Statin use not justified for healthy people with high cholesterol

  About 40 million adults in the United States regularly take statins to lower their cholesterol levels and reduce their risk of heart disease and stroke, according to American Heart Association data from 2020.

However, many of them don’t stand to benefit from these drugs based on new research from David Diamond, a neuroscientist and cardiovascular disease researcher in the Department of Psychology at the University of South Florida.

Diamond and his co-authors reviewed literature from medical trials involving patients taking either a statin or placebo. They then narrowed their review to look at study participants with elevated levels of low-density lipoprotein-cholesterol (LDL), the so-called “bad cholesterol,” which can be reduced with a statin. Some individuals with high LDL also had high triglycerides (fat in the blood) and low high-density lipoprotein (HDL), the “good cholesterol,” which put them at the highest risk of having a heart attack.

But others with high LDL were very different. They had low triglycerides and high HDL, which meant they were healthier. People with optimal triglycerides and HDL levels typically exercise, have low blood pressure and low blood sugar, and are at a low risk of a heart attack.

Diamond and his co-authors asked two questions: If people are at a low risk of a heart attack based on having optimal triglycerides and HDL, but they also have high LDL, does that raise their risk? Further, would these people benefit from lowering their LDL with a statin?

Their findings, published in the journal Current Opinion in Endocrinology, Diabetes and Obesity, showed LDL alone has “a very weak association” with heart disease and stroke. Their review went further, showing that when people with high LDL and optimal triglycerides and HDL were given a statin, there was no benefit.

Diamond put the findings into a diet and lifestyle context.

“People who are not overweight, have low blood sugar, exercise and are on a low-carb diet typically have optimal triglycerides and HDL, and sometimes they have high LDL,” he said. “Our findings show that the people who have this healthy combination of diet and lifestyle, as well as high LDL, showed no benefit from taking a statin.”

The authors say their review also challenges the long-held contention that low-carb diets, which are often high in saturated (animal) fat, contribute to heart disease. That contention has persisted for nearly 50 years, dating to when cardiologist Robert Atkins was challenged about the potential dangers of his high-fat Atkins diet before a U.S. Senate Subcommittee on Nutrition and Human Needs in 1973.

“High blood pressure, obesity, smoking and high blood sugar are the primary drivers of heart disease,” Diamond said. “Cholesterol is an innocent bystander, and saturated fat in the diet has been undeservedly demonized.”