Some of you may have noticed this study, others may not. The amazing ‘wonderdrug’ trial proving that cholesterol lowering drugs have unparalleled benefits on preventing stroke. Here is just one headline from the Daily Express. A major newspaper in the UK.
Statins slash stroke risk by 30 per cent: Millions more should be given drug, say experts
New research has found that the wonderdrugs – which include statins and fibrates – can slash the risk of suffering a stroke by a third in the elderly. And experts now say there is clear evidence that even among the over-75s – a group not routinely prescribed statins – people can benefit from the life-saving drugs.
It is yet more evidence that the cholesterol-lowering drugs are lifesavers and that their benefits outweigh the potential side effects. Lead researcher Christophe Tzourio, Professor of Epidemiology at the University of Bordeaux and Inserm, said: “A one third reduction in stroke risk, if confirmed, could have an important effect on public health.”1
And so on and so forth.
Colleagues of mine love to wave articles like this at me with a triumphant smirk. ‘Seems you’re wrong about cholesterol lowering after all.’ What do you say to that? Eh..’ I usually ask them if they actually read the study. ‘Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study.’2 I ask them this question, but I know that they’ve not. I find it rare to come across a doctor who would ever deign do such a thing as read a scientific paper.
However, when studies like this come out, I do feel the need to raise my enthusiasm to a sufficient level to have a peek at the paper. In this case it was rather easy. This paper was published in the British Medical Journal (BMJ), and I get it delivered to me every week by post. What a quaint thing, actual physical reading material.
My first problem, before I even started reading this study, is that I knew beforehand that a raised cholesterol level is not a risk factor for stroke. Never has been, not anywhere, not in any study I have read. Whilst you can find studies claiming that a raised cholesterol level (LDL) is a risk factor for heart disease [ and you can find others that show the opposite], I have yet to find any study demonstrating any association between raised cholesterol and stroke.
Here, for example, is a short extract from one massive study, the biggest, which looked at four hundred and fifty thousand people over seven million years of observation. It was published in the Lancet:
‘The associations of blood cholesterol and diastolic blood pressure with subsequent stroke rates were investigated by review of 45 prospective observational cohorts involving 450 000 individuals with 5-30 years of follow-up (mean 16 years, total 7·3 million person-years of observation), during which 13 397 participants were recorded as having had a stroke.
Most of these were fatal strokes in studies that recorded only mortality and not incidence, but about one-quarter were from studies that recorded both fatal and non-fatal strokes. After standardisation for age, there was no association between blood cholesterol and stroke except, perhaps, in those under 45 years of age when screened. This lack of association was not influenced by adjustment for sex, diastolic blood pressure, history of coronary heart disease, or ethnicity (Asian or non-Asian).3 [My bold].
Now, if you are unable to find an association between cholesterol levels and stroke in seven point three million years of observation then, you know what, it just ain’t there. In fact, I challenge anyone reading this blog to provide any evidence that cholesterol levels are associated with overall stroke risk. Gulp, that makes me hostage to fortune.
This is why stroke associations struggle when they talk about cholesterol and stroke. They seem desperate to say that raised cholesterol levels cause stroke, but just can’t. Here is how the National Stroke Association fudges the issue.
‘High cholesterol may raise your risk for stroke by increasing your risk for heart disease, a stroke risk factor.4’
Whilst it is, of course, true that having heart disease does increase your risk of stroke, and vice-versa, the rest of this statement reveals a yawning gap in logic [For the sake of this argument, let us assume it is true that a raised cholesterol causes heart disease].
A (raised cholesterol) → B (heart disease) →C (Stroke)
A does not → C
Question. If A does not lead to C, how does A lead to B, then leading to C? I shall ask for this to become a question in the Oxford and Harvard entrance exams.
[BTW, if you can work this one out, then please feel free to let me know how it works. Exactly.]
Anyway. We find a study demonstrating that two cholesterol lowering drugs, in this case statins and fibrates, significantly reduce the risk of stroke. But a raised cholesterol level is not a risk factor for stroke. Which means that there can be no possibility that the benefit seen can have been due to cholesterol lowering? That, my friends, is simple logic. No need for Oxford and Harvard to get involved at all. This could be discussed on entrance to kindergarten.
Now, just to add to my short analysis this study I would like to draw your attention to something not remarked upon by the popular press at all. However, I thought that you may find it interesting. It was the following statement from the paper:
‘We found no association between lipid lowering drug use and coronary heart disease (hazard ratio 1.12, 0.90 to 1.40).’ [For those who hate figures/confidence intervals, sorry, I left them in for those who like them].
This was the dog that did not bark in the night.
In summary, here we have a study showing that cholesterol lowering reduced the risk of stroke, when a raised cholesterol level is not a risk factor for stroke. On the other hand, it failed to show any benefit on reducing the risk of heart disease. Some would consider that a study such as this raises more questions than answers. However, with wearisome inevitability, it has been twisted around to provide further proof that everyone should be taking statins. Sigh.
1: http://www.express.co.uk/news/uk/578174/Statins-stroke-experts
2: Alperovitch et al: BMJ 25 May 2015 pp12.
3: Cholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts The Lancet Volume 346, Issues 8991–8992, 30 December 1995, Pages 1647–1653
4: http://www.stroke.org/stroke-resources/resource-library/cholesterol-and-stroke
Dr. Malcolm Kendrick 
No wonder it was easy for GP to re-start the statins to the 75 year old female I mentioned yesterday…patient has been a life-long Daily Express reader!
Now that is power, isn’t it.
I suppose that they’ve gotta sell them somewhere. When they recommend that Statins will cure ingrowing toenails and that anyone with feet, irrespective of age, should be prescribed Statins, we shall know two things.
Firstly that they are really struggling and secondly that sense is prevailing, at long last .
Hi John, I’m a new kid on the block. Joe Mercola has been my inspiration in many ways, but I am delighted to have found Malcolm. It is refreshing to find that some honest decent viewpoints are being aired. Not everyone thank God , is motivated by just profit margins.
Here is some more wriggle – ReachMD https://reachmd.com/activity/7451/ – warning, a rather weary `listen`… More drugs are being put forward, but not a single comment on lifestyle and diet let alone exercise. Well, of course not, can`t make money out of lifestyle changes, diet and exercise !
Afraid I cannot face reading the Daily Express article – ReachMD has filled my gizzard…
Well done Dr Kendrick, continue to hold up the fort of sanity.
Malcolm, I just saw u for the first time on Joe Mercola’s video. I have been rocking with laughter at the simplicity of common sense logic that u employ in your blog. So refreshing, uncomplicated & courageous to stand up against the generally pedalled nonsense from those with many degrees but little wisdom.
I am delighted to have found your writings. I’m a Blackpool lad of 71 years old, a Christian minister, living near Spain. Check out my site, I also teach on health but u know far more than me. http://www.dhmi.net
Meanwhile, today, in his regular Opinion column in the Times, Matt Ridley talks of the US diet advice revision, and references Drs Kendick and Ranskov.
Perhaps some statins have an effect on strokes not connected to their cholesterol-lowering properties?
http://lanzaroteonfoot.blogspot.com
http://thelanzarotetheyleft.blogspot.com
From: Dr. Malcolm Kendrick To: john_brindley@yahoo.com Sent: Monday, 25 May 2015, 10:29 Subject: [New post] The dog that did not bark in the night #yiv9441983542 a:hover {color:red;}#yiv9441983542 a {text-decoration:none;color:#0088cc;}#yiv9441983542 a.yiv9441983542primaryactionlink:link, #yiv9441983542 a.yiv9441983542primaryactionlink:visited {background-color:#2585B2;color:#fff;}#yiv9441983542 a.yiv9441983542primaryactionlink:hover, #yiv9441983542 a.yiv9441983542primaryactionlink:active {background-color:#11729E;color:#fff;}#yiv9441983542 WordPress.com | Dr. Malcolm Kendrick posted: “Some of you may have noticed this study, others may not. The amazing ‘wonderdrug’ trial proving that cholesterol lowering drugs have unparalleled benefits on preventing stroke. Here is just one headline from the Daily Express. A major newspaper in the UK.” | |
And the relevance of Lanzarote?
Perhaps Lanzarote causes strokes? Or it’s a good place to sell statins. Or the Daily Express.
I know too many friends who have been made very ill by taking satins.well done Dr Kendrick for your most interesting posts
Pingback: Malcolm Kendrick again: slam dunk | Mark's Daily Apple Health and Fitness Forum page
could it just be that statins reduce strokes by another mechanism that has nothing to do with cholesterol. Some evidence that statins have anti-inflammatory effects. I think there are better natural anti-inflammatories and would not recommend statins. Poor statins not really very good for saving hearts either.
“could it just be that statins reduce strokes by another mechanism that has nothing to do with cholesterol”: I suspect it could. Perhaps someone with a scientific bent might look into the matter, should anyone with a scientific bent ever work in the medical sciences again.
Hi Bernard. Thanks for the question. I have higher than standard usCRP indicating some inflammation, but no apparent cause. Therefore, what are the “better natural anti-inflammatories”?
Thanks
Teleoanalysis is pervasive in every pseudo-science based advice. They use it with abandon against saturated fat. It is funny how they use inappropriately Aristotle’s logic when it suits them (they use risk factor precisely in that way most of the time) and dodge it when it don’t. Everyone of them should see Tom Naughton’s Science for Smart People before writing down risk factor anywhere.
The first thing you always find in garbage like this is it’s reported by “something something important sounding of Epidemiology”.
Ash, you are so right. I have enjoyed so much of the information you have provided, particularly when you showed us the stats on the most prescribed pharmaceuticals to those received Medicaide and Medicaire. I learned a lot from you. I just wanted to give you a big thanks.
I must say, sport, that you are in bloody good form at the moment. Hats off.
Thank you.
Malcolm,
Just to put the cats among the pigeons (to retain the domestic pet theme going) I have one query about the above. To be clear, I’m a long standing cynic over statins and enjoyed your cholesterol con ebook enormously, however I’m not a subscriber to the BMJ and I’m unsure if I can access the study report readily.
Does the study claim that strokes are reduced due to lower cholesterol levels, or does it suggest that those who take these complex drugs have a lower incidence of strokes independent of the lowered cholesterol levels that inevitably occur with statins? If the latter there could be some plausibility in the claims, however the whole risk/benefit analysis would need to factor in the proven negative symptoms associated with statins.
Ray. You are right. But it was not just statins, it was fibrates as well (obviously the French still think these things are still worthwhile prescribing). I have long argued that any benefits of statins must be due to non lipid-lowering effects, and I stick to this. However, it is hard to see how you can reduce stroke, and not heart disease, by any mechanism yet proposed by the use of statins and/or fibrates.
The BMJ is becoming more patient friendly – Open access on this paper. Lots of numbers but it will take time to sort out what is going on. The Nos are not simply displayed; particularly for calculating Hazard ratios etc.
I so agree Dr. Kendrick. I was on a fibrate. After years on this medication, my pharmacist told me that the fibrate could be causing leg pain and cramps. Sure enough when I read the attached information, leg pain was the number one side effect. The Pharmacist suggested I get my CPK levels checked. When I approached my GP with the information given by a professional, she checked the CPK levels, said in all caps that my CPK levels were normal. She agreed to take me off the fibrates. The next time I saw her my cholesterol was at 200 (again). She then warned me of my high cholesterol and put me on Simvastatin. I was told over and over again that I had a back injury and that the pain in my legs was “referred”. I could not for the life of me ever remember severe back pain nor any accident precipitating this constant leg pain. On Simvastatin, I felt worse but she was happy that my cholesterol was at 121. There I stayed in terrible pain for years on end thinking I was protected but wondering why it felt so bad to be in good health. This is why I am forever grateful to those who dared question the common belief system that vilified saturated fats, advocated low fat diets, cholesterol lowering drugs, and the diet-heart hypothesis. It has been a long time coming and a tough road ahead still. The first book I could really relate to was, in fact, Dr. Kendrick’s. For whatever reason (maybe the sense of humor or the no nonsense way in which he presented information) the puzzle started coming together. But whatever I have learned through all this, it is working for me. Have faith, do the right thing no matter the cost to self, since you have more people to care about other than the self.
Ray – full text (PDF) here: http://www.bmj.com/content/350/bmj.h2335.full.pdf+html
Here’s what you need to know – the objective was “To determine the association between use of lipid lowering drugs…” from thereon in you pretty much know where things are going.
Smoke n mirrors. BYO popcorn.
Ash, many thanks. Will read, digest and comment.
Ray
Ash
Thanks for the link. Most helpful.
At a quick look the 30% is relative. The real &age of treated individuals or NNT not given. Will come back when I have had time to do the sums but I am left wondering how much the authors benefited.
There does appear to be a correlation between lipid lowering drugs and strokes in the study, less so when only age and gender are adjusted for (I presume there are standard methodologies for this) and more so when a large cluster of other factors ranging from education through to stroke suspect conditions such as smoking are factored in. I’m new to this so instinctively feel I’d need to understand how these various factors are ‘adjusted’.
Interestingly there doesn’t seem to be as much comment on the apparent increase in CHD in users of the lipid lowering drugs, which in the simpler model pretty much offsets any apparent improvement due to lower stroke occurrence. Perhaps that’s why a second model was needed?
My lay take on the study suggests that there could well be an advantage for some elderly persons to use these drugs as a stroke reducing strategy, but currently it seems unclear who in the trial would have specifically benefitted. Whether the data is capable of identifying who might benefit, I’m not sure, but based on model 1 I would suggest giving statins to all in the age range will at best result in the same mortality rate but with a different spread of cause. That sounds a little like Russian Roulette to me.
I know not whether simvastatin use or ‘binning’ the prescribed tablets are going to increase or decrease my life span. Won’t know until I’ve shuffled off my mortal coils and then I’ll be past caring. But what I AM reasonably certain of is that the aforementioned money-spinning drug has left me with persistent carpal tunnel-like syndrome, and associated joint pain. Having said that, at least I can now indulge in the forbidden grapefruit for brekkies😀
Yes, Leigh.
I Stopped the statins……Re-introduced grapefruit.
I Stopped Metformin…….Re-introduced fresh ginger!
Chucked the marge……Re-introduced butter.
Dumped Chorleywood process bread…..not sure what to replace that with…so…….just leave it out! ( I indulge in making real sourdough, but that is not practicable for many people).
Forget the breakfast cereals…..make quick scrambled eggs.
Leave the potato crisps etc on the shelf……eat high fat raw nuts.
Disregard the skinny lattes…..enjoy a dollop of double cream.
What other drugs/pseudo foods, could be replaced with nature’s own products?
Why are the health ‘experts’ not promoting these wonderful foods?
Could it possibly be that if we indulged in these sensible foods, there would be less need to fill up on pills?
Jennifer, how right you are!!! Of course, think of all those who do provide healthy foods for consumption!!! They will be the ones who will benefit now from our hard earned dollars!!
As a frugal pensioner, I had been waiting for the price of ‘Doctoring Data’ to come down on Amazon. After reading these posts I gave in and bought it. You have my money, full price.
It is worth every penny! Fabulous!
Thank you so much Dr Kendrick – I have learnt so much from you over the last couple of years and am so glad that the wider public are also getting to see beyond the BS.
You have a well deserved mention in the Times today, hurrah!http://www.thetimes.co.uk/tto/opinion/columnists/article4449967.ece
Hi Will, Funny that we were talking about just this thing, this morning. Thought you might like a read. R
Sent from my iPad
>
If you look at the daily express front page over a few week/months they tell some medical lie almost every day. In fact they just seem to keep reusing old ones on a rota basis, unfortunately people some people actually think this is a newspaper.
They’re just hooks to pull people in, to get them to buy the paper. Unfortunately people have been induced to become morbidly obsessed with these headlines and tend to believe almost anything that allows them to escape these inferred outcomes. It empowers the health care industry, it enriches the pharma companies and sells newspapers, telling the truth would close all these avenues so it has to be resisted.
Is there a lawsuit or criminal investigation somewhere in here? Deception, fraud, conspiracy to sell dangerous products. Pretty close to organized crime.
re: I find it rare to come across a doctor who would ever deign do such a thing as read a scientific paper.
… particularly a nutrition paper, most of which, alas, are the intellectual equivalent of junk food.
In the case of the present [non-nutrition] paper, which appears to be pay-walled at BMJ, was there anything revealing in the funding sources and any author conflict revelations?
My husband had a TIA five years ago while on simvastatin. I developed T2 D eight years ago while on the same statin and while religiously following the recommended diet, (LFHC). So at the very least the statin did not prevent these things happening. My A1C has been normal since I started a HFLC way of eating, following Dr Bernstein’s advice, and we stopped the statin immediately, and, DV, we’re still here. That’s only two people, but I think this can be multiplied by thousands, maybe millions, who took their doctors’ advice on medications and diet. My doctor told me to continue the lowfathighcarb diet, but warned that however rigorously I followed the rules, I would be on metformin by the end of the year. Diabetes is always progressive, he said. Not for me, it wasn’t! I am still bullied to take statins and blood pressure lowering drugs every time I go for a check up. The poor doctors are in for trouble if they go on obeying the “guidelines”, while more and more people start making sense of the available information, thanks to people like Drs Kendrick, Ravnskov, Bernstein, Malhotra, Harcombe, etc. Bravo!
Another one-sided post quoting a single study. It is irrelevant whether cholesterol is a risk factor for stroke, what matters is that statins reduce the risk of stroke in well performed RCTs. It may well be a pleotropic effect of the drugs anyway, it doesn’t really matter.
Your reliance on a single study that did not show a reduction in cardiovascular disease must be weighed against the evidence that statins do reduce all cause mortality, major vascular events and revascularisations from a Cochrane systematic review (1). If you add that study to the SR there would still be an effect. This is called cherry-picking, you seem fond of it.
I’m not suggesting for one minute that the effect of statins is large. Quite the opposite, it is actually a very modest effect indeed and one that I wouldn’t bother with for myself. What is so irritating is that people who claim to understand evidence continue to bleat on whenever there is some inconsistent piece of evidence or some fact that doesn’t fit the theory perfectly.
The evidence is clear, statins reduce events compared to placebo in RCTs, whether for primary or secondary prevention. You either accept that or you might as well give up on EBM.
1 http://www.cochrane.org/CD004816/VASC_statins-for-the-primary-prevention-of-cardiovascular-disease
Yes, Tom, I am more than well aware of the Cochrane collaboration meta-analysis, entirely based on an analysis of data from the Cholesterol Triallists Collaboration (CTT) in Oxford. It has to be based on the CTT analysis becasue the CTT will not allow anyone else to review their statin data. When the Cochrane Collaboration from UBC (Prof Jim Wright) tried to get one of thier researchers to reveiw the data they were told it was confidential. Prior to the CTT review the Cochrane collaboration held the view that statins were of no benefit in primary prevention. Professor Abramson from Harvard has criticised the CTT analysis and the following Cochrane report in some detail. You may wish to read his papaer in the BMJ – as, of course, I have done.
You may also wish to know that the recent study in the BMJ was not just on statins, but also on fibrates. Perhaps you didn’t read the paper to pick this up?
I can be accused of many things. But not knowing the data? And, whilst I sort of believe in Evidence Based medicine, I find I cannot believe in Evidence Based Medicine where no-one, but those who have recieved £288 million in funding from the pharmaceutical industry, can see the evidence…. My feelings are that this is not evidence based medicine at all. Perhaps you could argue this in another way?
As you Malcolm I am a strong advocate of ‘science’ and as you I am strongly against the present evident abuse. It is just disgusting for me to see all this ‘dancing’ to the tune of corporate money.
organisations never hide evidence when it supports them. They suddenly believe in transparency.
Dr. Kendrick, thanks for mentioning fibrates and statins, for I was on both. Your blog was indeed another example of how ridiculous and outdated this mentality is. I begged for some reason I felt so terrible. Actually, I was diagnosed with PAD when I had a blue toe. My GP did not believe I had any blockages. All my testing including ultrasound and CT with contrast did not show anything. He put me on a fibrate since that was what he thought he should do at the time. He scratched his head. I had normal B/P, no history in the family, no high cholesterol (210-220 at the highest which I don’t believe was high), was not overweight, but did have a history of smoking. He sent me to a Rheumatologist to rule out auto-immune. I think he was smart in his approach. Within six months of using fibrates, I developed a blockage in the abdominal aorta confirmed by angiogram. Fibrates, too, in some people have terrible side effects. I was one of those. When I complained…I was put on Simvastatin. My cholesterol numbers plummeted to 121. I felt worse than ever. My GP still had a hard time believing I had a blockage for I was too young for this. Even the hospital personnel were shocked. Two years later, I had two more stents in the iliac arteries all AFTER INITIATION OF FIBRATES AND STATINS. I suffered chronic unabated pain for years on end. Finally, I took myself off all these medications (1.5 years ago) as by 2013, I was on so many, that I did not know left from right. The same goes for my own mother. All her vascular problems came about after Baycol and Simvastatin use for 12 years. She is but a shadow of her former self. Her abdominal aorta as Dr. Kendrick says is “knackered” (hardened plaque), she has dementia, congestive heart failure, trigger finger, carpal tunnel syndrome requiring surgery, cataracts, constant UTI’s, anemia, stroke, operation on her carotid arteries and too many other things to note. Prior to this, she had no health problems except for one incident of stable angina which went away with an Ativan at the hospital. From that day forward, she was put on statins. So, someone tell me how either Fibrates and Statins prevent vascular disease? I really want to know. I do think with all my heart that most vascular problems come from diet and smoking as well as stress. Those are the risk factors for most. Yet there may be so many other things we have yet to identify due to this close minded obsession our medical society has with cholesterol lowering. You cannot pill pop your way to good health, my friends. The answer is hiding in plain sight. BTW, I have had no further vascular problems since I got off the statins. NONE! I do feel better, but have residual problems. I feel like a pariah as I refused to take my Simvastatin any longer. But that is okay with me!!!
I’m guessing that evidence- based medicine does not usually include ad hominem attacks, Tom? To argue your case using words like ‘bleating’ is unnecessarily personal and offensive to those of us who want to evaluate and understand medical issues.
I was wondering why Tom’s near troll has not been removed, but realise that it is actually quite useful. I suspect there might be a “conflict of interest” going on here. Is Tom perhaps paid a retainer by a pharmaceutical company? If he actually read the evidence so pithily presented in Dr Kendrick’s books he would be unable to attack with any logic, let alone use words like “bleat”.
I don’t remove near trolls. I hope that I can engage in debate with everyone, and I do welcome criticism – although I do ask people to avoid personal insults, as they cannot be answered in any way. I try to aim for reasonably respectful debate, if possible.
RE: “It is irrelevant whether cholesterol is a risk factor for stroke, what matters is that statins reduce the risk of stroke in well performed RCTs. It may well be a pleotropic effect of the drugs anyway, it doesn’t really matter.” Truth matters, always, in science, in communicaions, in human dignity.
Have you actually read the report? The reality appears to be trivial with a very low probability of benefit for the individual patient. No mention about the NNT – but then this has every appearance of an infomercial
Tom,
I know researchers don’t like to think about actual patient experiences, because they might be nocebo effects, and anyway they are anecdotes. Conceivably they also don’t like to think about the harm that may be being done by some of these treatments. Nevertheless, I’ll tell you mine. It is a repeat of earlier comments I have made on this blog – so I appologise to regular readers – but I think you need to engage a bit more with reality.
I was given Simvastatin at age 60, purely as a preventative measure. I didn’t notice anything significant for 3 years, and I felt very positive towards the drug – thinking of it as a live longer pill! Then I suddenly got severe cramps and extra weakness in my right leg, which had been weakened by polio. Obviously I didn’t expect this was due to Simvastatin, I thought I was coming down with Post Polio Syndrome(PPS).
Fortunately I remembered reading that statins could cause muscle pains (which sounded much less extreme than my problem) so I thought it might be prudent to stop the Simvastatin while my problem was resolved. Soon my problem seemed to be fading away, so I simply restarted my live-longer pill, until about a week later, the symptoms began to return.
All in all, I stopped Simvastatin 3 times before the penny dropped that Simvastatin was actually the sole cause my problem, and it took a further 9 months to recover.
Of course, I thought my experience might be unusual because of polio, but talking to others my age, I soon discovered that many people have had bad experiences with statins, particularly crippling muscle/joint pains (which incidentally make it near impossible to exercise), and I know one individual who suffered both muscle and memory problems so severe that he has given up statins despite the fact that they were prescribed not for prevention, but because he has partially blocked arteries in the legs.
Those were real-life contacts, but on the internet I have talked to people who did not recover properly from statin poisoning – one man in particular, was fit and active, and now uses a wheel chair part of the time.
The insidious problem is that the two main Simvastatin side effects mimic some of the side effects of growing older – limb pains and memory loss – and I am sure there are people who have been poisoned by statins and are unknowingly still taking the drugs.
I’d also hazard a guess that people who get problems with previously damaged limbs of all sorts later in life, get told that it is very unfortunate, but their limb is just worn out (insert a better medical term here) and there is nothing that can be done!
My experience would suggest that weakened limbs are more likely to be affected by statins – but has there been any research done on this – I doubt it, because one official estimate is that statins only cause side effects at the 1 in 10000 level!
Where do you find a lot of immobile, forgetful people? – in care homes.
If you are in a care home you don’t usually get to decide what drugs to take – you are fed them by the staff. Please think about what we may be doing to some of these people.
Please wake up a bit and see what a multi-billion dollar pharmaceutical industry that has control over the RCT’s, can do to people’s lives.
David Bailey
It is an interesting personal ‘anecdote’ you give us.
Still, to me anecdotes, as yours, well adhere to ‘science’ especially when you suspect a cause and remove the suspected cause and find the ‘effect’ disappear and every time you repeat your ‘personal’ experiment. This, the cause and effect, is the kernel of science to me. That is also why I cry when I think of the RCT’s performed in the shadows of Big Pharma and where you will never see the hard data.
And you can add thousands of such anecdotes. e.g. my own, without rocking Big Pharma. They are per definition immune to anecdotes by internal vaccination! They rule the medical world and the know it!
just call your anecdote a ‘case history’. Then it has more power, though it is still the same thing. Almost every surgical intervention was introduced without a single clinical trial done, and the benefits are, in one sense, purely anecdotal. Should we stop all surgical procedures?
Goran,
I did indeed realise after the event that my starting and stopping Simvastatin was a pretty good scientific test – and indeed I was a scientist up to PhD level, many years ago. However, I can assure you that I only persevered with the statin so long because I didn’t think it could really be doing that to me!
I think the trouble with RCT’s and the whole EBM movement, is that it lowers the significance of actual case histories in assessing the safety and effectiveness of medicine. Unless a patient actually dies on a drug, the rest of the story gets lost, because it is assumed that the RCT’s provide quality evidence, so who cares about the patients – at least for research!
However, I think thee are several things that come from my experience that could be usefully researched:
1) Is it the case that statin side effects may be focused on one limb that has been damaged in some way? This interaction must make it harder to spot statin problems.
2) Just how long can it take for statin side effects to appear – mine took 3 years.
3) I did notice that my Simvastatin pills changed from brick red to white tablets shortly before things went wrong. Obviously I was getting the same amount of the same chemical, but I have wondered if the new tablets had a smaller grain size (say) and so dissolved better and delivered a somewhat larger effective dose.
4) Someone should research how to treat people with statin damage – because as we know, not everyone does recover properly.
David, this is precisely why I want my mother in my home. I do not want her taking statins under any circumstances. I think of your experience with Simvastatin when I see those who have already had some weakness in the body which gets worse on statins. Many people in the U.S. are getting sick and tired of feeling sick and tired…and they are stopping them.
David,
” Someone should research how to treat people with statin damage – because as we know, not everyone does recover properly.”
I am afraid that this will never happen.
Taking the immense proportions of this statin industry it is just so disgusting for me to understand the suffering of various severity which has been inflicted on all those innocent patients consulting their GP doctor.
What is left of trust in our society when you have come to realise the magnitude of this delusion?
Malcolm,
Keep on your fight against medical stupidity!
Well if you read the recent Japanese study published in April this year (link available in earlier blog from Doc Kendrick) the evidence shows reduced overall mortality with higher cholesterol levels. This seemed to be especially the case for older (>=66 yrs) men and women. I also believe there was no correlation between strokes and higher cholesterol found in those studies. So the earlier comment about conclusions from a single study seems inaccurate in that there appears to be ample evidence from multiple sources that prescribing statins are questionable at best and health harmful at worst.
I had seen the headlines and forced myself to read the gushing and nauseating article in the Daily Express, and hoped you would cover the subject. As you so often do, you have come up trumps.
Thank you for this very timely article.
Hey, great interview with Mercola. Congratulations.
Now you’ll get even more insults. The more you are trolled, the more you’ll be read.
If you are called a quack by the right persons, you earn a lot of respect among other more important persons.
Malcolm,
“A → B →C
A does not → C
Question. If A does not lead to C, how does A lead to B, then leading to C? I shall ask for this to become a question in the Oxford and Harvard entrance exams.”
I guess this isn’t logically impossible! For example:
A = Not washing for a week.
B=Losing your girlfriend
C=Finding a new girlfriend
A -> B and B -> C (at least sometimes) but A definitely does not produce C!
I.e. B->C, but only if it was not caused by A!
More to the point, how was this result obtained? It goes without saying that the 30% gain was a relative risk, but what else was going on?
What was the rationale for mixing fibrates and statins, since as I understand it, fibrates were found to be useless at preventing anything.
David
Many decades ago I did a regression on the association of the cement production of the Tororo (Uganda) with the rising population tsetse in Busoga some 30 miles away. Result – a highly significant correlation.
They were associated in a very round about way.
Increasing industry requires buildings and houses for workers hence more cement.
Increasing industry requires more workers who come from poor agricultural holdings such as tsetse infested land. in turn this leads to reduced human activity which is known to benefit tsetse populations.
In short the correlation is due to two independent associations.
A classic example of what Dr Kendrick and yourself are saying. However it seems to be difficult for many to conceive.
Why cant more doctors be like you, Doc Kendrick? It is absolutely absurd that so many are so brow-beaten to believe the Cholesterol/Heart Disease theory. How can these bright minds be so blinded by statistical manipulation? Thank you on behalf of ALL of us who have crappy doctors..
re: Why can’t more doctors be like you, Doc Kendrick?
It’s their training. Fundamentally, they are not trained to be skeptical independent investigators. They are instead indoctrinated with consensus views, which are heavily influenced by the pharmaceutical industry.
Key topics are basically not taught at all, principally diet and biome. I’ve written on the diet problem specifically (link from my user name here). It’s probably just as well that they get so little diet training, as what would be taught (what the dietitians suffer through) would be incorrect.
Well said crandreww1999. They are just “following orders” and it is not their fault as if they do not follow those orders, anyone can sue them. They are stuck between a rock and hard place, I do believe. But, the truth is coming out slowly but surely.
I remember seeing doctors when there appeared to be few, if any, guidelines. The problem is that doctors are probably prone to as much insanity and incompetence as the rest of the population. I saw one of the nutty ones in the late 70s because I wanted treatment for severe indigestion. This was at a university practice where I was a student. This doctor liked using students as guinea pigs for his pet theories. And his theory on indigestion was that you needed to flood the stomach with something alkaline so that the stomach could heal. On the basis of nothing except his personal theories I was given a prescription for two HUGE antacids to be taken every hour of every day for two weeks, for as long as I was awake. I lasted about 10 days (I think) before I started retching at the merest whiff of these peppermint flavoured things and gave them up. Some months later I mentioned this “treatment” to another doctor, completely unconnected with the university. She nearly fell off her chair and muttered something about sodium and potassium levels.
I hate doctors who keep me ill and use guidelines as an excuse for doing so, or for doing nothing. But I am also aware that guidelines give us some protection from the insane ones.
The press are starting to catch on to the US fat U-turn and its implications:
http://www.dailymail.co.uk/health/article-3096634/Why-butter-eggs-won-t-kill-Flawed-science-triggers-U-turn-cholesterol-fears.html
Quote:
London-based cardiologist Dr Aseem Malhotra, science director of campaign group Action On Sugar, wrote in the British Medical Journal that it was time to ‘bust the myth of the role of saturated fat in heart disease’.
He added that the food industry had effectively contributed to heart disease by lowering saturated fat levels in food and replacing it with sugar.
Matt Ridley, a Tory peer and science author, yesterday said there should be an inquiry ‘into how the medical and scientific profession made such an epic blunder’.
He described the change of advice in the US as a ‘mighty U-turn’ and said studies linking high cholesterol and saturated fat in food to heart disease were ‘tinged with scandal’.
End quote
I think that at last something is starting to hit the fan!
Aseem is a good man, I spent an hour with Matt Ridley over the weekend, taking him through some stuff. He is a powerful voice, and will have a lot of impact.
Well…..things surely must be moving now….being a mere human, I am impatient, and want the momentum to escalate at a greater pace of knots.
Dr Kendrick, you are a credit to your profession by dedicating so much time to this important topic. And well done for not biting when nasty pasties ( oh, the thought of a nice, crispy, home made pasty…..ahh, ), have a go at you. We get to see how we might respond to unpleasant comments, when feeling the need to justify LCHF to our peers.
Dr Kendrick
A quick check on the paper revealed the following:
Extract from BMJ 2015;350:h2335doi: 10.1136/bmj.h2335
“During a mean follow-up of 9.1 years, 732 first ever non-fatal (n=527) or fatal (n=205) cardiovascular events
were diagnosed: 440 coronary events (for a total follow-up of 60 869 person years) and 292 strokes (for a
total follow-up of 61 727 person years). Crude incidence rates per 100 person years were 0.72 for coronary events and 0.47 for stroke. Among stroke cases, 227 were ischaemic, 57 haemorrhagic, and eight undefined.
Increased risk of stroke or coronary heart disease was associated with classic risk factors: older age, male sex,
high blood pressure, diabetes, and high body mass index”
Probability of incidence of CHD per person year = 440/60869. “P” = 0.0072
Of which 205/732 were fatal = 28%
Probability of incidence of strokes per person year = 292/61727 “p” = 0.0047 of which 34% were “saved”; this gives a probability of benefit per person year of 0.001608
Conversely this gives a probability of NO BENEFIT per person year of p = 0.998 or, rounded to two decimal places, 1.00 or near certainty of no benefit.
Table 2 | Association between risk of vascular events and lipid lowering drug therapy!. Coronary heart disease or stroke using Hazard Ratios.
Where the Confidence Interval includes 1.0 it is reasonable to consider a “No Effect”
1 Coronary heart disease or stroke: No significant results for the combined statin/fibrate group.
2. Stroke The only comparison that shows a positive benefit was the combined statin/fibrategroup
3. Coronary heart disease† No significant result for CHD prevention Though this is what is generally claimed
Certainly not “evidence(???)” on which I would trust a drug to be of benefit but then I do not belong to the medical establishment.
Matt Ridley has made a great post on his blog re cholesterol. He says it was a Times article too but I am not about to subscribe to the Times to read it.
Since you asked about the “gap in logic”…
If A → B and B→ C, then A → C (in the math/logic way).
However, if A is positively correlated with B, and B is positively correlated with C, then A may or may not be positively correlated with C. There is however a lower limit to the (positive or negative) correlation that A and C can have (a fancy formula).
The cholesterol stuff is about correlations, no about hard implications.
They use this all the time: Saturated fat raises total (or LDL) cholesterol; raised cholesterol causes heart disease; therefore, saturated fat causes heart disease. Avoidance of saturated fat is built on ludicrous chains of “causation” like this one.
Somewhat off the main topic, but still in the same vein of Big Pharma screwing the people without any scruples at all. None.
My wife is currently in Atlanta, Ga (apparently, the allergy capital of the cosmos) where she has had a rough time breathing during the height of the pollen season. After one visit to a doctor who seemed unaware that bronchospasm may require bronchodilators, she only got worse on his prescription of, er antibiotics (despite clear phlegm) and antihistamines (that bit seemed sensible). She got worse, with wheeze and growing shortness of breath, so I ordered her to A&E with a demand for a full check up and just maybe a script for a salbutamol puffer (Ventolin) and possibly a combined long acting brochodilator and corticosteroid (salmeterol & fluticasone) marketed as Seretide in Oz…because, you know, she has occasional asthma.
Now I was aware that the bastards had put Ventolin back on patent in the US by patenting the new ozone friendly propellant gas and maybe even the puffer design or whatever, and that it was very expensive for an old medicine that has been off patent everywhere else for ages. I thought it was maybe $40 for a twin pack. Nope. Turns out they charge between $50 and $100 for ONE puffer (she got ONE and paid $58!). The kicker was the combination puffer…$180!!!!!!! We get a salbutamol generic for $4 and Seretide for $6 in Oz as generics as pensioners on the Pharmaceutical Benefits Scheme Not in the US…thousands of uninsured elderly asthma and COPD patients die in the US because they can’t afford to breath. Others band together to get some old fart to drive to Canada with a boot (trunk) load of prescriptions where they can buy them for peanuts.
Upshot was I express couriered her over some cheap “socialised medicine” from Australia. 😉
Read this and weep (from the New York Times, so it’s not like they don’t know they are being screwed):
..and by “screwed” I meant “murdered for money”. Grrrr.
Sean, when an article gets to the New York Times…I promise you, it will garner much attention. The NYT is read by everyone who still reads and is curious about the world around them. It is very liberal but the people of influence (from nearly every segment of that society), that is, almost have to read it. It is like the Sunday Mass Missal in the Catholic Church. You whisper enough in the right ears and things get done and changed sometimes more quickly than you can ever imagine.
I just looked at the article in the Express, and scrolled on down to the comments. It seems that readers are not, on the whole, hoodwinked by this screaming headline – thank heavens!!
Since I can’t leave things like, “BTW, if you can work this one out, then please feel free to let me know how it works. Exactly.” alone, please allow me to preface this with the proviso that correlation-based “raises your risk” statements are in the main bogey men meant to frighten children into compliance with an authority figure or attempts by frightened (adult) children to practice sympathetic magic. With that proviso out of the way, an exact explanation.
Studies, and consequently their risk factors, are all functions of time. (E.g., but backwards: no one claims that smoking raises your risk of developing cancer inn the 30-seconds afterwards.) All correlative studies are over some timeframe, and because research funding is almost as finite as patience, these timescales are far shorter than a human lifespan. Therefore, to properly announce a study, it should be something to the effect of “eating hamburgers for 3 years raises your risk of [whatever] within 5 years”. Non-correlative results should also be reported in the same way, “eating at least one steak per week for 2 years shows no correlation with growing more hair in the following year, in balding men over 65”. For convenience, I’ll denote this as A(5yr)→B, since most studies seem to look for the onset of the condition in the same period as whatever they’re trying to correlate it with (as if the time to look for not sleeping correlating with bad grades on tests is during bedtime, rather than when exams are given, but that’s another issue). Thus it is possible to have:
A(20yr)→B and B(10yr)→C, but also a study showing that A(10yr) ↛ C.
Or to write it out not symbolically, it is logically possible (quite a low bar) that 30 years of high cholesterol is correlated with stroke, but not 10 years of high cholesterol, and that if all of the cholesterol/stroke studies are in the 10 year range, than the correlation would only be detected by a combination of longer cholesterol/heart disease and heart disease/stroke correlative studies added together.
The premises I mentioned above are hogwash, of course, and it’s more than absurd to talk about correlations as other than the fodder for constructing/designing proper controlled experiments, but the logic above is, technically, valid. I have my suspicions that it was what the original people meant – neglecting conflicting data is much easier than considering a second dimension in a problem – but, well, quod erat demonstrandum; there is the thing we were to demonstrate.
In your article you said :
“Question. If A does not lead to C, how does A lead to B, then leading to C? I shall ask for this to become a question in the Oxford and Harvard entrance exams.
[BTW, if you can work this one out, then please feel free to let me know how it works. Exactly.]”
My thoughts would be…
If A leads to B, research may find this is because of reason X.
If B leads to C, research may find this is because of reason Y.
X and Y may cancel each other out, or negate each other in some way, or may be completely unrelated to each other. In this case A cannot lead to C. So, nobody can ever claim with certainty that A –> B –> C therefore A –> C.
I read this report a couple of weeks ago in Pulse and found a couple of doctors remarked on the non association between vascular events and lipid lowering. Hopefully more GP’s will have read that article and noticed that too: http://www.pulsetoday.co.uk/clinical/cardiovascular/statins-reduced-risk-of-stroke-by-30/20010000.article#.VWTUw0vzfLQ
Dear Dr Kendrick,
I am not a supporter of statins, and generally prefer my patients not to take them. My only concern is with things like plaque formation in the carotids throwing off emboli. What is the effect of statins on this plaque formation? Also I do recall seeing a paper that stated calcification in the wall of the arteries was associated with statin use too.
Many thanks
Statins increase NO synthesis and therefore may have significant anti thrombotic effects, which are probably beneficial. This, in my opinion, is how they work to reduce CV events
Dr Kendrick,
You may remember the following report:
The Lancet13 August 1988, Vol.332(8607):349–360, doi:10.1016/S0140-6736(88)92833-4
Originally published as Volume 2, Issue 8607
RANDOMISED TRIAL OF INTRAVENOUS STREPTOKINASE, ORAL ASPIRIN, BOTH, OR NEITHER AMONG 17 187 CASES OF SUSPECTED ACUTE MYOCARDIAL INFARCTION: ISIS-2
ISIS-2 (SECOND INTERNATIONAL STUDY OF INFARCT SURVIVAL)
COLLABORATIVE GROUP
The aspirin/streptokinase combination was very effective in early MI (HzR) Odds ratio 0.5707; CI from 0.4955 to 0.6573
and “p” = 5.30e-15
But this article has never been cited since publication in any journal according to Elsevier Ltd.
I wonder why.
No-one can any money why.
Robert, I have also read that about statins causing calcification in arterial walls. In my own experience with my mother, this I believe to be true. When I found out she has this calcification in her abdominal aorta, I thought…”My God, what have they done to my mother?” Statins are poisons and do not help the elderly. My mother was a vibrant 70 something women when started on statins. She has gone downhill ever since. It is a slow agonizing death, too. She has been tortured, bit by bit.
“Statins Linked to Diabetes and Complications in Healthy Adults” May 2015. A retrospective cohort study over 6.5 years.
Found:
“After adjustment for confounding factors — including the fact those who used statins had more visits with healthcare providers than nonusers — those who took statins still had an 85% higher risk of developing new-onset diabetes (odds ratio [OR], 1.85) and more than double the risk of diabetes with complications (OR, 2.53), as well as in increase in overweight/obesity (OR, 1.12) compared with those who didn’t take statins.”
You would think this would make the pro statin advocates jump a bit but no
“I think the risk/benefit ratio in people with diabetes and statins remains the same as it was before” WHAT??? and
“People who have diabetes who are on a statin should continue with the statin.…This increased risk of diabetes, to me, is not relevant to their reason for taking the statin,” WHAT??? again.
In the article above a pro statin advocate states “A one third reduction in stroke risk, if confirmed, could have an important effect on public health.”
I would counter ” An 85% increased risk of developing diabetes in a previously well population, could have an importnat effect on public health.”
This study just looked at diabetes and no other side effects.
A fixed delusion is a fixed delusion.
I saw this article, but cannot remember where. could you point me at it, and the ridiculous comments by the statinators.
http://www.medscape.com/viewarticle/845232?nlid=81709_1842&src=wnl_edit_medp_wir&uac=149972MJ&spon=17
and http://www.medscape.com/viewarticle/840884
I am not sure if you need to register to gain access. But I think it is free to medics.
thanks. I have access, cheers
Can’t statins raise blood pressure? I thought that was a significant risk factor for strokes. Which swiftly brings me to my next question. What sort of strokes are they preventing? I’ve been led to believe there are basically two kinds, hemorrhagic and ischemic. I can see how drugs that interfere with clotting might prevent the ischemic kind, but not sure how they could help with hemorrhagic strokes. In fact high blood pressure and reduced clotting seems like a recipe for more hemorrhagic strokes to me. Since I’m told hemorrhagic strokes are much more likely to do permanent damage, I’m wondering if the study makes the differences in the incidents of these types of stroke clear. Does it?
No… he said hastily. Pretty sure it does not. In fact, most strokes are unidentified. You cannot tell unless you do a brain scan which type of stroke it is. Though haemorrhagic tend to be worse, in general.
So I guess they might not give any indication of how fatal the strokes that did happen were?
Probably not.
I love science.
Dr. Kendrick, I just watched your interview with Dr. Mercola (whom I follow and greatly admire) and it was not only informative but entertaining as well. As you often mention your dear father when you begin to explain how you came to question the “authorities”, I often smile as I picture him ripping pages out of a text book. Apparently it made a huge impact on your way of thinking. I feel the same about my own father who said often “Don’t let them hit you upside the head with a psychology book, then pretend to know everything…many if not most of those professors are taught to indoctrinate you to their way of thinking, so don’t get caught up in that trap!” How right he was.
I think we all should give a hats off to Malcolm and also pay tribute to his dad who helped him become the man he is today!! We must often turn to the wisdom of our ancestors to find the strength to do what is right when others tuck tail and run. God Bless Mr. Kendrick who no doubt was a man of great wisdom!!!
Hear hear!
Blush
Can a PET scan determine the level of damage or the stage one is in from dementia or Alzheimer’s disease? I know they are so expensive, but I don’t see it being done that often. I do see CAT scans done, however. What’s the difference?
A PM examination is the only way to be certain that a: the person had Alzheimer’s and b: the extent. CAT scans are done to exclude other diagnoses.
So if I recall correctly Dr. Kendrick, if you have high blood pressure, that is a symptom, not the disease, correct? Would that not be a clue that something has gone on like what doctors call a “mini stroke”, or some other medical condition? I never had high B/P until I was in a lot of pain. They gave me B/P meds. I was on them for a long time. I don’t take them any longer and my B/P is fine. But, it was hard getting off them because your blood pressure will spike for a while.
I do not see how reducing cholesterol could affect haemorraghic stroke: ischaemic stroke perhaps. I seem to remember you raised this issue in the past.
So, in reality, when identifying “protective” associations with stroke it would seem necessary to identify the type. For example, warfarin would be more likely to be associated with haemorrhage than ischaemia. Otherwise it is necessary to define a mode of action that encompasses both events. None that I am aware of but then that is unlikely to deter the presentation of an ad hoc hypothesis based on no evidence!
Dear Malcolm
Could you please send me a copy of the BMJ article.
my best regards
thank you for your good work.
I don’t have the rights to send on BMJ articles, sorry. If I did so, they would not be happy.
A novel treatment for asthma or simply another income stream?
http://www.sciencedaily.com/releases/2015/05/150526084953.htm
I think this YouTube video is an interesting study on the truth about lying. And, it may very well tell us a lot about ourselves and personal relationships. It also explains what many here have discussed and that is…once you get into that mode of lying, it gets easier and easier and bothers your conscience less and less.
OT, but thought you might be interested:
http://io9.com/i-fooled-millions-into-thinking-chocolate-helps-weight-1707251800
Hi maryl@2015, how long before you blood pressure was ok after stopping the meds.
thanks.
Hi Carol, it was about one week. I bought a blood pressure cuff just to monitor it for that week. And, I have taken it several times since then. It is stable. But, I cannot speak for others. I suggest you get a B/P cuff or take it at the pharmacy if they have one.
Thanks.
Hi Malcolm, how does one go about convincing one’s elderly father that the statins he’s taking are slowly killing him?
Everytime I see my father he’s bereft of energy and generally weak. I try informing him that it’s his medication which leaves him like that, but he’s a stickler for Doctor’s orders.
Anyway, it’s great to see scientific scepticism alive and well in the 21st century. If only this could be transcribed into other areas of modern medical quackery too, such as ionising radiation for cancer treatment.
Perhaps just say that there would be no harm in taking a statin holiday for a couple of months. See how he feels. If no better, re-start. If much better, have a think.
Thanks for your advice. I’ll give that a try. I’ve suggested he take Ubiquinol before, but unless it’s coming from a Doctor he sadly doesn’t want to know.
Well. I am a doctor. He may obviously feel I am not a ‘proper’ doctor. Whatever one such may be.
Dr Kendrick,about your killer quote above, (the one from The Lancet ending “or ethnicity (Asian or non-Asian).3 [My bold]”.
I see that the next sentence in the original is: “However, because the types of the strokes were not centrally available, the lack of any overall relation might conceal a positive association with ischaemic stroke together with a negative association with haemorrhagic stroke”.
Believe me, I am not pursuing an academic point. I have just had a transitory ischaemic, I am being pressed to take statins, I don’t want to; I thought your post and Lancet quote conclusive. But the qualification looks on the face of it to be highly significant. How do you rate the import of that ‘however’ sentence? I ask in all goodwill.
I would draw your attention to the word ‘might’. Anything might be hidden in there, anything might not be. We don’t know. Having said this, my own view is that there is probable a difference between the two types of stroke with regard to cholesterol levels. What, of course, is interesting is that statins do reduce the (relative) risk of stroke. This cannot be anything to do with lowering cholesterol levels.
My poor father was on fibrates, was very proud of his super low cholesterol level, and then has a catastrophic haemorrhagic stroke. He had brain surgery but never fully recovered spending 10 miserable months on an acute hospital ward before finally dying. He became the “poor old bloke in the corner” that he used to talk about when he was in hospital for his other medical problems. It makes me angry when I see these claims published!
I share your pain and anger