Malcom Kendrick, M.D. - Questions and Answers
Newsletter readers were invited to submit some general questions on heart health. Here are the questions with the answers from Dr. Malcolm Kendrick, M.D.
Dr. Kendrick has worked in family practice for almost twenty years. He has specialized in heart disease and set up the online educational website for the European Society of Cardiology. He is a peer-reviewer for the British Medical Journal.
Dr Kendrick is the author of The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It.
Question 1. I would like to ask Dr Kendrick a question. I have read his book where he has already explained the HPA axis ( hypothalamic-pituitary-adrenal axis ) concept of stress. I think that many people associate heart attacks with stress and his explanation contributes positive evidence to that belief. How would someone respond to being left alone after 48 years of married life?
Dr. Kendrick: The answer is, I am afraid, complicated. People react to things in different ways, so while one person may be devastated by being left alone, another may see an opportunity to forge a new life. Stress, as I see it, can be positive, or negative. And reactions to different stressor(s) can be positive or negative. If the person who is left alone feels powerless, lacking in support and loses an important social support mechanism that has kept them going for 48 years, the stress will inevitably be highly damaging.
Question 2. I recently learned that depression in men is different than women, that a man can have anger, hostility & aggression whereas a woman is sad with loss of interest in things. Is there a gender difference in heart attack risk due to depression?
Dr. Kendrick: I believe that the different rates of heart disease between men and women (especially younger women), can be explained by the different ways that men and women deal with 'stressors' and also by the strength (or lack of it) in men's social networks. Men, I think, do tend to react more aggressively to situations that women may be able to cope with better. This can drive them into depression and anxiety and therefore disrupt the neurohormonal system in a terribly destructive way.
Question 3. I have read that inflammation could also be the reason for strokes as well as the furring of arteries. I would like to find the source of high blood pressure and how to gauge whether one person's blood pressure is fine whilst for another, the same would cause problems.
Dr. Kendrick: I think that, in most cases, raised blood pressure is caused by an increased sympathetic tone. That is, an increase in the long term activation of the 'fight or flight' reaction, or what I would call 'chronic negative hpa-axis activation'. Any degree of raised blood pressure is an indication of an underlying physiological problem, and does raise the risk of stroke. I believe that inflammation is a secondary reaction, driven by an underlying problem with the immune system which is also directly influenced by the sympathetic nervous system.
Question 4. If you take cholesterol drugs you have blood tests that can show liver problems. Are other organs affected?
Dr. Kendrick: Cholesterol drugs, including statins, all interfere with liver function to a greater or lesser degree. Some people have an immediate and severe reaction, in others it is milder. There is some evidence that, over time, liver damage will worsen. Other organs such as muscle, the brain, all nerve cells, the lungs, the pancreas etc. can all be damaged by statins.
Question 5. You have written about the direct connection between heart disease and stress. If someone in a high stress job takes a different career path with less stress but also much lower income, would the financial stress wipe out the job change benefits?
Dr. Kendrick: As with all types of potentially negative stressors, the effects depend very much on the individual. If loss of income leads to loss of status, loss of social support networks, worry about the future etc. then the financial stresses may well wipe out job change benefits. As with all discussions on 'stress' you have to look at the individual and measure their physiological reaction. I would tend to advise that people need to look at the things that are most important to them (honestly) before making decisions that could be harmful.
Question 6. Please explain the pros/cons in long-term statin use and how do you use statins in your office?
Dr. Kendrick: In my opinion the likely damage/side-effects of statins outweigh benefits in all but a small minority of people. Namely those (men) who have very high risk of cardiovascular disease (CVD) - by which I mean men who already have diagnosed CVD. I can see no benefit in women, or in men without pre-existing diagnosed CVD. Even in men with pre-existing CVD, if they suffer side-effects then they should stop taking the statin as any benefit will be cancelled out by the long-term loss of quality of life.
In general in my day to day practice, I take people off statins - and try to reassure them that they are not going to drop dead within five minutes. Very occasionally I start statins, but I try to use a low dose to minimize side-effects.
Question 7. What is the best way to eliminate the need for cholesterol medicine in a male, age 76, who also takes blood pressure medicine?
Dr. Kendrick: There is no need to take cholesterol medication aged 76. There is no clinical study data to support doing this, and it is most likely that, at this age, you will suffer significant and highly debilitating side-effects. Also, remember that in the elderly population, the higher the cholesterol level, the longer you will be expected to live.
Question 8. From reading message-boards all over the internet it seems that many people have been negatively impacted by taking statins. Is it because of the high number of people taking statins or are the side effects more likely with statins than other drugs?
Dr. Kendrick: Obviously, there are a very large number of people taking statins, so there will be a large number with side-effects. I think that the reported number is only the smallest tip of a huge iceberg. Personally I see at least one new person a week with clear statin related side effects. That is over fifty a year. If every GP saw this many it would be five million in the USA alone each year. However, doctors are very reluctant to accept that statins cause any problems at all, so they are keen to dismiss any reported side-effects.
In my view statins add fifteen years to your life. By this I do not mean you live fifteen years longer. I mean that they make you feel fifteen years older. This is a direct effect of their actions on reducing energy production in all cells throughout the body.
Question 9. Is mainstream medicine finally paying attention to the dangers some people have with taking statin drugs?
Dr. Kendrick: I wish it were so, but such is the cognitive dissonance and confirmation bias present within the medical profession that I sometimes wonder what it would take to get doctors to admit there may be a problem. It is estimated that Vioxx® killed around one hundred thousand people in less than five years and no-one noticed a thing, until a whistleblower in the National Institutes of Health ( NIH ) pointed out what was happening.
In my opinion statins are destroying the lives of countless people around the world. Via e-mail and other channels I hear heart-rending stories almost every day, and in each case the doctors dismissed the possibility that statins could possibly be the problem - out of hand. If I had a pound ( I live in the UK ) for every time I have heard the phrase 'statins don't do that' I could have written off the national debt by now.
Dr. Malcolm Kendrick (MbChB MRCGP) M.D.
Dr. Kendrick has worked in family practice for almost twenty years.
He has specialized in heart disease and set up the online educational website for the European Society of Cardiology.
He is a peer-reviewer for the British Medical Journal.