The Statinator Paradox
Pity the poor lipophobes and statinators. They’ve just taken another grievous wound to their favorite theory and haven’t even got sense enough to know it. In fact, not only do they not have sense enough to realize they’ve taken the hit, they’re actually crowing about it.
The current issue of the Journal of the American Medical Association (JAMA) has an article titled Trends in High Levels of Low-Density Lipoprotein Cholesterol in the United States, 1999-2006 that puts another major dent in whatever validity remains of the lipid hypothesis of heart disease.
I’m going to start categorizing the types of findings published in this paper under the rubric of The Statinator Paradox. I find it interesting that whenever scientists discover data that shows the opposite of what their hypotheses predict, they don’t conclude that their hypotheses might be wrong; instead they deem the contradiction a ‘paradox’ and bumble on ahead with their hypotheses intact.
The lipophobes hold the hypothesis dear that saturated fat causes heart disease. When the data began to surface that the French eat tons more saturated fat than do Americans yet suffer only a fraction of the heart attacks, the French Paradox was born. Nothing wrong with our hypothesis, it’s just those pesky French people who are somehow different. It’s a By God paradox, that’s what it is.
Same thing happened with the Spanish. Researchers looked at the food consumption data in Spain and discovered that Spaniards had been eating more meat, more cheese and more dairy while decreasing their consumption of sugar and other carbohydrate-rich foods over a 15-year period. And, lo and behold, during this same period, stroke and heart disease rates fell. Can’t be. Saturated fat causes all these things. But the data show… Thus came the Spanish Paradox.
Statinators and lipophobes believe with all their little fat-free hearts that LDL-cholesterol is bad and is the driving factor behind heart disease. So whenever I come upon data that gives the lie to this notion, I’m going to start calling it the Statinator Paradox.
This JAMA paper is a classic case of the Statinator Paradox.
Researchers using the NHANES data looked at the change in the prevalence of elevated LDL cholesterol and found that it fell substantially from 1999-2000 to 2005-2006. In a period of about six years the prevalence of high LDL cholesterol dropped by a third, which is a lot of drop in a fairly short period of time.
And since everyone knows that high LDL cholesterol causes heart disease, it should go without saying that during this same time period there occurred a significant decrease in the prevalence of heart disease. Right? Uh, well, no, not really. If anything, the prevalence of heart disease actually increased. But not to a statistically significant degree. So statistically there was no difference in the prevalence of heart disease during a time in which high LDL cholesterol levels were falling. But if high LDL cholestrol causes heart disease…? It’s the ol’ Statinator Paradox writ large.
It was fun reading this paper because a basically fairly simple project was cloaked in all the regalia of academia and academic speak.
It starts out with a great opening sentence that is a paragon of academic weaselry:
High total blood cholesterol is recognized as a major contributing factor for the initiation and progression of atherosclerosis.
Recognized? What does that mean?
I could substitute words in this sentence and come up with the following:
The policies of Barrack Obama are recognized as a major contributing factor in the initiation and progression of socialism in America.
What does that mean? Depends upon whom you say it to. If I were to shout this sentence at a Sarah Palin campaign event, I would be cheered loudly. If I said it at a Nancy Pelosi event, I would be tarred and feathered. Since the ‘truth’ of the sentence is a function of the bias of the person hearing it, it’s not a meaningful sentence. As written, the sentence doesn’t mean squat, which makes it perfect for academic writing.
The authors, I’m sure, are believers in the lipid hypothesis but just can’t muster the gumption to write ‘high total blood cholesterol IS a major contributing factor…’ Instead they use the word ‘recognized,’ which makes the sentence meaningless and lets them off the hook should the lipid hypothesis ever blow up in their faces.
In setting up the study, the researchers went through a lot of rigmarole to allocate subjects to three different categories depending upon their degree of risk for developing heart disease. In determining this risk, researchers used the Framingham risk equation, which relies to a great extent on cholesterol levels to allocate that risk. Which is strange since the Framingham Study has never shown elevated cholesterol to be a risk factor for heart disease.
Once subjects were divvied into these three groups, the researchers measured LDL-cholesterol levels and calculated what percentage of subjects in each group had high LDL-cholesterol levels. The threshold as to what was high varied as a function of the risk level of the group as a whole. The bar for what was high was lowest in the high risk group and highest in the low-risk group. In other words, if subjects had multiple risk factors, then an LDL-cholesterol level of anything over 100 mg/dl was considered ‘high,’ whereas in subjects in the lowest risk category, an LDL-cholesterol level over 160 was considered ‘high.’
Researchers calculated as a percentage the number of subjects who had high LDL-cholesterol in each risk group and did the calculations again six years later.
The weighted age-standardized prevalence of high LDL-C levels among all participants and among participants in each ATP III risk category decreased significantly during the study periods.
Which is what they were crowing about. Our therapy dramatically decreased the number of people at risk for heart disease.
But as for heart disease itself:
No significant changes were observed in the prevalence of CHD or CHD equivalents from 1999-2000 to 2005-2006.
So what did our researchers conclude from the fact that there were one third fewer people with high LDL-cholesterol yet there was no decrease in heart disease?
They concluded the obvious. There were still two thirds of people with LDL-cholesterol levels that were too high. And, no doubt, these people were not on statins.
Don’t believe me? Here it is in their own words.
However, our study found that almost two-thirds of participants who were at high risk for developing CHD within 10 years and who were eligible for lipid-lowering drugs were not receiving medication.
So, let me see if I’ve got this straight. This study shows no evidence that lowering LDL-cholesterol levels decreases the prevalence of heart disease. And what we conclude from this data is that we simply need to treat more people. Brilliant!
As I was reading this paper online, I got a bing alerting me that I had an email from Medscape bringing me the latest in mainstream medical thought. I opened the email and began scrolling through the various articles displayed when my eye fell on one titled “Lipids for Dummies.”
I clicked on it, and what opened was a video of a statinator of the deepest dye interviewing an alpha statinator about how to best deal with the risk of heart disease.
It was unbelievable.
Here in a short interview is everything that is wrong with mainstream medicine today. We have two influential doctors at the pinnacle of their academic and clinical prowess – no doubt on the payrolls of multiple pharmaceutical companies – who are absolutely full of themselves blathering on about expensive treatments that have no true scientific grounding. And their BS is being disseminated to practicing doctors everywhere. Instead of ‘Lipids for Dummies’ this interview should have been called Dummies for Statins.
Watch and just shake your head.
These guys aren’t really talking about reducing the risk for heart disease or early death; they’re discussing how to use extremely expensive medications that are not particularly benign to treat lab values. As I’ve written countless times, statins can quickly and effectively treat lab values, but there is little evidence they treat much else. So if you want to have lab values that are the envy of all your friends, statins are the way to go. But if you want to really reduce your risk for all-cause mortality, you might want to think twice before you sign up for a drug that will cost you (or your insurance company) $150-$250 per month, make your muscles ache, diminish your memory and cognition, and potentially croak your liver.
If you wonder who underwrites these kinds of interviews, take a look at the actual Medscape link in which the video is embedded. See if you, like Sherlock Holmes, can figure it out.
This link requires requires free registration.
(If I weren’t so pleased with a nice Sous Vide Supreme review we got today, this kind of nonsense would make me contemplate seppuku.)