Are Statins Worth It? (Part 1)

**Michael Greger** (0:00)
Trying to stay healthy can seem like a full-time job sometimes, especially with all the conflicting information that's out there, but I'm here to make that job a little easier. Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger. Since there's benefit to getting our LDL cholesterol as low as possible, why aren't statin drugs prescribed for everyone? Here's our first story.
LDL cholesterol, also known as bad cholesterol, is unequivocally recognized as the principal driving force in the development of atherosclerotic cardiovascular disease, our leading cause of death. Over the decades, we have seen the guidelines shift to lower and lower LDL targets on the basis of clinical trials demonstrating that lower is better, starting in the 1980s with an LDL target of 130, then down to 100 in the 90s, and maybe down to 70 for those at really high risk, and then maybe even down to 55, 40, or 30 over the last decade. Those more recent targets might actually be closer to normal for the human species. Even after we learned to use tools so we could hunt, normal LDL has been in the 50 to 70 range. But today, the average in the Western world is more like 120 mg per deciliter. No wonder heart disease is our leading cause of death in men and women. Recently, guidelines started scrapping targets in favor of just pushing for LDL levels to be as low as possible because the lower the better. No threshold seems to exist below which LDL cholesterol lowering does not further reduce risk. When it comes to LDL, it's possible that lower is better for longer, even if you start out at low risk. The risk reduction of major vascular events is independent of the starting LDL cholesterol, meaning that even people starting out with an LDL under 80 had about the same relative risk reduction. So even if your LDL is quote unquote normal, even if other heart disease risk factors are considered optimal, it's considered of utmost importance to control it. So why not just put cholesterol-lowering drugs like statins in the drinking water like we do fluoride? Why aren't statins prescribed for everyone? Because of the downsides. There's the risk of side effects, plus the burden of having to take a pill every day for the rest of your life. So that's why these drugs are only recommended for people at relatively high risk of having a heart attack, for whom the pros of cholesterol lowering outweigh the cons of taking the drug. OK, but when it comes to LDL, if lower is better for longer, and the earlier the better, and the only reason we're not giving more drugs is the downsides, what if there were safe, simple side effect free solutions to lowering our cholesterol? For example, eating specific types of healthy foods every day?
Well, in that case, regardless if we're on drugs or not, shouldn't we utilize every safe, no downside strategy there is to get our LDL down as low as possible? Before I get to all those strategies, let's answer the on drugs or not question. According to the latest cholesterol clinical practice guidelines from the American Heart Association and the American College of Cardiology, the number one take-home message is a lifelong heart-healthy lifestyle. OK, but when do they also recommend drugs? If you've been diagnosed with heart disease, like if you already had a heart attack and are trying to prevent another one, then drugs are considered non-negotiable. OK, but what about primary prevention, meaning preventing that first heart attack? Well, if you have an LDL of 190 or more, then don't pass go, don't collect $200, go straight to statins. Similarly, if you're between 40 and 75 and have diabetes, then an LDL of even 70 gets you a statin recommendation. Now, if you don't have known cardiovascular disease or diabetes, and your LDL is between 70 and 190, then statins are generally recommended if your risk of having a cardiovascular event, like a heart attack or stroke, is 7.5% or more over the next 10 years. Even at a 10-year risk as low as 5%, a statin may be recommended if you have risk-enhancing factors such as high triglycerides or a bad family history.
And if you're in the intermediate risk category, where statins are recommended, but you're still on the fence, a coronary calcium scan imaging test can be done to help you decide.
How do you figure out what your 10-year risk is? In a previous video I did on the topic, I recommended three common risk calculators, but I have a new favorite, uprevent.com.
That's just the letter U, dash, prevent, prevent.com. It's free and endorsed by the European Society of Cardiology. Not only does it give you a 10-year risk estimate and a lifetime risk estimate, but it estimates how long you may have before the event, and best of all, you can then toggle various treatment options to see what may happen to your risk if you follow them, like what happens if you stop smoking, or increase your step count, or start a statin.