How well have they been studied? — The statin class of drugs are widely prescribed to reduce blood cholesterol levels, according to the hypothesis that this will reduce the risk of heart disease and benefit the individual taking the statin. However, like most drugs, it is inevitable that statins will have unanticipated effects in certain individuals. While…

What are they based on? — Primary care for cardiovascular disease (CVD) — the prevention of a CVD event in people who have not experienced one before — is an established objective in clinical practice. The premise is that certain health or lifestyle indicators associate with the risk of a future CVD event, such as a…

Evidence vs. emminence — As long ago as 2005 an audit of just 18 patients, admitted to an emergency department, reported that there were 3,679 pages of clinical guidelines associated with their conditions. Imagine what it is like now. What started out as support for evidence-based medicine, and as a means for clinicians to…

How robust is the evidence? — It probably started when medical authorities put the blame for heart disease (atherosclerosis) on circulating cholesterol. In the modern era, this goes back to the 1950s or before, when heart disease was still relatively rare, but increasing. Heart disease became publicly prominent in 1955, when US President Eisenhower suffered a…

Or, how to make a 1.1% benefit look like 36% — Until recently, statins were the most profitable class of drugs in the history of medicine, and the most profitable of them all has been Lipitor (Atorvastatin), manufactured by Pfizer (the largest pharmaceutical company by revenue). Here is a Lipitor advertisement from the early 2000’s highlighting that, in patients with multiple…

What is the strength of the evidence… — Briefly, the cholesterol hypothesis proposes that by getting into arterial walls and causing atherosclerosis (plaque buildup in arteries), cholesterol increases the risk of cardiovascular disease (CVD) and cerebrovascular disease (strokes). However, according to a perhaps unlikely source — the American Heart Association: “Exactly how atherosclerosis starts or what causes it…

How fatty molecules (e.g. fatty acids and cholesterol) get moved around in our water-based bloodstream — We are water-based lifeforms. However, we need fats and fat-like molecules such as cholesterol (collectively known as lipids) for a host of important cellular functions — as critical as building cells and providing cellular energy. Consequently, we have evolved a means of transporting fat around our bodies in water-friendly capsules…

Its evolution and crucial importance to our biology — We are told about good cholesterol and bad cholesterol. However, the good cholesterol is only considered good because it is carried by high-density lipoproteins (HDLs) to the liver, which then has the option of sending it to the intestine to be eliminated in faeces. So, it’s only good because we…