The Misguided War on Cholesterol

I was recently sent this as a glaring example of 40 years of anti-cholesterol brainwashing.
An 85 year old woman was prescribed a high dose statin, had liver problems, and they 1.) Say it was just latent hepatitis, and 2.) Suggest rechallenge with Statins! *

It really saddens me to read reports of this kind. It violates every bit of common sense I ever acquired in my 23 years of family practice and runs antagonistic to everything I have learned in the past seven years from my own research and experience with statin side effects.

My two episodes of statin associated transient global amnesia in the year 2000 set my present course of researching the side effects of this class of drugs. Their potential for harm exceeds even my wildest expectations and to think how little of the truth has reached today's doctors.

I understand the brainwashing of the past 40 years because I was part of it, riding the anti-cholesterol bandwagon with all my peers, singing the same song to my patients about the dangers of eggs, whole milk and butter. Then I read Uffe Ravnskov's, The Cholesterol Myths, and Kilmer McCully's The Homocysteine Revolution and was finally freed of my oppressive mind-warp.

If we have learned anything these past few years it is that cholesterol appears irrelevant to atherosclerosis and increased cardiovascular risk. Only in the well-known familial hypercholesterolemia of genetic etiology do blood lipids add to the underlying problem. For the remaining 98% of those with the usual elevated cholesterol seen everyday, inflammation appears to be the cause suggesting treatment should be directed at this cause.

I have learned that statin drugs benefit cardiovascular disease risk and atherosclerosis by their powerful anti-inflammatory effect. Sure they reduce LDL cholesterol and for years that was confusing. Statins have a strong dual role and only their ability to reduce inflammation is relevant to the benefit they produce. So why were these doctors trying to reduce this 85 year old patient's cholesterol?

The next thing to emerge from the most recent decade of longitudinal studies is that older women, and especially 85 year old women, receive no benefit whatsoever from statin treatment unless heart disease is already present. So here we have a medical team trying to lower irrelevant cholesterol in a patient for whom there is no justification in the first place?

Then once having induced liver inflammation, perhaps the most common side effect of statins, especially in older people, this medical team found that because she had antibodies for Hepatitis C, that in itself was sufficient cause for liver inflammation to reassure everyone and justified their putting her back on the same statin, triggering yet another attack of liver inflammation.

Did I get this right? Is there something here I did not understand? Sadly, I shake my head for I understand too well how little about statin side effect are reported back to the doctors. Unless FDA corrects this oversight, it is likely that years will go by before doctors are fully informed. Meanwhile problems of this nature and much worse will continue.
*Acta Neurol Taiwan. 2007 Sep;16(3):163-7.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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