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When you watch most commercials for cholesterol drugs, they always have the disclaimer "Not proven to reduce the risk of heart attack or stroke".

If the drugs which reduce cholesterol do not reduce the risk of heart attack, should we question more seriously the original premise that too much cholesterol leads to heart attack?

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    How can we answer this with a straight face when there is no conclusive research one way or the other? – Satanicpuppy Feb 25 '11 at 16:53
  • Aren't there at least two kinds of cholesterol? – Paul Mar 27 '11 at 3:03
  • As an anecdotal data point, my doctor recently told me that 100% of the cardiologists he knows (and he knows quite a few) take statins whether their cholesterol is high or not. – Robusto Jun 26 '11 at 15:34
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The drugs that lower cholesterol you're asking about are called Statins.

There is a recent Cochrane Review1 (also discussed by Steven Novella on Science Based Medicine) that discusses the use of statins for primary prevention. The conclusion of that review is that there is a small but significant reduction of cardiac events and deaths when treated preventively with statins. The effect in secondary prevention, preventing a second heart attack, is larger, as reviewed in another Cochrane Review2.

There is clear evidence that lowering cholesterol via statin-treatment can prevent heart attacks. It gets much more complicated if you ask how high exactly the cholesterol level should be before treatment is advisable. And there is some debate, also from the authors of the first review, whether the small effects in primary prevention are significant enough to warrant routine treatment with statins.


[1] Mayor, Susan, Cochrane review questions evidence for statins for primary prevention in low risk groups, BMJ 2011

[2] Wei et al., Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials, BMJ 330, 821 (2005)

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    Can this answer be updated or removed please? It is non-sequitur. Statins lower heart attacks and lower cholesterol, it doesn't mean lowering cholesterol is the reason for reduction of heart attacks. And apparently this is exactly the case: nytimes.com/2016/04/04/health/… – sashkello Feb 2 '17 at 22:16
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It is not clear whether statin treatment is beneficial in a primary prevention setting, that is in people without prevalent CVD who are at relatively lower risk. The recent results of the JUPITER trial1 have fuelled an intense debate whether statins should be given for primary prevention of CVD. http://ebm.bmj.com/content/16/1/8.full?keytype=ref&siteid=bmjjournals&ijkey=2O5HDIwLeaWMI This study therefore questions the widespread practice of prescribing statins to middle-aged patients with an average cardiovascular risk profile who do not have overt CVD. Statin use in low risk young patients remains very controversial

Early statin trials reported significant mortality benefits, yet serious concerns have been raised in some studies regarding biased results, premature trial terminations, under reporting of adverse events, high numbers of patients lost to follow-up and oversight by the pharmaceutical company sponsor https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513492/

the above is an excellent article that explains both the history and problems of statin therapy. The name of the game is ABSOLUTE Risk reduction or ARR, Relative risk reduction is a ploy use by pharma to promote a drug's benefit. If I say Aspirin reduces your risk of a heart attack by 25% I would probably be correct but not accurate. The Relative Risk Reduction (RRR) is the percentage your risk is reduced by a therapy. So, 25% sounds great except it is deceptive because it doesn't use your actual risk of a heart attack. If you are a young healthy male in his 30's your risk of a heart attack may be only 4% http://heart.arizona.edu/heart-health/prevent-heart-attacks/risks

if I give you aspirin and it reduces your risk by 25% it actually reduces your risk to just 3%, only a 1% ABSOLUTE Risk Reduction (not 25% RRR) and that reduction is at a 3% increase for dying from a bleed. I could actually increase your all cause or total mortality by 2%. I may spare you from dying in your old age from a heart attack because you die middle age from head bleed or hemorrhagic stroke. To understand medical therapies you have to understand how statistics are manipulated

"There are three kinds of lies: lies, damned lies, and statistics." Samuel Clemens

  • I can't submit the edit myself because it doesn't meet the 6-character minimum, but it's Samuel Clemens. – phoog Feb 2 '17 at 15:10
  • Since the question is not about statins, but cholesterol, this answer doesn't exactly address it. I suggest adding a paragraph about controversy with cholesterol in particular: nytimes.com/2016/04/04/health/… – sashkello Feb 2 '17 at 22:19
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    The role of blood cholesterol levels in coronary heart disease and the true effect of cholesterol-lowering statin drugs are debatable. In particular, whether statins actually decrease cardiac mortality and increase life expectancy is controversial.the global prevalence of CHD, despite worldwide statin usage and cholesterol lowering campaigns, has reached pandemic proportions. Coronary heart disease is an extremely complex malady and the expectation that it could be prevented or eliminated by simply reducing cholesterol appears unfounded. ncbi.nlm.nih.gov/pmc/articles/PMC4513492 – Richard Stanzak Feb 2 '17 at 23:13
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I've always found this obsession over cholesterol odd. It's like saying: more people die in cars when the speedometer is on a high number, lets see if we can get the speedometer to not go so high, while not changing anything about the actual speed of the car.

As far as I understand it there are many different types of cholesterol (or should i say many different elements that make up the group cholesterol?) some of them are really bad for you, others, not so much.

The most mentioned elements are HDL and LDL with the HDL being the good kind and the LDL the bad kind. Some sources say the proportion matters more than the total cholesterol level.

American heart association

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    Strictly speaking, there is not more than one type of "cholesterol." Cholesterol is transported in a lipoprotein, and there are lots of types of these: HDL, LDL, VLDL, and so on. – Matt Oct 14 '13 at 19:22
  • Please summarize the relevant parts of your references. As it stands, this is basically a link-only answer. – user3150 May 26 '15 at 8:19

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