We all know the mantra: high cholesterol causes heart attacks, so foods high in saturated fats which raise cholesterol should be avoided. We also know that by the age of 40, as many as one in three of us will be taking cholesterol-lowering drugs called statins, to reduce our risk of coronary heart disease.Now a controversial new documentary is questioning this received wisdom. It asks whether the link between saturated fat (found in foods like butter and cream), high cholesterol and coronary heart disease is as straightforward as believed – and warns that we mess with cholesterol levels at our peril. Statin Nation: the Great Cholesterol Cover-Up, made by Justin Smith, a former personal trainer at the BBC turned film director, includes interviews with cardiologists and other specialists, yet it has been widely attacked by others in the medical establishment as “simplistic” and a “travesty”.
Smith’s film will be released as video on demand next month and was “crowd funded” – made with money he raised from the general public. In it, he asks why it is that, if high cholesterol causes heart disease, cholesterol levels for men in Britain are the 15th lowest among 45 countries in Europe – yet Britain still has one of the highest levels of heart attacks. He also queries why both men and women in the lowest social economic group die of heart disease at far higher rates than their richer peers, yet do not have higher cholesterol levels.
While the “bad” low-density lipoprotein (LDL) cholesterol is widely blamed for clogging up the arteries and causing heart attacks, doctors in the documentary argue that it is wrong to see cholesterol (or saturated fats) as the villain of the piece. They suggest that key to heart disease is initial damage to the artery wall – and that cholesterol is one of the substances used to effectively form a scab over the rupture, before the artery wall grows over this again. “Essentially cholesterol is there to help repair damage,” says Dr Malcolm Kendrick, a Scottish GP and author of The Great Cholesterol Con. “It’s a bit like blaming firemen for causing fires, because they are there when fires break out.”
The film also claims a US study from 2009 showed that patients with heart disease had lower levels of LDL cholesterol than the general population, as did studies in Hawaii and Austria. Yet, with statins pushed as the answer, the cholesterol-lowering industry” is worth billions – the statin Lipitor made $13 billion for Pfizer in 2010.
However, some experts have criticised the film for being overly simplistic and failing to understand the clinical trials it discusses. They argue that in every major study people with higher blood cholesterol had higher rates of heart disease.
Prof Colin Baigent, whose team conducted the largest-ever study reviewing evidence of the effect of statins published in May, said Smith’s conclusions were a “travesty”.
“Apparent contradictions in the evidence are not what they seem,” says Prof Baigent, a Medical Research Council scientist based at Oxford University. “For example, when people get sick, their livers make less cholesterol, so in some older people low cholesterol is a sign of illness that may increase their risk of death. Yet we also know that lowering cholesterol prevents heart disease in older people. Both observations are entirely consistent with cholesterol being a cause of heart disease.”
He also points out that, with many statins now out of patent (the average course of statins costs the NHS £1.30 a month), these drugs are cheap and cost-effective. Statins are currently recommended for those who have a 20 per cent risk of heart attack, but Baigent, whose team meta-analysed 27 randomised controlled trials, concluded that even those at low risk of heart disease could benefit from statins. Kausik Ray, professor of cardiovascular disease prevention at St George’s Hospital, London, is one expert who features in the film, but told The Daily Telegraph that he disagreed with its conclusions.
“The film’s view is simplistic,” says Ray. “There is no doubt that high cholesterol levels are related to coronary heart disease.” Yet he points out that high cholesterol is only one risk factor, with high blood pressure, smoking, diabetes, obesity and family history also being key.
He also sympathises with the film’s message that statins (now taken by seven million people in Britain) may not be the answer to Britain’s heart disease problem and that healthy people should not be “medicalised” – for example, by giving statins to all those over 50. “Rather than doing that, I’d like to see people encouraged to make lifestyle changes earlier in life – stopping smoking, changing their diet, exercising more,” says Ray. “If they do all that and they still appear to be at high risk of heart disease or strokes, it’s at that point that we should offer statins.”
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