Statins: other approaches do just as well

Statins are among the most prescribed drugs in the world. When it comes to lowering bad cholesterol or LDL (sometimes also called LDL-C for low-density lipoprotein cholesterol), statins are in the majority of cases the treatment of first choice and prove to be effective. Nevertheless, some patients do not tolerate these drugs, in particular because of side effects in the muscles.

Scientists have investigated whether other drugs or treatments such as a specific diet could have the same effectiveness as statins in lowering LDL and reducing cardiovascular risk. The answer is yes, these treatments (excluding statins) are capable of providing the same level of protection for heart health. We know that a high level of LDL greatly increases the risk of suffering from cardiovascular diseases such as myocardial infarction or stroke.

Numerous studies have shown a reduction in cardiovascular risks with the taking of statins, but there was a lack of conclusive studies with treatments considered to be more marginal. In addition, treatment recommendations (guidelines) often speak of statins but forget the final objective, that is to say a lowering of the LDL level in the blood. A bit as if we were no longer interested in a path to follow rather than the final destination.

Review of 49 clinical studies

To reach these conclusions, a team from the Brigham and Women’s Hospital attached to Harvard University in Boston who conducted this study analyzed or reviewed 49 clinical studies already published, counting a total of more than 300,000 individuals. Among these studies, 25 focused on statins and the others concerned a special diet for a healthy heart rich in particular in dietary fiber, the intake of ezetimibe which is a molecule blocking the absorption of cholesterol in the digestive tract, drugs acting on bile, gastric bypass surgery which has the effect of promoting the conversion of cholesterol into bile acid and newer cholesterol medications called PCSK9 inhibitors.

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The lower the LDL level, the lower the risk of a cardiovascular event.

The authors found that the association between reduced LDL levels and the risk of suffering serious cardiovascular events such as death, stroke or heart attack was similar between the different therapies. Each reduction of 1 mmol/L (or 39 mg/dL) in LDL was associated with a 23% to 25% relative decrease in the risk of suffering serious cardiovascular events. The treatments had a different impact on lowering cholesterol levels. Ezetimibe lowers LDL by 20%, statins by 30-50% depending on dosage, and PCSK9 inhibitors by about 60%.

But what must be remembered is that each unit of LDL reduced in the bloodstream reduces the risk of cardiovascular disease, regardless of the method or treatment used by the doctor. For example, if a special diet allows you to lose 1 mmol/L of LDL and a statin leads to the same decrease, the end result is the same. According to the American scientist, the results show that several methods make it possible to achieve this objective. There is a rather linear relationship between the decrease in LDL and that of cardiovascular risk. The lower the LDL level, the lower the risk of a cardiovascular event.

Highly effective alternatives to satins

This research work also shows that non-drug methods such as diet, supplemented by regular physical exercise, are very valid therapies for reducing cardiovascular risk. To take an image, the main thing is truly the destination (having an LDL level within the norm) and not the path to get there.


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