AHA Recommends Statins for the Poor, People Near Airports, and Everyone in the Southeastern US

Not really, but why not? The American Heart Association now recommends cholesterol-lowering drugs for people who don't necessarily have low cholesterol, just risk factors for heart disease. (1) What is a risk factor? It's something that is statistically associated with heart disease. Everyone say it with me: association is not the same as causation. Take a look at the map below:

Map from the Center for Disease Control.

Obviously, living in the southeastern US (or Appalachia) is a risk factor for heart disease. As my father says about most car accidents happening within a few miles of home, you'd better move away from there. But the whole population there can't move out west, and I don't want them bringing their sweet tea and hushpuppies and green and orange jello here. The obvious solution is to prescribe statins by ZIP code, right? That goes for people who live near airports, too.(2)

The AHA could get together with the IRS and doctors could prescribe statins by AGI (adjusted gross income). That's a joke, but something like that has actually been suggested by a professor at the University of California at Davis.

"Doctors could, for instance, moderately increase the dosage of cholesterol-lowering drugs to reflect the higher risk imposed by socioeconomic status," said [Peter] Franks, whose research focuses on addressing health-care disparities. "Changes like this would be easy to implement, and the benefits could be significant."(3)

Some things that can cause heart disease (they're not just risk factors) are small dense LDL, thyroid dysfunction, (4) smoking and diabetes(5). Why not work directly on those? An Associated Press article related a telling quote:

"It is practically impossible to find a large group of outside experts in the field [of heart disease] who have no relationships to industry," said Dr. George Mensah of the [National Heart, Lung and Blood Institute].(6) 

Those "relationships" to the pharmaceutical industry are financial: research grants, speaking fees, and swag.(7)

And the relationship between statin use and heart attack? In this study(8), statin use had no relationship to "primary events" (heart attack or cardiac death). Statin use and not dying? Dr. John Briffa recently reviewed a study by the Cleveland Clinic.

In this study, the researchers made this assessment over an 8-year period. Death rates over this time were not statistically lower in those taking statins compared to those who were not.(9)

He adds, ‘there was a trend toward’ are weasel words.

Statins and side effects? Michael Eades, a study wonk, writes,

Multiple studies have shown that taking statins does reduce both the incidence and severity of heart attacks. But these same studies don’t show any increase in longevity for those taking statins (other than the small benefit for men under 65 who have had heart attacks). Why. Statins simply trade one risk for another. Take them and you reduce the risk of a heart attack but increase your risk for cancer, diabetes, kidney failure, and side effects related to the drugs themselves. Many people die each year from statin-induced side effects. Despite what anyone may tell you, statins are not benign drugs.(10)

The push to get more people--80 million adults--sounds a lot like the new guidelines from 2001, when the experts tried to get 36 million Americans on statins.

In 2001, the Expert Panel on Detection, evaluation and Treatment of High Blood Cholesterol in Adults issued perhaps the most influential document in the history of modern American medicine. Written as part of the National Cholesterol Education Program, the updated guidelines incorporated the findings of the most recent clinical trials into concise recommendations designed to assist doctors in reducing their patients' risk of developing coronary heart disease (CHD). The recommendations are bold and offer the tantalizing hope that coronary heart disease in all but the very old will become a far less common occurrence. This goal can be reached, according to the guidelines, by increasing the number of Americans taking statin drugs, from 13 million to 36 million....

The excitement generated by these new guidelines was unprecedented. Dr. Claude Lenfant, the director of the National Heart, Lung and Blood Institute, under whose auspices the NCEP does its work, told the New York Times that if the new guidelines were followed, coronary heart disease "would no longer be the number one killer [in the United States]."(11)

Peter Wehrwein estimates that as of 2011, around 32 million Americans were taking a statin.(12) And yet heart disease is still the number one cause of death in the US.(13) It didn't work out, but the idea is so bold an tantalizing, and the pharma people are so nice. And since people are getting wise to the fact that cholesterol is a necessary hormone, which your body doesn't make in order to self-destruct, the experts are scurrying away from the idea of lowering it. Besides, they can get so many more people on medication if they decide on lower-risk risk factors.

1. "Do you need to take statins to lower your cholesterol level?" by Ashley Hayes. November 13, 2013. CNN.com.   http://www.cnn.com/2013/11 /13/health/cholesterol-risk/
2. "People Who Live Near Airports At Increased Risk For Cardiovascular Disease" by Larry Huston. October 8, 2013. Forbes.com. http://www.forbes.com/sites/larryhusten/2013/10/08/people-who-live-near-airports-at-increased-risk-for-cardiovascular-disease/
3. "Lower socioeconomic status linked with heart disease despite improvements in other risk factors." August 26, 2011. http://www.ucdmc.ucdavis.edu/publish/news/newsroom/5660
4. "What tests are MORE important than cholesterol?" by William Davis MD. May 12, 2013. http://blog.trackyourplaque.com/2013/05/what-tests-are-more-important-than-cholesterol.html
5. "Insight into Why A1c Correlates So Strongly with Heart Attack" by Jenny Ruhl. May 28, 2011. http://diabetesupdate.blogspot.com/2011/05/insight-into-why-a1c-correlates-so.html
6. "U.S. doctors urge wider use of cholesterol drugs" by Marilynn Marchione. DenverPost.com. November 13, 2013. http://www.denverpost.com/nationworld/ci_24511181/u-s-doctors-urge-wider-use-cholesterol-drugs
7. Overdosed America by John Abramson MD. Harper Collins, 2004.
8. "Cardiac Outcomes After Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes" by Lawrence H. Young, MD; Frans J. Th. Wackers, MD, PhD; Deborah A. Chyun, MSN, PhD; Janice A. Davey, MSN; Eugene J. Barrett, MD; Raymond Taillefer, MD; Gary V. Heller, MD, PhD; Ami E. Iskandrian, MD; Steven D. Wittlin, MD; Neil Filipchuk, MD; Robert E. Ratner, MD; Silvio E. Inzucchi, MD; for the DIAD Investigator. April 15, 2009. JAMA. 2009;301(15):1547-1555. doi:10.1001/jama.2009.476. http://jama.jamanetwork.com/article.aspx?articleid=183751
9. "Doctors can help you get back on your statins, but does this help you?" by John Briffa MD. September 13, 2013. http://www.drbriffa.com/2013/09/13/doctors-can-help-you-get-back-on-your-statins-but-does-this-help-you/
10. "Statins: Not for everyone…maybe not for anyone" by Michael Eades, MD. October 31, 2013. http://www.proteinpower.com/drmike/statins/statins-everyone-maybe-anyone/
11. Overdosed America, pages 129-130.
12.  "Statin use is up, cholesterol levels are down: Are Americans’ hearts benefiting?" by Peter Wehrwein. April 15, 2011. http://www.health.harvard.edu/blog/statin-use-is-up-cholesterol-levels-are-down-are-americans-hearts-benefiting-201104151518
13. "Leading Causes of Death." CDC website. 2011. http://www.cdc.gov/nchs/fastats/lcod.htm