Cholesterol and Statin Drugs -

Steven Sinatra, MD Cardiologist Turns From Choir Boy to Disbeliever  by Jeffrey Dach MD

Steven Sinatra MD, a board certified cardiologist in Connecticut and popular author, admits he was a cholesterol believer for many years, and even gave lectures on behalf of statin makers Merck and Pfizer.  However, after years of clinical practice, Sinatra turned from choirboy to disbeliever because of the following observations:  

1) many patients with low cholesterol will go on to develop heart disease.

2) In many patients with cholesterol above 280, angiograms show normal coronary arteries.  They don't have heart disease.

3) Population studies discredit cholesterol.  For example, the French have the highest cholesterol levels in Europe of 250, and they also have lowest incidence of heart disease.   On the Greek Island of Crete, average cholesterol is well over 200, yet there was not a single heart attack there in ten years. 

4) Half of all heart attacks occur in people with normal total cholesterol.

A Vending Machine for Statin Drugs?

Recently, Steven Sinatra MD wrote an excellent article  in the Townsend Letter in which he remarks that drug companies Merck and Pfizer have transformed the medical profession into one big vending machine for statin drugs.(1)(2)(3)(4)

Obsolete Blood Test

Dr. Sinatra also tells us that the Cholesterol blood test your doctor orders for you is now obsolete, and has been replaced by the VAP, a more sophisticated lipoprotein panel which provides a wealth of useful information absent from the old cholesterol panel your doctor orders.  What is this added information?

LDL Particles - Not All Sizes are Equal


Firstly the VAP provides LDL particle size. Small LDL particle size is the dangerous one associated with increased risk of heart disease. Large buoyant LDL particle size is the safe one, with less heart disease risk.

Secondly the VAP includes Lipoprotein (a), a marker of high risk for heart disease risk.

Left Image: LDL particle with cholesterol ester in the center surrounded by phospholipid outer coating.



Total Cholesterol?

Sinatra says total cholesterol doesn't mean much unless you have a level over 320 which increases risk of stroke.  Reducing cholesterol can be accomplished with weight reduction and increasing dietary fiber. He would not give a statin drug for this unless you are a male with documented heart disease.

Low LDL?

Sinatra says that low LDL below 80 is associated with adverse side adverse side effects of cancer, aggression, cerebral bleeding, amnesia, and immune dysfunction. 

Just Don't Do It

Here is Dr Sinatra's advice to you if your doctor tells you to take statin based on the standard cholesterol panel:

1) Don't do it. Ask for a VAP test.

2) If you are a 50-75 year old male with small dense LDL on a VAP test, then go for the statin drug. It's a good idea. If you are over 75, don't take a statin drug as the drugs cause increased mortality in the elderly.

3) If you are a woman, avoid statins, as no statin drug study has ever shown a benefit in all-cause mortality for women by lowering cholesterol, and adverse effects of the drugs are horrendous.

See my article on this topic: Cholesterol Lowering Statin Drugs for Women, Just Say No by Jeffrey Dach MD

4) If you have elevated lipoprotein (a), do not take a statin.  The drugs don't work for this. Instead use Niacin (B3) 500-2000 mg per day, fish oil 2-3 grams per day, and nattokinase 100 mg per day. 

The Greatest Scam Ever

The famous Framingham Study is the foundation and basis of the cholesterol theory of heart disease. This is the idea that elevated cholesterol levels causes heart disease, and that statin drugs reduce cholesterol thereby preventing heart disease.  A Biochemist and participant in the Framingham study, George Mann, later described it as the "the greatest scam perpetrated on the American Public".

I Stopped My Statin Drug - Now What ?

Once patients get off statin drugs, the next question is what replaces the statin drug?  What lifestyle modifications and nutritional supplements are used to prevent or reverse heart disease?  There is an entire program devoted to this.  It is called is the Track Your Plaque Program devised by William Davis MD, a Wisconsin cardiologist.  Contained within Davis's program is the Linus Pauling Protocol among other things which is described in this article:

CAT Coronary Calcium Scoring, Reversing Heart Disease by Jeffrey Dach MD


William Davis MD Warns About the Evil Trio

If total cholesterol is not useful as a predictor of heart disease risk, what is? Which lipoprotein markers on the VAP test are the ones to look for?  Davis tells us the VAP test sometimes reveals an evil trio of lipoprotein abnormalities which are strongly predictive of heart disease, often leading to advanced heart disease at an early age.(6)

Here is the evil trio:

1) Low HDL--generally less than 50 mg/dl.
2) Small Particle Size LDL--especially if 50% or more of total LDL.
3) Lipoprotein(a)--an aggressive risk factor by itself.

Left Image: Dante's Inferno

If you have the evil trio, rather than robotically prescribe a statin drug, Davis recommends lifestyle modification and dietary supplements.  Davis remarks that some of his greatest heart disease reversals have been in patient with this evil trio, which responds well to the regimen listed below.  Reversal of Heart disease is determined by reduction in coronary calcium score (or less of an increase).

Here is Dr Davis' program for Reversing Heart Disease and the Evil Trio

1) Niacin--increases HDL, reduces small LDL, and reduces Lp(a)

2) Elimination of wheat, cornstarch, and sugars--Best for reducing small LDL; less potent for Lp(a) reduction.

3) High-fat intake--Like niacin, effective for all three.

4) High-dose fish oil--Higher doses of EPA + DHA 3000 mg per day.

Here are a cases from the office of people on statins that I see very day. Statin Case Reports From the Office:

Number One  - Chronic Psoriatic Rash from Statins:

Dan is about 65 with no history of heart disease and has been on a statin drug for a cholesterol of 220 about two years.  His major problem is a red raised rash on his forearms, and hands and forehead which looks a lot like psoriasis, present for about 2 years.  Dermatologists have been stumped and of no help.

Dan's VAP show large buoyant LDL particles indicating low risk for heart disease.  His coronary calcium score was 75th per centile indicating only mildly above average risk of heart disease (50% per centile is average risk).

I told Dan that the rash was most likely a reaction to the statin anti-cholesterol drug, and advised a two week trial off the drug to see if the rash resolves.  Three weeks later Dan returns to the office, and reports the skin rash is gone.

Number Two- Lupus-like Skin Lesion from Statins

Sarah is an 82 year old with no history of heart disease and on a statin drug for a cholesterol of 235.  She had been to the dermatologist because of skin lesions on her face near the temple areas which were biopsied and reported by the pathologist as inflammation in the skin suggestive of lupus erythematosis.  Sarah is concerned she has Lupus and cam to see me for a second opinion.  I told Sarah she did not have Lupus and advised her that the skin eruptions were a reaction to the statin drug.  Sarah stopped the statin drug and three weeks later reported the skin had returned to normal.

Number Three- Early Alzheimer's from Statins

Lori is a 52 year old post menopausal with chief complaint of memory loss, cognitive dysfunction and severe fatigue.  She had no history of heart disease and been on a statin drug for many years for a cholesterol of 230.   I advised her to stop the statin drug.  However, her cognitive dysfunction and memory loss continued unchanged.  She was unable to find the office for a follow up visit, gave up and drove home.

A study by Muldoon showed virtual 100% of patients on statin drugs have some element of cognitive impairment, ranging from mild to severe symptoms of amnesia and cognitive dysfunction. (5)  I have found this to be the case in actual clinical practice.

Number Four- Wheelchair bound non-healing deep infections from statins

Jim is a war veteran and was paralyzed from a roadside bomb many years ago, and has since been wheelchair bound. Although there is no history of heart disease, his doctor placed him on a statin drug for a cholesterol of 245 about two years ago.  Shortly thereafter, Jim developed non-healing chronic decubitus infections at the ischial tuberosities at the site of pressure sitting in the wheelchair.  Jim has had numerous surgical procedure and drainages, debridements, and multiple courses of antibiotics for these chronic infections which refuse to heal.  In this case, the statin drug prevents healing of chronic infection.  Jim stopped the statin drug, began an intensive nutritional  program to boost immunity and healing ability and reported improvement after 6 weeks.

Jeffrey Dach MD
7450 Griffin Rd Suite 180/190
Davie, FL 33314
Phone: 954-792-4663
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Links and References:

(1) http://www.spacedoc.net/stephen_sinatra_1
Dr. Stephen Sinatra - From Cholesterol Choirboy to Non-Believer

(2) http://www.spacedoc.net/stephen_sinatra_2
Dr. Stephen Sinatra - How to Determine if You Really Need a Statin

(3) http://www.spacedoc.net/stephen_sinatra_3
Dr. Stephen Sinatra - Statins, CoQ10, and Carnitine

If we have to prescribe a statin we always make sure the patient takes an ample amount of supplemental CoQ10 - at least 100 mg daily and taken with a meal.

(4) http://www.townsendletter.com/June2009/June2009.htm
Clearing Up the Cholesterol Confusion by Steven Sinatra, MD, FACC, FACN
A well-known cardiologist explains why he doesn't think lowering cholesterol is the answer for preventing heart disease, and debunks the routine prescription of statins for all but specific cases.

(5) http://www.ncbi.nlm.nih.gov/pubmed/10806282
Am J Med. 2000 May;108(7):538-46.

Effects of lovastatin on cognitive function and psychological well-being.

Muldoon MF, Barger SD, Ryan CM, Flory JD, Lehoczky JP, Matthews KA, Manuck SB.
Center for Clinical Pharmacology (MFM), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

CONCLUSION: Treatment of hypercholesterolemia with lovastatin did result in small performance decrements on neuropsychological tests of attention and psychomotor speed.

(6) http://heartscanblog.blogspot.com/2009/05/lethal-lipids.html
Lethal lipids-Heart Scan Blog William Davis MD
 
There's a specific combination of lipids/lipoproteins that confers especially high risk for heart disease. That combination is:
Low HDL--generally less than 50 mg/dl
Small LDL--especially if 50% or more of total LDL
Lipoprotein(a)--an aggressive risk factor by itself

Total Cholesterol and Heart Disease