How low should our cholesterol be and just how safe are statins?

Jun 4 2006

Experts in Sweden are warning that the new U.S. recommendations for lowering cholesterol levels would increase the risk of harmful side effects with no overall reduction in deaths.

According to the American National Cholesterol Education Program people at high risk of heart disease should be treated more aggressively and by that they mean that LDL-cholesterol concentrations should be lowered to less than 1.81 millimoles per litre of blood (mmol/l) in high-risk individuals.

At present guidelines generally recommend 2.56 mmol/l as a healthy reading.

Uffe Ravnskov, an independent researcher from Lund, Sweden says that in order to achieve this most of the Western world’s adult population would be on statins, and doses would have to be more than eight times higher than currently used, and this in turn would increase both the number and seriousness of side effects.

Ravnskov's team suggest that such high doses would mean side effects could include heart failure, myalgia and rhabdomyolysis (which destroys muscle tissue), neurological problems and cancers.

The Swedish warning on the potential risks of using statins in high doses has evoked strong criticism from some of the top U.S. cardiologists who say the researchers have ignored the findings of many large clinical trials that show the benefits and safety of statins, even in large doses.

Dr. Steven E. Nissen, interim chairman of the department of cardiovascular medicine at the Cleveland Clinic, and president of the American College of Cardiology says high doses of statins are safe and this is supported by many studies which have shown most people tolerate such drugs very well and there is no reliable data on heart failure, neurological symptoms, and cancer.

Nissen says he believes that the benefits of statins outweigh the risks and in terms of how low cholesterol should be, Nissen says it depends on the patient and whether there is existing coronary disease; then it probably should be as low as possible and other experts agree with this view.

Some experts are not quite so convinced however and say statins are known to upset the liver, upset muscle function, and possibly affect brain function, and such information is possibly suppressed due to the large commercial interest in statins which are the biggest-selling drugs in the world.

One expert goes as far to say he is against the taking of statins to prevent heart attacks and points out that there is no evidence to prove that they help women.

The Swedish researchers say that any reduction in non-fatal events may be outweighed by more numerous and more severe adverse effects.