Letter to your doctor about taking statins.

If your doctor is pushing you to take a statin drug to lower your LDL Cholesterol you might consider printing out this letter and presenting it to him to point out some of the concerns about this treatment and that you would be open to his response to those concerns.
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Patient’s Details:

Dear Doctor   ____________________ 

I wish to raise the following concerns with you regarding your advice that I should lower my cholesterol with the use of statins or other medications.

Large scale studies have shown that cholesterol levels follow a normal distribution having a range of values from around 2.7 mmol/l (105 mg/dL) to 8.8 mmol/l (343 mg/dL). This same normal distribution is seen in people who do have heart disease and people who do not have heart disease [1].

I am concerned about the definition of ‘high’ cholesterol, since most adults naturally have a cholesterol level that is above the suggested target.  Furthermore, records show that cholesterol levels in industrialised countries are decreasing, not increasing [2]. What is being suggested as ‘high’ is in fact just normal in many cases. 

I am also concerned by the fact that most people who have a heart attack have an average cholesterol level, not a high cholesterol level: this has been found during studies completed on people in the UK, Australia, New Zealand and America [3]  [4]  [5].

Studies have also raised questions about so called ‘bad’ cholesterol. A study published in the American Heart Journal looked at cholesterol levels for people who have been admitted to hospital in America with coronary artery disease (CAD). The study included 136,905 people.The average LDL level for this group of people was 2.7 mmol/l (105 mg/dL) [6].Which was actually lower than the average level for the general population: the average for the general population was 3.2 mmol/l (125 mg/dL) [7].

If people with CAD have lower LDL levels than the general population, then where is the evidence that higher LDL levels cause heart disease?

The conclusion of a BBC Radio 4 program in the UK was that 99% of people who take statins for primary prevention do not benefit from them. This was admitted by the UK governments chief advisor on heart disease (Professor Boyle) [8].

Any benefit associated with statins is routinely shown as a relative percentage reduction and this is misleading for patients. To illustrate this point we could look at the Lipid Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA) [9].

Within the group of people who were given the statin, 1.9% of them had a heart attack or died of heart disease, versus 3% of people in the placebo group. The statin reduced the risk by just 1.1%. Unfortunately the authors of the report described the results as a 36% relative risk reduction.

There is evidence that high cholesterol in elderly people is associated with a longer life. This was the conclusion of a study completed by a team of researchers at Yale University School of Medicine [10]. Researchers in the Netherlands also found that in the case of the elderly, life expectancy increases when cholesterol levels are higher. Those with higher cholesterol levels appeared to be better protected from cancer and infection [11].

I am also concerned that adverse effects from statins have been under-reported. The procedures used during clinical trials, such as the run-in period, may mean that the trial participants are not representative of the general population.

‘Stopped Our Statins’ is a forum for people who have experienced significant adverse effects from the use of statins. The most commonly reported adverse effects on this forum include:

Gout, Numbness / Tingling of the Hands/Feet, Muscle ~ Weakness, Cramps, Spasm, Stiffness, Insomnia, Loss of Libido, Impotence, Heart Palpitations, Heart Arrhythmias, Depression, Short Term Memory Loss, Long Term Memory Loss, Transient Global Amnesia, Neck and Shoulder Pain, Fatigue, Migraine, Headaches, Chest Pain, Digestive Disorders, Trouble Walking (Shuffling), Trouble Walking (Balance), Hand Tremors, Speech - Trouble finding the right word, Slurred Speech, Dizziness, Sciatica Pain.

Although this data is not part of a clinical trial it does provide testament to the wide range of adverse effects experienced in the real world with real people.  

Before I make the decision whether or not to lower my cholesterol through medication, I would be very grateful if you could provide a response to the points raised above.

Thank you very much for your consideration.

Yours sincerely,

 References:

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[1] Smith, J 2009 $29 Billion Reasons to Lie about Cholesterol: Making Profit by Turning Healthy   People into Patients Troubador Publishing, Leicester

[2] Blood Cholesterol Chapter 10 of the British Heart Foundation Coronary Heart Disease Statistics. July 2007

[3] Durrington, P Dyslipidaemia Lancet 2003; 362:717-731

[4] Tonkin, AM et al. Effects of Pravastatin in 3260 Patients with Unstable Angina: Results from the LIPID Study Lancet 2000; 355:1871-1875

[5] Rubins, HB et al. Distribution of Lipids in 8,500 Men with Coronary Artery Disease American Journal of Cardiology 1995; 75:1202-1205

[6] Sachdeva, A et al Lipid Levels in Patients Hospitalized with Coronary Artery Disease: An analysis of 136,905 Hospitalizations in Get with the Guidelines American Heart Journal 2009; 157:111-117

[7] Carroll, MD et al Trends in Serum Lipids and Lipoproteins of Adults, 1960-2002 Journal of the American Medical Association 2005; 294:1773-1781

[8] BBC Radio 4 Program “The Investigator” April 3, 2008 20:00hrs GMT

[9] Sever, PS et al. Prevention of Coronary and Stroke Events with Atorvastatin in Hypertensive Patients who have Average or Lower-Than-Average Cholesterol Concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): A Multicentre Randomised Controlled Trial Lancet 2003; 361:1149-1158

[10] Krumholz, H et al. “Lack of Association Between Cholesterol and Coronary Heart Disease Mortality and Morbidity and All-Cause Mortality in Persons Older Than 70 Years” Journal of the American Medical Association 1994; 272:1335-1340

[11] Weverling-Rijnsburger, AW et al. “Total Cholesterol and Risk of Mortality in the Oldest Old” Lancet 1997; 350:1119-1123