Dr. Duane Graveline - Questions and Answers
Newsletter readers were invited to submit some general questions on cholesterol and statins. Here are the questions with answers from Dr. Graveline.
Dr. Graveline is the author of Lipitor®, Thief of Memory; Statin Drugs, Side Effects and The Misguided War on Cholesterol; and The Statin Damage Crisis.
Question 1: You have written extensively about the side effects of statin drugs. Does this mean that you are against the use of statins?
Dr Graveline: My focus on telling statin users and doctors about the true side effect profile of statins originated when I experienced for myself the cognitive side effect of statins known as transient global amnesia.
When my write-up of my statin experience was published in the media, the result was a flood of statin adverse reports to me from thousands of other statin victims. On comparing my own statin ADRs ( adverse drug reactions ) with those of the FDA's Medwatch, I soon realized that serious discrepancies existed between my information and what the FDA was saying about the various statins.
One of the first major discrepancies was that of reporting statin associated amnesias of the transient global amnesia type. In 2008 I obtained raw data from Medwatch and counted my own transient global amnesia cases finding 662 reported from the period 1998 thru 2005.
The entire reason for Medwatch is to monitor these post-marketing ADRs and for reporting to doctors discrepancies from pre-marketing expectations. Transient global amnesia (TGA) was not even mentioned prior to 2000.
Another instance of major discrepancy is in the reporting of cases of ALS-like neuromuscular degeneration associated with statin use. By 2006 I had nearly 100 reports of this malady, sufficient to prompt me to join hands with The People's Pharmacy® to try to identify the true incidence.
Joe Graedon of The People's Pharmacy® and I previously had used his syndicated column to find out the true incidence of transient global amnesia back in1999 when nearly every doctor in the United States was saying that "statins did not do that."
We found nearly thirty TGA cases within a few weeks along with hundreds of reports of statin associated confusion, disorientation and forgetfulness from people having no awareness that statin drugs could be causing this.
The People's Pharmacy® set up an ALS reporting system for their 22 million readers, which has resulted in hundreds of additional cases of this ALS-like condition along with cases where the diagnosis was highly suggestive and hundreds of cases of non specific myopathies.
But despite my efforts to tell the truth about statin ADRs, my studies have led me to the conclusion that statins do modestly help reduce cardiovascular risk via their anti-inflammatory role. So I am not against the use of statins entirely, but I believe that very low doses can provide this benefit, not the cholesterol busting doses.
Atherosclerosis is an inflammatory process, LDL cholesterol reduction is irrelevant. Our misguided focus on cholesterol has led us to higher and higher statin doses with more and more ADRs resulting from the inevitable mevalonate blockade.
CoQ10 must be administered at the beginning of statin treatment and it still needs to be determined what the proper dose level for inflammation suppression is. I doubt this low dose statin approach will be associated with significant ADRs from mevalonate blockade yet should give significant anti-inflammation.
Question 2: You are retired now but if you were still a practicing physician, under what circumstances, if any, would you prescribe a statin?
Dr Graveline: I would recommend that all high-risk people consider low dose statins. High risk for me means personal history of stroke or heart attack or family history of premature cardiovascular disease.
Question 3: Some experts say that statins are safe enough to add to the water supply, others say that they are poison. What do you think?
Dr Graveline: As long as statins are prescribed to lower cholesterol through the existing mechanism of mevalonate blockade they will be toxic to many. I have no doubt that most of these thousands of statin damaged victims would consider they have been "poisoned".
Only if statins are prescribed for inflammation suppression, using dosages having no significant effect on the mevalonate pathway, such as those I have discussed for low dose therapy, will they deserve to be used broadly.
Question 4: You have called it "The Misguided War on Cholesterol" in your books. What do you mean by that?
Dr Graveline: Back in the mid-1950s cholesterol, excess weight, sedentary life style, high blood pressure and smoking all were considered as "associated" with cardiovascular risk. Abruptly, with the erroneous work of Ancel Keyes, cholesterol became "causative".
The powers that be desperately needed a number, any number, on which to focus their cardiovascular risk reduction efforts. By choosing cholesterol everybody won - the drug companies, the food industry, doctors and even the patients who were promised a few extra years. The only problem is that cholesterol now appears to be irrelevant to atherosclerosis.
Question 5: Why do you think it is important to take CoQ10 if you are on a statin?
Dr Graveline: CoQ10 has both structural and functional roles in our mitochondria. Because of the inevitable mevalonate blockade by these reductase inhibitors, CoQ10 synthesis is affected early on, at the very beginning of statin therapy, so it must be co-administered with the statin.
Once mitochondrial damage has occurred there is no significant opportunity for CoQ10 to make a difference. Even Merck could foresee problems early on when they filed for a patent application for their combined CoQ10 / statin pill citing "for the inflammation to come" to the patent office for justification. The patents were granted in May 1990.
Question 6: Why does the current treatment for high blood pressure seem to require 2-3 medications for a lot of people when in years gone by it seems only one medication was adequate?
Dr Graveline: There has been considerable concern voiced over today's upper acceptable blood pressure of 120/80 mmHg seen in many medical offices today. Most say the documentation for this is entirely lacking and the only target blood pressure fully justified by clinical research is 140/90mmHg in vogue some two decades ago.
Therefore, in my opinion, doctors who are medicating to 120/80 are doing so without medical justification. Most doctors will allow some increase of systolic for age in line with the normal trend for increased rigidity with time, adding 10 systolic for every decade of age above 50. This means a 70-year old person would be allowed 160/90 and an 80-year old person would be allowed 170/90 before treatment is initiated.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Updated July 2016