The raison d'etre of this website is to provide you with hard scientific information which may help you make informed decisions in your quest for health (so far I have blogged concise summaries of over 1,500 scientific studies and have had three books published).

My research is mainly focused on the effects of cholesterol, saturated fat and statin drugs on health. If you know anyone who is worried about their cholesterol levels and heart disease, or has been told to take statin drugs you could send them a link to this website, and to my statin or cholesterol or heart disease books.

David Evans

Independent Health Researcher

Saturday, 21 May 2016

Doctor says statins may be over prescribed five to six fold when using the American College of Cardiology/American Heart Association faulty risk calculator

This study was published in the Journal of the American College of Cardiology 2016 May 10;67(18):2118-30
 
Study title and authors:
Accuracy of the Atherosclerotic Cardiovascular Risk Equation in a Large Contemporary, Multiethnic Population.
Rana JS, Tabada GH, Solomon MD, Lo JC, Jaffe MG, Sung SH, Ballantyne CM, Go AS.
Division of Cardiology, Kaiser Permanente Northern California, Oakland, California; Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Medicine, University of California, San Francisco, San Francisco, California.
 
This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/27151343

The 2013 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations calculator is used to estimate 10-year absolute risk for atherosclerotic cardiovascular disease (ASCVD) in primary prevention (people who have not developed clinically manifest cardiovascular disease).

The goal of this study was to evaluate the accuracy of the 2013 ACC/AHA Pooled Cohort Risk Equation. The study included 307,591 ethnically diverse adults without diabetes and not taking statins (aged 40-75 years) who were assessed over five years for or a total of 1,515,142 person-years.

The study found:
(a) Those with a predicted risk of up to 2.49% of having atherosclerotic cardiovascular disease events, only had an actual 0.20% risk.
(b) Those with a predicted risk between 2.50-3.74% of having atherosclerotic cardiovascular disease events, only had an actual 0.65% risk.
(c) Those with a predicted risk between 3.75-4.99% of having atherosclerotic cardiovascular disease events, only had an actual 0.90% risk.
(d) Those with a predicted risk of over 5.0% of having atherosclerotic cardiovascular disease events, only had an actual 1.85% risk.

Rana concluded: "In a large, contemporary "real-world" population, the ACC/AHA Pooled Cohort Risk Equation substantially overestimated actual 5-year risk in adults without diabetes, overall and across sociodemographic subgroups."

Senior author of the study, Dr Alan S. Go, chief of Cardiovascular and Metabolic Conditions Research at the Kaiser Permanente Northern California Division of Research, commented: "The (ACC/AHA Pooled Cohort Risk Equation) overestimation is approximately five- to six-fold... Translating this, it would mean that we would be over-treating a good many people based on the risk calculator... Our study provides critical evidence to support recalibration of the risk equation in 'real world' populations, especially given the individual and public health implications of the widespread application of this risk calculator."

Thursday, 19 May 2016

Low cholesterol associated with a 320% increased risk of suicide

This study was published in the BMJ 1992 Aug 1;305(6848):277-9

Study title and authors:
Low serum cholesterol concentration and short term mortality from injuries in men and women.
Lindberg G, Råstam L, Gullberg B, Eklund GA.
Centre for Public Health Research, Karlstad, Sweden.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/1392858

This study set out to investigate the relationship between cholesterol levels and death rates from injuries including suicide. The study included 26,693 men and 27,692 women, (aged 45-74 years), who were followed for 20.5 years.

The study found:
(a) Those in the lowest 25% of the cholesterol distribution had a 180% increased risk of death from injuries compared to those in the top 25% of the cholesterol distribution.
(b) Those in the lowest 25% of the cholesterol distribution had a 320% increased risk of death from suicide compared to those in the top 25% of the cholesterol distribution.

Lindberg concluded: "Together with observations from intervention trials the findings support the existence of a relation between (lower) serum cholesterol concentration and suicide."

Links to other studies:
Both low cholesterol levels and declining cholesterol levels are associated with increased risk of death from suicide in men
Low cholesterol levels are associated with higher rates of attempted suicide
The lower the cholesterol level - the higher the risk of suicide
 

Tuesday, 17 May 2016

Low cholesterol is associated with an increased risk of depression and anxiety

This study was published in Psychosomatic Medicine 1999 May-Jun;61(3):273-9
 
Study title and authors:
Relations of trait depression and anxiety to low lipid and lipoprotein concentrations in healthy young adult women.
Suarez EC.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
 
This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/10367605
 
The NEO depression scale measures the tendency of individuals to experience depressive affect or mood. Scores range from 0 to 32. High scores are indicative of individuals who are prone to feelings of guilt, sadness, hopelessness, and loneliness.

The trait anxiety subscale of the STPI measures an individual’s enduring tendencies to experience anxious moods and anxiety states. STPI anxiety scores range from 10 to 40, with high scores indicating higher anxiety.

This study investigated the association of cholesterol levels with depression and anxiety. The study included 121 healthy adult women between the ages of 18 and 27 years. Depression was assessed using the NEO depression scale and anxiety was measured by the trait anxiety subscale of the STPI. The women were put into two groups:
(i) Those with cholesterol levels under 4.14 mmol/L (160 mg/dL). (Low cholesterol group)
(ii) Those with cholesterol levels over 4.14 mmol/L (160 mg/dL). (Moderate to high cholesterol group).

The study found:
(a) The women in the low cholesterol group had a 170% increased risk of depression compared with the women in the moderate to high cholesterol group.
(b) The women in the low cholesterol group had a 141% increased risk of anxiety compared with the women in the moderate to high cholesterol group.

Suarez concluded: "Findings from the current study support the general hypothesis that naturally occurring low lipid and lipoprotein concentrations are associated with trait measures of depression and anxiety. These findings are potentially relevant in relation to observations of increased Non Illness Mortality in persons with spontaneously occurring low cholesterol levels as well as to observations of the increased frequency of depression and anxiety in women."

Links to other studies:
Suicide attempters have low cholesterol levels
Low cholesterol associated with depression in elderly men
Low cholesterol levels associated with fatigue and depression

Friday, 13 May 2016

Statins associated with higher risk of death and heart failure in heart attack patients

This study was published in JRSM Cardiovascular Disease 2016 Apr 21;5:2048004016639442
 
Study title and authors:
Association of statin use and stress-induced hyperglycemia in patients with acute ST-elevation myocardial infarction.
Yan C, Qin M, Juan YS, Tao LY, Dong GM, Zechun Z, Chun YX, Liang CH, Yin L, Kang M.
Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
 
This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/27158481

Stress induced hyperglycemia is a medical term referring to transient elevation of blood glucose due to the stress of illness. Numerous studies have demonstrated a strong association between stress hyperglycemia and increased risk of poor clinical outcomes, including mortality, morbidity, length of hospital stay, infections and overall complications.

This study investigated the association of stress induced hyperglycemia following statin use in patients who had been hospitalized after a heart attack. The study included 476 patients who were divided into two groups based on the presence or absence of diabetes.

The study found:
(a) In patients without diabetes, statin users had a 98% increased risk of stress induced hyperglycemia compared to those not taking statins.
(b) In patients with diabetes, statin users had a 3% increased risk of stress induced hyperglycemia compared to those not taking statins.
(c) Patients with stress induced hyperglycemia had a 161% increased risk of heart failure compared to patients without stress induced hyperglycemia.
(d) Patients with stress induced hyperglycemia had a 253% increased risk of dying in hospital compared to patients without stress induced hyperglycemia.

Yan concluded: "Statins are related to higher stress hyperglycemia and cardiac incidences after acute myocardial infarction."

Links to other studies:
Review reveals statins only extend life by 3 or 4 days. Closer analysis finds they may actually shorten life.
Statins double the risk of death in patients with coronary artery disease
Statins increase the risk of death in four year trial
 

Wednesday, 11 May 2016

Medical error is responsible for over a quarter of a million deaths and is the third most common cause of death in the US

This study was published in the BMJ 2016 May 3;353:i2139
 
Study title and authors:
Medical error-the third leading cause of death in the US.
Makary MA, Daniel M.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
 
This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/27143499
 
This study analyzed the scientific literature on medical error to identify its contribution to US deaths. Four studies were found and comprised of the following:
(i) A 2004 report of inpatient deaths associated with the Agency for Healthcare Quality and Research Patient Safety Indicators in the Medicare population estimated that 575 000 deaths were caused by medical error between 2000 and 2002.
(ii) The US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180,000 deaths due to medical error a year among Medicare beneficiaries alone.
(iii) Classen (2004) et al estimated over 400,000 deaths a year.
(iv) Landrigan et al (2002) estimated 134,581 inpatient deaths a year from poor inpatient care.
 
Of note, none of the studies captured deaths outside inpatient care—those resulting from errors in care at home or in nursing homes and in outpatient care such as ambulatory surgery centres.
 
A literature review by James (2013) estimated preventable adverse events, described an incidence range of 210,000-400,000 deaths a year associated with medical errors among hospital patients.
 
This analysis found:
(a) In 2013 this study estimated the rate of death from medical error of 251,454 a year using the studies reported since 1999.
(b) The authors believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths.
 
Makary concluded: "Medical error is the third most common cause of death in the US"

Sunday, 8 May 2016

Study stopped early because statins increased the risk of acute kidney injury in patients with kidney disease

This study was published in the Journal of the American Medical Association 2016 Mar 1;315(9):877-88
 
Study title and authors:
High-Dose Perioperative Atorvastatin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial.
Billings FT 4th, Hendricks PA, Schildcrout JS, Shi Y, Petracek MR, Byrne JG, Brown NJ.
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
 
This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/26906014

This study investigated the relationship between short-term high-dose perioperative atorvastatin and acute kidney injury following cardiac surgery. The study included 615 patients (199 statin-naïve and 416 statin-using) and 308 of these were randomized to atorvastatin and 307 to placebo. The average patient age was 67 years.
(i) Patients naive to statin treatment were randomly assigned 80 mg of atorvastatin the day before surgery, 40 mg of atorvastatin the morning of surgery, and 40 mg of atorvastatin daily following surgery or matching placebo.
(ii) Patients already taking a statin prior to study enrolment continued taking the preenrollment statin until the day of surgery, were randomly assigned 80 mg of atorvastatin the morning of surgery and 40 mg of atorvastatin the morning after or matching placebo, and resumed taking the previously prescribed statin on postoperative day 2.

The study found:
(a) After an interim review, the data and safety monitoring board recommended stopping the group naive to statin treatment due to a 235% increased risk of acute kidney injury among these participants with chronic kidney disease receiving atorvastatin.
(b) After a further review, the data and safety monitoring board later recommended stopping for futility, as the data revealed statins were increasing the risk of acute kidney injury by 6% overall and by 61% in statin naïve patients.
(c) Those who took statins had a 25% increased risk of the more serious stage 2 or stage 3 acute kidney injury compared to those who did not take statins.

The study also revealed:
(d) Those given the statins had a 20% increased risk of muscle pain compared to those taking placebo.
(e) Those given the statins had a 44% increased risk of stroke compared to those taking placebo.
(f) Those given the statins had a 11% increased risk of atrial fibrillation compared to those taking placebo.
(g) Those given the statins had a 202% increased risk of in hospital death compared to those taking placebo.

Links to other studies:
Statins increase the risk of diabetes in kidney transplant patients
Statin use is associated with a 30-36% increased incidence of acute and chronic kidney disease
Statin use associated with a 59% increased risk of kidney failure

Sunday, 1 May 2016

Statin treatment associated with depleted levels of coenzyme Q10 and cytochrome oxidase

This study was published in Toxicology Mechanisms and Methods 2009 Jan;19(1):44-50
 
Study title and authors:
Decreased ubiquinone availability and impaired mitochondrial cytochrome oxidase activity associated with statin treatment.
Duncan AJ, Hargreaves IP, Damian MS, Land JM, Heales SJ.
Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 1BG, UK.
 
This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/19778232

This study investigated the involvement of statins in impaired cellular energy production. Mitochondria are the cells power plants, and coenzyme Q10 (ubiquinone) and cytochrome oxidase (complex IV) are vital enzymes needed in cellular energy production.

In a study published in the Journal of the American College of Cardiology, coenzyme Q10 (ubiquinone) was shown to lower cardiovascular deaths by 43% and lower the overall death rate by 42%.

Cytochrome oxidase (Complex 4) deficiency is a condition that can affect several parts of the body, including the muscles used for movement (skeletal muscles), the heart, the brain, or the liver. Cytochrome oxidase deficiency can lead to muscle weakness (myopathy), poor muscle tone (hypotonia), severe brain dysfunction (encephalomyopathy). Approximately one quarter of individuals with cytochrome oxidase deficiency have a type of heart disease that enlarges and weakens the heart muscle (hypertrophic cardiomyopathy). Another possible feature of this condition is an enlarged liver, which may lead to liver failure. Most individuals with cytochrome c oxidase deficiency have a buildup of a chemical called lactic acid in the body (lactic acidosis), which can cause nausea and an irregular heart rate, and can be life-threatening. Many people with cytochrome oxidase deficiency have a loss of mental function, movement problems, hypertrophic cardiomyopathy, eating difficulties, and brain abnormalities. Cytochrome oxidase deficiency is frequently fatal in childhood.

(i) Two patients experiencing muscle problems following treatment with simvastatin (40 mg per day) and cyclosporin (patient 1) and simvastatin (40 mg per day) and itraconazole (patient 2).
(ii) Analysis of the two patients skeletal muscle revealed a decreased ubiquinone status (77 and 132; reference range: 140-580 pmol/mg) and decreased complex IV activity (0.006 and 0.007 reference range: 0.014-0.034).
(iii) To assess statin treatment in the absence of possible pharmacological interference from cyclosporin or itraconazole, primary astrocytes (cells from the central nervous system) were cultured with lovastatin.
(iv) Lovastatin treatment resulted in a decrease in ubiquinone (statin treatment 97.9 versus control 202.9 pmol/mg), and a decrease in complex IV activity (statin treatment 0.008 versus control: 0.011).

Duncan concludes: "These data, coupled with the patient findings, indicate a possible association between statin treatment, decreased ubiquinone status, and loss of complex IV activity".