Aug. 20 (Telegraph) -- We all know the mantra: high
cholesterol causes heart attacks, so foods high in saturated fats
which raise cholesterol should be avoided. We also know that by
the age of 40, as many as one in three of us will be taking
cholesterol-lowering drugs called statins, to reduce our risk of
coronary heart disease.
Now a controversial new documentary is questioning this
received wisdom. It asks whether the link between saturated fat
(found in foods like butter and cream), high cholesterol and
coronary heart disease is as straightforward as believed – and
warns that we mess with cholesterol levels at our peril. Statin
Nation: the Great Cholesterol Cover-Up, made by Justin Smith, a
former personal trainer at the BBC turned film director, includes
interviews with cardiologists and other specialists, yet it has
been widely attacked by others in the medical establishment as
“simplistic” and a “travesty”.
Smith’s film will be released as video on demand next month
and was “crowd funded” – made with money he raised from the
general public. In it, he asks why it is that, if high
cholesterol causes heart disease, cholesterol levels for men in
Britain are the 15th lowest among 45 countries in Europe – yet
Britain still has one of the highest levels of heart attacks. He
also queries why both men and women in the lowest social economic
group die of heart disease at far higher rates than their richer
peers, yet do not have higher cholesterol levels.
While the “bad” low-density lipoprotein (LDL) cholesterol is
widely blamed for clogging up the arteries and causing heart
attacks, doctors in the documentary argue that it is wrong to see
cholesterol (or saturated fats) as the villain of the piece. They
suggest that key to heart disease is initial damage to the artery
wall – and that cholesterol is one of the substances used to
effectively form a scab over the rupture, before the artery wall
grows over this again. “Essentially cholesterol is there to help
repair damage,” says Dr Malcolm Kendrick, a Scottish GP and
author of The Great Cholesterol Con. “It’s a bit like blaming
firemen for causing fires, because they are there when fires
break out.”
The film also claims a US study from 2009 showed that
patients with heart disease had lower levels of LDL cholesterol
than the general population, as did studies in Hawaii and
Austria. Yet, with statins pushed as the answer, the
cholesterol-lowering industry” is worth billions – the statin
Lipitor made $13 billion for Pfizer in 2010.
However, some experts have criticised the film for being
overly simplistic and failing to understand the clinical trials
it discusses. They argue that in every major study people with
higher blood cholesterol had higher rates of heart disease.
Prof Colin Baigent, whose team conducted the largest-ever
study reviewing evidence of the effect of statins published in
May, said Smith’s conclusions were a “travesty”.
“Apparent contradictions in the evidence are not what they
seem,” says Prof Baigent, a Medical Research Council scientist
based at Oxford University. “For example, when people get sick,
their livers make less cholesterol, so in some older people low
cholesterol is a sign of illness that may increase their risk of
death. Yet we also know that lowering cholesterol prevents heart
disease in older people. Both observations are entirely
consistent with cholesterol being a cause of heart disease.”
He also points out that, with many statins now out of patent
(the average course of statins costs the NHS £1.30 a month),
these drugs are cheap and cost-effective. Statins are currently
recommended for those who have a 20 per cent risk of heart
attack, but Baigent, whose team meta-analysed 27 randomised
controlled trials, concluded that even those at low risk of heart
disease could benefit from statins. Kausik Ray, professor of
cardiovascular disease prevention at St George’s Hospital,
London, is one expert who features in the film, but told The
Daily Telegraph that he disagreed with its conclusions.
“The film’s view is simplistic,” says Ray. “There is no
doubt that high cholesterol levels are related to coronary heart
disease.” Yet he points out that high cholesterol is only one
risk factor, with high blood pressure, smoking, diabetes, obesity
and family history also being key.
He also sympathises with the film’s message that statins
(now taken by seven million people in Britain) may not be the
answer to Britain’s heart disease problem and that healthy people
should not be “medicalised” – for example, by giving statins to
all those over 50. “Rather than doing that, I’d like to see
people encouraged to make lifestyle changes earlier in life –
stopping smoking, changing their diet, exercising more,” says
Ray. “If they do all that and they still appear to be at high
risk of heart disease or strokes, it’s at that point that we
should offer statins.”
www.statinnation.net

-0- Aug/20/2012 06:10 GMT