Statins are big business. The single drug Lipitor has generated over $140 billion in sales between 1996 and 2012. Not a total surprise, since 25 million are taking them now in the US and an additional 13 million will have them recommended under the new prescribing guidelines.
Do they work? Are they the miracle drugs that doctors seem to think they are? No, they aren't. A picture is worth a thousand words. First, here is the death rate from heart attacks over the past 60 years:
Notice that the peak is in 1968 and has steadily declined since then. Must have been when statins were introduced, right? Nope, that was in 1996. There isn't even a blip on the graph indicating that statins had any impact.
Next, consider this:
This is showing the risk of coronary heart disease (CHD; the thing statins are supposed to be preventing). But better still, it illustrates the relationship between total cholesterol (which statins lower), HDL cholesterol (aka "good cholesterol,") which statins mildly elevate, and risk of CHD. Translation: high HDL protects from CHD; total cholesterol doesn't matter. For example, looking at the far right on the graph, when HDL is above 60mg/dl, the risk of CHD is very low regardless of total cholesterol! It's low even for people with cholesterol over 260.
What this graph makes obvious is that total cholesterol has very little impact on the risk of CHD! What really has an impact on CHD is the HDL cholesterol level.
So, statins lower total cholesterol - not a great benefit - and they will raise HDL modestly (at best about 10%, or 4 points in someone with HDL at 40mg/dl). What else raises HDL? Lots of things. Exercise, for one thing. Niacin, also known as vitamin B3, does everything good to change cholesterol numbers: it raises HDL, and it lowers LDL and total cholesterol. In fact, according to the Mayo Clinic, niacin can raise HDL cholesterol by as much as 30%!
So maybe statins aren't so awesome after all. What makes them different than other HDL-raising therapies? A big difference is that statins block production of something very very very vital to your health: coenzyme Q10. This enzymes is necessary for the production of energy within every cell of your body. Fatigue an issue with statin? It's one of many side effects.
Are you getting the sense that I'm not a fan of statins? These drugs have even worse effects than I'm writing about here. Stay tuned for the story on why these drugs might just lead you to a diagnosis of dementia as well.