taking these useless drugs, so many will be crippled and maimed and if they are diabetics and ask why has this happened to me? will be told. That is diabetes I’m afraid, don’t you know, it’s always progressive. Many others will not be around to ask any questions and statins may well have helped them on their way to an early and painful death.

    Keep up the great work Malcolm, any chance of you writing a post on the complete dietary madness recommended for diabetics?, maybe even another book. I know of many who could help you with the ammo!

    Kind regards Eddie

    Reply
    1. Dr. Malcolm Kendrick Post author

      More of a grimace than a smile. ‘The king is dead, long live the king…’ ‘Cholesterol is dead, long live statins.’ Or ‘Cholesterol is dead, but hold on just one goshdarned minute there son…. long live PCSK9 inhibitors…. Well, you know, pay me enough money and I will say anything.’ (A quote by someone called Stephen Nissan – who bears no relation to anyone living, or dead, or who may even be an international key opinion leader in cardiology).

      Reply
      1. Carolyn

        What I really just do not understand is “how” are the 10’s of thousands of GP’s, Cardiologists et all perpetuating this and being hood-winked? Why do they not get it? I’m baffled, utterly baffled. Any ideas? You are right, this is utterly, barking mad

    2. danny lyons

      It does not make any difference how smart you are, who made the gas or what his name is, if it disagrees with real life its wrong and that’s all there is to it. After suffering a MI in 2010 I quickly came to the conclusion that there is a load wrong with medicine, medication and Pharmaceutical companies. I have acquired and studied as best I can a collection of books and papers on the subjects of cardiology, obesity, medication and diabetes. Over the course of the last two years I have stopped taking statin medication, I am no longer type 2 diabetic, and I have lost 140lb in body weight now weighting a healthy 161lb.Not taking statins and having a LC/HF diet coupled with some understanding through books, papers and internet of my medical conditions has completely changed my life. I’m not saying that low carb high fat diet is for everyone but as Prof Tim Noakes says: if your carbohydrate intolerant and you keep to the recommended diet consuming large quantities of carbs you are going to get very sick.

      Reply
  9. L. Schaffner

    Ironically, I had just started to re-read your book, Dr. Kendricks, and then all this comes out. Is the risk calculator they are talking about the Framingham one that you discuss in your book that is unreliable?

    The cynic in me thinks that since statins are now available in generic forms, that the drug companies and their shills will soon be throwing statins under the bus in favor of their new PCSK9 inhibitors. This could be interesting.

    Thank you for your blog, Dr. Kendricks.

    Reply
  10. LaurieLM

    This is such for-obscene-profit madness, it’s craven.
    Big Pharma and their shills claim ‘side-effects’ are rare- 1 in 10,000.
    I have 4 anecdotes, with dastardly 100% devastating effects.
    7 years ago, my then 83 year-old father-in-law died, from poisoning by Lipitor. He hadn’t been on it until very late in his life- went on the year before. But when he started, it polished him off in 2 handfuls of months.
    5 y.a. I read Taubes and we took my then 52 y.o. husband off. He had been on for, EGAD, 5 years. His serious debilitating depression nearly completely cleared up.
    3 y.a. I took my then 85 y.o. Dad off. His CHF abated, his cataracts and gout calmed down, his kidney failure eased, he dropped weight, and he is no longer confused. He’s old and has health issues, but there is much less (almost no) of a revolving door at the entrance of the hospital for him now.
    My retired Doc sis cannot be convinced to stop taking them. It’s clear and sadly obvious to me to see they are actually and literally dissolving her once spectacular brain. Our brains ARE cholesterol- that Lipitor degrades. Women don’t benefit one single bit and she is scared that we have a family history of heart disease. HELLO- our Dad is 88 for Pete sake! And he hasn’t lived that long because he used to take Lipitor. Our mom is 86 and demented. She ate corn oil, grains, sugars, potatoes and Raisin Bran cereal with low-fat milk, mostly vegetarian all the time I remember.
    This is a race to the psychotic bottom if you ask me. Thank you for your advocacy.

    Reply
  11. Dr Paul Travis

    “The new guidelines recognize that for patients who have exhausted lifestyle efforts and are considering drug therapy…” Exhausted lifestyle efforts?? What does that mean? I’ve been a GP for 25 years and know only too well how quickly some doctors (even ‘specialists’…whoever they are) are to reach for their prescription pads rather than encourage their patients to continue with their lifestyle changes; drastically reduce sugar consumption, eat real food and keep working those muscles. Its not easy but lifestyle is the key. Drugs should not be viewed as an optional substitute.

    Keep up the good work Malcolm, we are right there with you. Disheartened maybe but doing what we can for humanity.

    Reply
  12. Sue Richardson

    If it wasn’t for the fact that I believe these ‘scientists’ are very very bad people, I would almost feel sorry for them now. They seem to be hysterically back-peddling, but trying not to look as though they are by producing various other distractions to fool us out of their clever medical top hats. The answer to my query about what is wrong with scientists is that they are motivated by money too, yes I see that. I think too, that it has made them all barking mad. Thankgoodness for Dr K. And the others who continue to counteract them. Don’t ever get so weary with it all that you give up Dr K. One of the doctors said on The heart of the matter programme, we may have to wait until this generation dies out. A scary thought, but that’s why the good guys have to carry on. The younger generation are out there, and hopefully they are listening. No wonder the Mad Scientists are panicking!

    Reply
    1. Steve Priors

      I have always been interested in the human condition. Why we do what we do and so on. I’m not really sure how I would define badness or goodness for that matter but…

      As an observer, one can see crazy things happening everywhere. Sometimes we find so called whistle-blowers who are willing to put themselves on the line and in so doing often lose their job and possibly their livelihood. Other companies may be quite reluctant to take on someone who has told the truth!

      There’s an interesting book called Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions and Hurtful Acts, Carol Tavris (Author), Elliot Aronson (Author).

      It might just be worth a read and for me it goes some way to explain why Cognitive Dissonance is the norm.

      People can and do rotten things occasionally but they/we/me are unlikely to acknowledge it. It’s even possible and perhaps even likely our memories get transformed and we won’t even remember our transgressions.

      Money, power, job security are just some of the things we want. If a research scientist wants that next research grant he/she knows not to rock the boat otherwise they will go to the bottom of funders lists.

      I bet many of us will at some point be in a difficult situation and may have to compromise the truth in some way.

      From a personal perspective and I do enjoy seeking the truth, it’s sometimes very hard to continue the battle especially when I need cash to live on.

      The issues which Dr Kendrick is really up against is as much human nature as anything else.

      No one wants to feel they have done anything bad because they see themselves as good people and so it goes on.

      Reply
      1. Sue Richardson

        I realise people do wrong things because they are afraid of the consequences, and in one sense it’s understandable. But it doesn’t excuse them, especially when their fellow men are concerned. If they are proved wrong, instead of insisting they aren’t, they should have the courage to hold up their hands and admit it. Yes, it’s human nature not to want to do that, and it must be quite terrifying to be in a prominent position and have to admit to a serious error. But it’s the right thing to do – human nature or not.

      2. Sue Richardson

        Steve, my wording about the scientists being bad men may have sounded too all embracing, because I feel cross with these ‘learned’ men in influential positions. I don’t say they are bad in all areas of their life, but I do say that they are very bad as far as their responsibility as a scientist is concerned. Re the book you mentioned, I’m not so sure it takes a whole book to explain why people don’t own up to their mistakes/tell lies. Most parents could give you a number of reasons, fear of the consequences, embarrassment, pride being just three to begin with.

  13. Robert Park

    As the alternative to statins there is nature’s natural products which the cartel of pharmaceutical companies seek to emulate but are seldom successful except, of course, at suppressing the information. If I can introduce here, to those who are unaware of them, a few interesting considerations.

    Serrapeptase (generic name) which clears plaque from arteries, so no need for by-passes or stents. It is also an anti-inflammatory and clears phlegm from the lungs. Hawthorn extract for heart support and Co-Q10 too which also possesses many health benefits to both the ill and the elderly. Ramp down on vegetable oils in the diet (mono and poly unsaturated fats) which, although nutritious, are harmful to the body and especially polyunsaturated fats which research has shown to be ‘potent’ suppressors of the immune system yet some believe they are on a healthy diet! While it is accepted that the reduction of carbohydrates helps prevent diabetes and diabetic related problems, little consideration has been given to the benefit of saturated fat in the diet to control diabetes; the more taken the better the control (in other words, do not take butter with your bread but rather a little bread with your butter). Of course, saturated fat turns to cholesterol which makes hormones which provides the body with excellent health and makes one feel really good but few medics will disclose this little secret!

    “All the world’s a bit queer except thee and me yet even thee is a tad odd!”

    Reply
    1. Sue Richardson

      I remember my husband’s grandfather, who was from Yorkshire saying something similar: ‘everyone’s queer except me and thee – and I’m not so sure about thee’.

      Reply
      1. NM

        Most likely; he’s hoping you’re not a “real” doctor so he can discount your opinions easily and return to the comfort of his prescription pad.

      2. Kevin O'Connell

        Maybe he/she can’t be bothered to click on “about”.
        There are alternatives, generally covered in the Cipolla book mentioned in this thread.

  14. Tyrannocaster

    Dr. Kendrick, thanks for your entertaining rants, of which we need more. i am really pleased to see that your posts generate lively comments, because that means you’re being read. Keep it up, and thanks again.

    Reply
  15. Steve Prior

    Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions and Hurtful Acts

    Carol Tavris (Author), Elliot Aronson (Author)

    I have always been interested in the human condition. Why we do what we do and so on. I’m not really sure how I would define badness or goodness for that matter but…

    As an observer, one can see crazy things happening everywhere. Sometimes we find so called whistle-blowers who are willing to put themselves on the line and in so doing often lose their job and possibly their livelihood. Other companies may be quite reluctant to take on someone who has told the truth!

    There’s an interesting book called Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions and Hurtful Acts, Carol Tavris (Author), Elliot Aronson (Author).

    It might just be worth a read and for me it goes some way to explain why Cognitive Dissonance is the norm.

    People can and do rotten things occasionally but they/we/me are unlikely to acknowledge it. It’s even possible and perhaps even likely our memories get transformed and we won’t even remember our transgressions.

    Money, power, job security are just some of the things we want. If a research scientist wants that next research grant he/she knows not to rock the boat otherwise they will go to the bottom of funders lists.

    I bet many of us will at some point be in a difficult situation and may have to compromise the truth in some way.

    From a personal perspective and I do enjoy seeking the truth but it’s very hard to continue the battle especially when I need cash to live on.

    The issues which Dr Kendrick is really up against is as much human nature as anything else.

    No one wants to feel they have done anything bad because they see themselves as good people and so it goes on.

    Reply
  16. Jennifer

    My GP warned that I was at grave risk of a “coronary event”, culminating in a stroke or cardiac arrest, if I had the audacity to stop taking the statins prescribed over the 10 years since being diagnosed as type 2 diabetic. No suggestion that by drastically reducing carbohydrate intake, I would be doing my health a great big favour! All horrible muscle pains have now gone, but I fear my short term memory has been damaged. At 66 I am not interested in any form of litigation, but I will watch with interest as to how the situation unfolds.

    Reply
  17. PeterVermont

    A doctor friend said many cardiologists are not testing already. They simply prescribe the highest possible statin dose and since they have done all that is possible there is no reason to test.

    Reply
  18. dearieme

    So, in short:

    We have been seriously misleading you for years about the hazards of cholesterol. If we had backbone we’d apologise. But since we don’t so we simply instruct you to Trust Us And Do As You’re Bloody Well Told.

    Reply
    1. Wendy

      I’ll trust my gut before I trust anyone pushing those statins. I believe they’ve brought on my mother’s diabetes and my dad’s memory problems, intestinal isues and extreme tiredness.. My cousin has experienced memory problems and quit taking them. I already take two different asthma medicines and thyroid. I have drug allergies, and also am concerned about drug interactions. I had early menopause, and never had a heart attack; everything I have read about warnings of these drugs has stated that I am a higher risk for problems with statins than not taking them. My gp and her staff don’t believe me. I’m going with my gut, anyway.

      Reply
  19. cafemoi

    100% of us diabetics are now going to be prescribed statins. 68% of us die of heart disease of some sort, so therefore our risk level determines we need to reduce our cholesterol. [If the reason is simply inflammation reduction, then certainly diet can reduce it, like my LCHF diet has dropped my H-CRP to <= 1, or take a mini-aspirin. Duh.]

    And the 68% death-by-CHD rate seems an obvious indication of cause. We, the diabetes community, are inflicted with sugar control problems. Isn't sugar the obvious target? Isn't this the strongest association of anything we have ever tested? Why, for god's sake, do we keep prescribing sugar-based diets for us? Why can we not get over the fact that a healthy, naturally raised animal is good for us? [again, all the meat tested as causing heart disease has been grain(sugar) fed. Hello?]

    I challenged my doctor on his logic: "you want to take me out of the 68% group and put me in the 32% group? You think I'll enjoy dying sightless and legless on a dialysis table? Or, if I am lucky, I might wither away in oncology? I watched my mother suffer through that. I've watched too many of my compatriots die tragic deaths. No thanks. No doc, I want to die on center ice from a heart attack. Flip off the fucking switch and be done with me." He said "fair enough." Love the man, almost.

    My head hurts. I need bigger shoulder pads.

    Reply
    1. Wendy

      cafemoi, your logic is certainly something to think about. I’ve just talked to my husband and oldest daughter, in the last couple weeks, about NOT wanting to linger with a slow painful death. I’d rather have the heart attack, as long as it’s thorough. We have watched too many relatives with dementia, neurodegenerative, cancer, etc, also. If we’d have to choose, I’d rather have Quality life over quantity. I’ve already outlived several family members, blood relatives and not. But, God has the ultimate plan. I just hope He takes my ideas into consideration……

      Reply
      1. cafemoi

        The ultimate answer is to find the healthy lifestyle. No matter how you approach it, drugs do not make us healthier. Most people who really examine outcomes will agree our general diet is killing us off, causing enormous healthcare problems. Yet our healthcare policy makers insist we continue eating high grain, high sugar, low fat diets. I have seen nothing but good from completely discarding this insane approach and eating the opposite. I write this with a mug of coffee accented with coconut oil and whipping cream, my breakfast.

  20. thetinfoilhatsociety

    I think that lowering cholesterol, according to the report does NOT matter, because they state clearly that fenofibrates and niacin lower cholesterol but do not reduce risk. Besides, how seriously can you take a study that says basically everyone over 45 should take a statin? And how seriously can you take a report where 7 of the 15 authors have financial ties to the pharmaceutical companies and one of the co-chairs has Significant financial links – their word, not mine.

    Reply
  21. John C

    I am not sure that the main point behind the reasoning for the change in the policy regarding statin prescription has beed grasped here.

    This is the important bit and what follows logically from it.

    From the NY Times report:

    “….Zetia has been viewed with increasing skepticism in recent years since studies showed it lowered LDL cholesterol but did not reduce the risk of cardiovascular disease or death….”

    In other words statins in general have a mechanism of action unrelated to LDL cholesterol lowering, most probably an anti-inflamatory effect, but in the case of Zetia no anti-inflammatory effect, only cholesterol lowering, so ditch it.

    What these guys on the committee have done is have an each-way bet. They are now prescribing statins essentially as anti-inflammatory agents, but just in case cholesterol does contribute to heart disease we better keep it there somewhere in the guidelines.

    Any sensible person would look around and see what other ant-inflammatory pills are available if you can’t/wont change eating or lifestyle habits.

    Oral magnesium (Mg oil is for crackpots) and aspirin.

    Read the refereed journals and make up your own mind. Dozens of well researched articles, meta analyses etc out there.

    Reply
  22. J

    I’m CURED. Its a miracle. According to these geniuses guidelines I, as a 46 year old lean, fit , non smoker, non diabetic with no family history of CVD has overnight gone from, according to a local doctor, being at high risk of “spontaneous heart attack or stroke” because of my 7.9mmol cholesterol level (Ldl 4.0, Hdl 3.8, Trig 0.67) to having very low risk at all.(Even my Ldl well below the new 190mgdl cutoff.) No wonder I have been jumping out of bed with such pep in my step inexplicably the last few days. What a sad fiasco and bad joke the clutching at straws is. Thank’s Dr Kendrick for another brilliant, funny and insightful post. It was your book that helped me calm my nerves after that rather irresponsible diagnosis above.You are the man.
    J (Actor from South Africa).

    Reply
    1. dearieme

      Well said. One can also be cured by arguing the toss. In the course of five years my GP has slowly and reluctantly moved from the position “You are a diabetic and MUST take statins” to “You are not really a diabetic at all”. Clearly arguing has been good for my health.

      Ignore all this stuff about food and exercise, folks: it’s arguing that does the trick!

      Reply
      1. Wendy

        dearieme, Ahhh, I knew arguing was good for something!! I’m probably the most argumentive one in the family; nobody else wants to rock the boat!
        I won’t take advice from a doctor without questioning, espcially after one doctor nearly messed me up many years ago, and lied to me about it.
        And, NObody knows me as well as I do, so they better not think they know me better just because they have initials after their name. There, I said it.

  23. Debra

    I can’t imagine why anyone would think that interfering with a necessary biochemical pathway responsible for the synthesis of cholesterol , co enzyme CoQ10, Vitamin D, steroid hormones, bile salts, heme a (really important for a functional electron transport chain), various prenylated proteins would be a beneficial intervention.
    Has anyone ever died from a deficiency of statins?

    Reply
  24. Louise Bloxham

    Hello Dr K. I’ve been doing lots of reading about the saturated fat/heart disease question. (Am reading your book at the moment). I got to wondering why Ancel Keys became so concerned with heart disease and why it had started to rise through the early part of the last century in America. Clearly he has been pretty much proved wrong and fat was not to blame. What else then – sugar is the obvious culprit but what could have changed around that time? Answer is orange juice!! It became possible to pasteurize orange juice in the mid 1910’s and transport fresh orange juice around the US. Found this web page about the history of orange juice in the States. http://www.thebestofrawfood.com/history-of-orange-juice.html

    Kind regards and thanks for your blogposts. Last one was a gem. Louise Bloxham

    >

    Reply
  25. David Bailey

    Malcolm,

    Here is an article in Saga that is a response to your article at the same place.

    http://www.saga.co.uk/health/medicines/statins-benefits.aspx

    In it, he says:

    “Cholesterol is the single greatest risk factor for heart disease and a major risk factor in stroke and disease of the arteries.”

    and

    “Dr Kendrick uses studies selectively. He doesn’t mention the trials involving tens of thousands of people showing benefit from statins. He focuses entirely on the negative.”

    He also seems to downplay the side-effects:

    “Side effects certainly do occur but the Dutch survey Kendrick mentions doesn’t reveal what percentage of patients would have suffered such problems if they were taking a placebo tablet.”

    In view of the amount of detail in your book, these comments seem unfair – particularly the first tywo. Have you tried to pursue this further with the author? The frustrating thing seems to be that it is so hard to get these issues thrashed out to a conclusion.

    Reply
    1. P. Winter

      Dr M Schachter who wrote the article is an editor in chief of theTherapeutic Advances in Chronic Disease, this journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers involved in the medical treatment of chronic disease.” Original research manuscripts of well-designed trials are also welcomed that show drug or drug class efficacy in a particular disease”. No wonder he defends statins, conflicts of interest?

      Reply
      1. David Bailey

        I am probably naive, but it would be great if Dr M Schachter could be pinned down a bit. I mean, if he says that there is overwhelming evidence that “Cholesterol is the single greatest risk factor for heart disease and a major risk factor in stroke and disease of the arteries.” (to take just one of his statements) then can’t anyone shame him into stating what that evidence is! The sheer vagueness of that statement suggests that he can’t back it up.

        It is as though we had a debate about whether 2+2=4 or 2+2=5, but the debate ended inconclusively!

        David

      2. Dr. Malcolm Kendrick Post author

        The statement is, of course, complete bollocks. Just to refute one part. There has never been a study, anywhere, demonstrating that a raised cholesterol level is a risk factor for stroke. At any age, any sex, any population. Cholesterol levels are a minor risk association in younger men. But the risk disappers in older men, and does not exist in women.

  26. Professor Göran Sjöberg

    Thank you for your relentless fighting attitude towards this continuing madness!

    I have just read your your great book which inspired me to my recent chronicle at Dr Annika Dahlqvist blog in Sweden. Dr Dahlqvist has now been in the hot air for about 10 years due to her stout attitude against the common grain by advocating the most forbidden – eating, LCHF, Low Carb High Fat (read saturated) food. She was close to losing her licence on her attitude but has saved many lives of her patients.

    Her attitude triggered the fact that, today, about one quarter of our population is cutting the carbs and the margarine while adding butter and other saturated fats to the food. Myself, a CHD, dead man walking since 14 years, I am feeling great when now climbing the scaffolds on my house or doing my heavy gardening at maximum pulse rate.

    In springtime we will have a LCHF-cruise in the Stockholm archipelago when I will give a talk on “The Great Cholesterol Con”

    Reply
  27. JustMEinT Musings

    Dr. Kendrick….. I am aware that you and your associates do not always agree, but I am seriously interested in your opinion – in regards to Doc Graveline’s latest Article…..
    DUANE GRAVELINE – former NASA Scientist and Doctor has jumped onto the latest Statin Bandwagon……….. for years he has written about the dangers of Statin Drugs… this is his take on the new USA Guidelines:

    The American Heart Association (Ref 1.) and the American College of Cardiology (Ref 2.) on Tuesday 12 November 2013 released new treatment guidelines departing radically from the past four decades of allegiance to cholesterol causality as the cause of heart disease and stroke.

    What it really amounts to is a long overdue adjustment by Big Pharma to the reality of cholesterol’s extraordinary importance to body function and the realization that the benefit of statins has nothing to do with cholesterol reduction but rather is due to the anti-inflammatory and immunomodulatory properties of statin drugs.

    The truth is that cholesterol is irrelevant to cardiovascular disease risk and their present statement is as close as they can get to the real truth without provoking people to ask really picky questions.

    I am sure you have noticed how in the past few years the previous dietary restrictions have been liberalized; restrictions that used to emphasize minimizing the consumption of eggs and whole milk and avoiding butter entirely.

    Remember the cholesterol numbers racket? First 200, then 170, 150, 130 and even 70 if you were high risk. Remember the terror of the office visit waiting to see what your number was this month?

    The drug companies are not going to tell you now that your cholesterol numbers are meaningless and it all has been a major con but that’s what it has been. Statins inhibit a intracellular transcriptase known as nuclear factor kappa B (NF-kB) and that’s what provides the benefit.

    Bottom line is if you have cardiovascular disease or if cardiovascular disease is prevalent in your family you are high risk and should be on a statin. I agree completely with this philosophy. My only argument is the dose.

    Why use a cholesterol lowering dose when cholesterol is not the problem? Available research suggests that much lower doses suffice for inhibiting NF-kB. If your present dose is lowering your cholesterol it is probably too high for your needs.

    The issue here gets complicated but it involves the mevalonate pathway. Your statin drug blocks this pathway. That’s how they designed it – to block this pathway to block cholesterol synthesis. The problem is that this also blocks the synthesis of CoQ10 and dolichols.

    Both biochemicals are vital to cellular function and when inhibited are the cause of most of the side effects like myopathy, neuropathy, ALS-like neurodegenerative damage, etc. So your statin dose should be sufficient to block the
    NF-kB pathway but not enough to affect the mevalonate.

    Two relevant articles on Low Dose Statins:

    A Case For Low Dose Statins?

    Low Dose Statins

    Ref 1. http://blog.heart.org/new-heart-disease-and-stroke-prevention-guidelines-released/

    Ref 2.
    http://www.cardiosource.org/news-media/publications/cardiology-magazine/2013/11/new-accaha-prevention-guidelines-address-blood-cholesterol-obesity.aspx

    An opinion piece in the New York Times on the new guidelines titled,
    “Don’t Give More Patients Statins”: worth reading

    Duane Graveline, M.D., M.P.H
    Former USAF Flight Surgeon
    Former NASA Astronaut
    Retired Family Doctor

    Reply
    1. Dr. Malcolm Kendrick Post author

      Thanks for your thoughtful post. Yes, Duane Graveline and I communicate regularly. We agree on most things (to do with statins and suchlike). I would have to say that I do not agree that atherosclerosis is due to iflammation. I do not agree that statins work by modulating inflammatory responses (whichever pathway you consider most importatnt). In my world inflammation is a response to injury (real or perceieved) by the body. Inflammation is always casued by something. As Affe Ravnskov says. All anti-inflammatories, except aspirin, increase the risk of CHD – steroids, the most poweful anti-inflammatories are worst of all. I beleive that statins work by increasing NO synthesis in the endothelial cells, thus reducing thrombus formation. (I may be wrong, Duane may be right, but I still like my hyopthesis better). As to the other question should we use low dose statins? I am ambivalent. The story of aspirin may be apposite here. At first we gave 400mg, then 200mg, then 100mg. Now it is found that 75mg does all you need – and reduces side-effects to a minimum. Statins may provide the majority of any benefit at a very low dose. So, perhaps worth trying.

      Reply
    2. Charlie

      If statins work by reducing NF-kB I rather use the natural approach there are many foods and supplements that reduce them http://www.bu.edu/nf-kb/table-1/ and not risk the toxic effects of the statins. If they work by NO exercise is much better, also food and supplements like argine and citrulline can do a better job than statins. Celery, cress, chervil, lettuce, red beetroot, spinach, rucola can be very high in NO generating capacity. For a good table of food with NO generating capacity (Santamaria, P. Nitrate in vegetables: toxicity, content, intake and EC regulation, Journal of the science of food and agriculture
      86:10–17; 2006.).

      Reply
    3. Philip Thackray

      JustMEinT,
      Where did you fine the Graveline article? I went to SpaceDoc.com but could not find it there?
      Thanks for you help
      Phil

      Reply
  28. Ron

    O.K., now I think I have it figured out:

    Do you presently have cardiovascular disease? (y/n)……………….If yes, take a statin.

    Are you a diabetic? (y/n)……………………………………………………….If yes, take a statin.

    Is your LDL Cholesterol above 190? (y/n)……………………………….If yes, take a statin.

    Have you answered no to all of the above? (y/n)……………………..If yes (not to worry), take a statin.

    What’s interesting is the status cholesterol has been relegated to in the recent recommendations. For instance, if you do not have cardiovascular disease and are not a diabetic and (subsequent to recent guidelines) ask your doctor to assess your cardiovascular risk on the basis of LDL Cholesterol alone and in isolation (kinda like the way they’ve been doing it for years), your doctor will now have to do a complete 180 and admit that ldl cholesterol levels up to 190 is NOT a cause for concern. I have no clue how the average doctor can reconcile this fact??? But there is no question about it, and there is no getting around it……. it is a fact!!! The ldl cholesterol he had been taught to fear (fear he had been transmitting to his patients for decades), has now been relegated to non-issue status (again, when viewed in isolation as a cardiovascular risk factor which he had been taught to do). Obviously, due to the caveats included in the guidelines (10 year, >7.5%, blah blah blah) he will probably never have to confront this FACT, this contradiction with his patients.

    Reply
    1. Dr. Malcolm Kendrick Post author

      ‘We are all capable of believing things which we know to be untrue, and then, whene we are finally proved wrong, impudently twisting the facts so as to show that we were right. Intellectually, is possible to carry this process for an indefinite time: the only check on it is that sooner or later a false belief bumps up against solid reality, usually on a battlefield.’ George Orwell.

      Reply
  29. labrat

    I downloaded the risk calculator. It’s a joke.
    Age,sex,race,TC,HDL,SBP,Tx for HBP, DM, Smoking status.
    It doesn’t take into account weight, fitness, family history, crp or a host of other known or suspected contributors to risk.
    Cookie cutter guidelines for today’s new automaton MD’s.
    Sad.

    Reply
  30. Lorna

    . ‘Statins may provide the majority of any benefit at a very low dose. So, perhaps worth trying.’
    AND…
    Bottom line is if you have cardiovascular disease or if cardiovascular disease is prevalent in your family you are high risk and should be on a statin. I agree completely with this philosophy. My only argument is the dose.’
    Are statins now ok then for people with CV disease at low doses? And is any LDL cholesterol level now irrelevant at any level (realise the ‘guidelines’ now say over 190 is an indicator). If cholesterol is not a risk factor at 190, why is it a risk factor at 190 and beyond?

    Reply
    1. dearieme

      Remember that “risk factor” doesn’t mean “cause”, it just means “positive correlate”. There are, I fear, some doctors who would prefer that you didn’t realise that.

      Reply
  31. John C

    Wonder where the money came for this?

    “The Australian Medical Association has taken out a full-page advertisement in this morning’s state newspaper, promoting the use of Statins, claiming they reduce the risk of stroke and heart attack.The group of drugs have come under scrutiny recently, after an ABC science program questioned their merit.”

    Reply
  32. J

    Check out the article from US Dallas paper re what a fiasco the risk calculator is and how it massively overestimates risk. (Suprise, suprise.) The buskers, I mean specialists have been meeting behind closed doors on the weekend to come up with answers ie a defense, for their
    incompetence.

    I tried the calculator on the weekend and after putting in my details which are all optimum except my cholesterol numbers I got a 1.5% 10 year risk but a 50% lifetime risk??????. (I am 46 yr old male, non smoker, non diabetic, perfect bp etc with high cholesterol.) So all I did was change the chol no”s to their ideal range and got a 5% lifetime risk, hmmmm again. So I left the hdl at 50(their optimum no, not over 100 which mine is which is to0 high for the calculator apparently) and changed the total chol from 170 to 180 and suddenly got a 35% lifetime risk.So a 10mg total cholesterol raise (at a stupidly low 170 ideal point according to them already) raises risk by 700%. Are you @#$%ing kidding me?. Dr K I don’t know how you have remained remotely sane dealing with this all these years.

    Reply
    1. Dr. Malcolm Kendrick Post author

      I have just done a little blog on this very matter, going up today (at some point). I have tended to ignore lifetime risk for the utter bollocks that it is. (Did you now that your lifetime risk of dying is 100% – why goodness me, whoda thunk). However, I quite like the idea that raised LDL by 10mg/dl increases lifetime risk by 700%. how have I remined remotely sane. Well, there are those who would say I have not. Sanity depends on your point of view. I use Alice In Wonderland as my current guide to the world. I can understand it better that way.

      Reply
      1. Jennifer

        This thread is so entertaining, it is interfering with my knitting schedule today! Oh, what the heck, it is not worth finishing the cardi, because I have stopped taking my statins, so I am unlikely to live long enough to get up to the armholes! But may I suggest that the scientists have now arrived at the armpits, or am I just getting too silly now.
        I am so pleased that I learned logic at Senior School 50 years ago, as it is coming in so useful now.

      2. Sue Richardson

        Your reply made me laugh nearly as much as Doctor K’s posts, Jennifer. I hope you get up to the armholes before the statin police come calling.

      3. J

        You are a king among men Dr K. Thanks very much for taking the time for a personal response, much appreciated.

  33. Pingback: I Link, Therefore I Am - #1 - PALEO DIET BASICS

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