Do Statins Really Prevent Heart Attacks?

The following excerpt is from Justin Smith’s book Statin Nation: The Ill-Founded War on Cholesterol, What Really Causes Heart Disease, and the Truth About the Most Overprescribed Drug in the World(Chelsea Green, 2018) .

Heart disease is caused by the complex interaction of a large number of factors associated with the stress response, nutrition, lifestyle, the immune system, and the environment. Not only do all of these categories interact, but the importance of each category varies greatly between different people. For example, one person’s heart attack could be caused primarily by psychological stress, which predisposed that person to infection. Another person’s heart attack could be caused by a combination of nutritional deficiencies and high blood glucose levels.

Taking a cholesterol-lowering statin medication offers very little protection against any of the real causes of heart attacks. The data from statin clinical trials predicts that statins could prevent a heart attack for around 1.6 percent of people who take the medication over a five-year time period. But we must also keep in mind that although this data comes mostly from randomized clinical trials, these trials have inherent weaknesses.

The populations used in clinical trials are selected, and the trial procedure involves a “run-in period” during which large numbers of trial participants can be excluded from the final analysis, for a variety of reasons decided by the researchers. The trial itself can be designed in a way that is more likely to result in a positive result for the medication being tested, and the final published report is written by statisticians and professional writers who work for the company sponsoring the trial. Overall, it could be argued that clinical trial reports do not accurately represent the real-life populations who are expected to take the medications. In fact, when researchers look retrospectively at the benefits of statins, statins appear to be having no positive impact. 

HOW TO PREVENT HEART DISEASE

In order to prevent heart disease and heart attacks, one of the most important factors to consider is nutrition. Nutrition can be incredibly complicated, with nutritionists offering many conflicting viewpoints and opinions. In addition, as individuals we have precise individual nutritional requirements. However, in general, the basis of cardio-protective nutrition can be quite straightforward.

Animal based proteins (meat, fish, seafood, poultry, and eggs) provide the best nutritional source for vitamins A, D, B1, B2, B3, B6, B12, pantothenic acid, biotin, coenzyme Q10, and saturated fatty acids, but these foods do not contain vitamin C, which humans need to consume every day. Vitamin C is provided by vegetables and fruit. Potassium, another important nutrient for the heart, is also obtained from vegetables. Therefore, ideally, humans should consume both animal- and plant-based foods every day.

Vegetables should be the main carbohydrate that is consumed, since vegetables do not cause the same dramatic fluctuations in blood glucose as other carbohydrates. In particular, there is evidence that cruciferous vegetables are particularly good for the heart.

There is currently a raging debate about the nutritional adequacy of a vegetarian diet. If the animal proteins that are consumed largely consist of factory-farmed animals that are routinely injected with hormones and antibiotics and fed foods that they were not designed to eat (such as cows being fed grain instead of grass), then there is a strong argument to be made for a vegetarian diet being healthier, but it is not because of the fat or cholesterol content of animal-based foods.

Meat, poultry, and eggs from organic farms, and wild fish and seafood (not withstanding the way humans have polluted the oceans) are highly nutritious and cardio-protective.

And of course there are a number of possible compromises, such as following a largely vegetarian diet that includes fish and eggs. Whether or not a vegetarian diet supplies all of the required nutrients depends on the individual person and their lifestyle.

It is also a good idea to consume fermented foods whenever possible. “Fermented” simply means that the food is left to sit until the sugars and carbohydrates convert into health-promoting bacteria. Fermented foods could support the digestive system and the immune system, and they also contain vitamin K2, which helps calcium enter into the bones where it is needed and, in theory, can help to keep calcium away from the coronary arteries where it might otherwise accumulate and cause hardening and stiffening.

There is a great opportunity for the future of heart disease prevention to be based on a more integrated approach that considers a wide range of the real causes of heart disease and that is tailored to the individual person. Studies have shown a number of nutritional interventions to be superior to statins in both efficacy and the safety profile. Redirecting resources to these areas and stress management is highly likely to be of much greater benefit to society than the continuation of the prescription of statin medication en masse.