About 40 million adults in the United States take statins regularly to lower their cholesterol levels and reduce the risk of heart disease and stroke, according to 2020 American Heart Association data.
However, not many of them benefit from these drugs based on new research by David Diamond, a neuroscientist and cardiovascular disease researcher in the University of South Florida’s Department of Psychology.
Diamond and colleagues reviewed the literature from clinical trials involving patients taking either a statin or a placebo. Then they narrowed their review to consider study participants who had elevated levels of low-density lipoprotein (LDL), or “bad” cholesterol, which can be reduced with statins. Some individuals with a high LDL level also have high triglycerides (blood fats) and low high-density lipoprotein (HDL), the “good cholesterol,” which makes them more likely to have a heart attack.
But others with high LDL were very different. They have lower triglycerides and higher HDL, which means they are healthier. People with optimal levels of triglycerides and HDL typically exercise, experience low blood pressure and low blood sugar, and are at low risk of a heart attack.
Diamond and colleagues asked two questions: If people have low heart attack risk based on having optimal triglycerides and HDL, but also have high LDL, does this increase their risk? Furthermore, would these people benefit from lowering their LDL level with statins?
Their findings, published in the journal Current Opinion in Endocrinology, Diabetes and Obesity, showed that LDL alone has a “very weak association” with heart disease and stroke. The review went even further, showing that when people with high LDL, optimal triglycerides and HDL were given a statin, there was no benefit.
Diamond put the findings in the context of diet and lifestyle.
People who are not overweight, who have low blood sugar, who exercise and who follow a low-carb diet usually have optimal triglycerides and HDL, and sometimes high LDL. Our findings show that people with this healthy combination of diet and lifestyle, in addition to a high LDL level, showed no benefit from taking statins.”
David Diamond, neuroscientist and cardiovascular disease researcher, Department of Psychology, University of South Florida
The authors say their review also challenges the long-standing claim that low-carb diets, often high in saturated (animal) fats, contribute to heart disease. This controversy has been going on for nearly 50 years, dating back to the time cardiologist Robert Atkins was challenged about the potential dangers of his high-fat Atkins diet before the US Senate Subcommittee on Nutrition and Human Needs in 1973.
“High blood pressure, obesity, smoking and high blood sugar are the main drivers of heart disease,” Diamond said. “Cholesterol is an innocent bystander, and saturated fats in the diet are undeservedly demonized.”
Diamond acknowledges that his research is controversial and has led to strong support, along with criticism from some within the medical community who have challenged his views on LDL and statins. He cautions that the goal is to raise awareness and should not be considered medical advice.
Diamond’s interest in the association between LDL cholesterol and the risk of heart disease and stroke is personal.
About 25 years ago, he was overweight and was diagnosed with high triglycerides and low HDL, a fatal combination. His doctor told him he was at risk of heart disease and prescribed a statin to lower his bad cholesterol. Instead of taking medication, Diamond began studying diet and heart disease.
“I knew my problem was that I ate too many carbs — bread, potatoes, sugar,” Diamond said. “I was able to control my weight and reduce my risk of heart disease by following a low-carb diet. In the process, I became aware of the obsession with linking cholesterol to heart disease.”
Diamond has since published more than a dozen papers on the consensus that cholesterol causes heart disease. His recent research paper included a review of the medical literature linking statins to many adverse effects, including diabetes, muscle and kidney damage, and poor brain functioning.
“Some statins have been linked to cognitive impairment because they interfere with the brain’s ability to produce cholesterol, which is essential for creating new brain connections and forming memories,” Diamond said.
According to Diamond, people who are overweight and have diabetes may benefit from taking statins because in addition to lowering LDL, the drugs prevent clotting and excess inflammation, two known risk factors for heart disease.
However, for those who would rather take medication than make diet and lifestyle changes, Diamond has a message: “People who take statins may not realize that they are less likely to have a heart attack or stroke, and the effects of statins may harm them.” “
The study’s co-authors are Brigham Young University professor Ben Beckman and Paul Mason, a physician in New South Wales, Australia.