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Keep taking the statins |
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Keep taking the statins
Publication: Times 2
Date: 26 January 2007
DR THOMAS STUTTAFORD
If people at risk of strokes and heart attacks throw away their statins, many will die
As this is the season for strokes and heart attacks, as well as frosty mornings, all those who know they are at risk should consider, then reject, the opinions expressed recently by Dr Malcolm Kendrick on statins.
If extracts from his book fairly reflect his beliefs, then he seeks to persuade people to abandon statins and have a high-fat diet. If followed, this advice could cause a public health disaster to make the damage done by the MMR vaccinations debate seem as nothing. Dr Kendrick’s book apparently rebuts internationally accepted teaching — and the sheaves of scientific papers to support it — that statins have revolutionised the life expectancy of people in danger of a coronary thrombosis or an ischaemic stroke. The latter, the most common form of stroke, is caused by a clot in a cerebral blood vessel.
Dr Kendrick apparently denies a relevant relationship between high levels of low-density lipoprotein cholesterol and triglycerides — two of the fats circulating in the blood — and heart attacks and strokes. He suggests that doctors should tell patients that fighting cholesterol with statins is bunk.
He extends his case by suggesting that doctors should recommend a high-fat diet, including as much saturated animal fats as desired, for it doesn’t matter a damn. The book is reported as suggesting that the protection statins offer is so small as to be insignificant, and anyway applies only to men.
In fact women with atherosclerotic heart disease are undertreated. Too often early symptoms of heart disease, less obvious in women, are either ignored or misinterpreted. Currently women also respond less well to treatment, but this is improving. One problem has been the patronising belief that all older women put on weight and, in consequence, have raised cholesterol and blood pressure. As this is a gender effect, the argument runs, women need neither statins nor intensive treatment for blood pressure.
Yet post-menopausal women’s risk of death from cardiovascular disease is as great, if not greater, than men’s. Furthermore, scans of arteries of patients before and after treatment with statins demonstrate both the increase in diameter of previously furred-up arteries, and reduced cholesterol levels. The level of high-density, cardioprotective “good” cholesterol increases, while levels of the damaging forms — low-density cholesterol and triglycerides — fall. Recent work at the DeBakey Heart Centre in Houston, Texas, suggests that statins also reduce harmful inflammation in the arteries that may precipitate rupture of a fatty arterial plaque and cause a coronary thrombosis.
When the Medical Research Council in Oxford and the University of Sydney reviewed the case histories of 90,000 patients who had been treated with statins, they concluded that the risk of a heart attack or ischaemic stroke was reduced by about a third. The benefits started immediately and increased the longer statins were taken and the farther cholesterol levels fell. The survey also revealed that although statins are especially valuable to those at high risk of a heart attack or stroke, they are also cardioprotective for people whose cholesterol levels would previously have been considered normal.
The National Institute for Health and Clinical Excellence (NICE), not noted for expressing hasty or extravagant views, supports the greater use of statins. We, doctors and patients, should follow its advice and ignore that of Dr Kendrick.
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