Right now, 40 million Americans take statins to lower cholesterol in an attempt to prevent complications of atherosclerosis such as heart disease and stroke. Despite this, heart disease is still the No. 1 cause of death in the U.S., and stroke is the fifth leading cause of death. Patients on high-intensity statin therapy can still have heart attacks, strokes and other vascular issues. Thus, it is important for both the health care provider and the patient to understand the role of statins in heart disease prevention.
One important concept during the health care providers and patient discussion about statins is the statistical term "number needed to treat" — or NNT — meaning the number of patients that must get a specific treatment before one event is prevented.
For the primary prevention of heart disease (preventing the first event), the number of patients that need statin therapy to prevent one death from heart disease is 167. To prevent one heart attack the NNT is 77, and to prevent one stroke 250 patients need to be on a statin. This is based on data from a meta-analysis published in 2010 which had a 4-year follow-up. Review the abstract here. For secondary prevention of heart disease, the NNT is closer to 80 (read more here).
The patient needs to know that being on a statin does not give them a free pass to eat a diet high in cholesterol and saturated fat. This needs to be strongly reinforced by the health care provider at every visit. In fact, diets that are cholesterol-free and low in processed and refined foods (aka, a whole-foods plant-based diet) can markedly reduce serum cholesterol levels to the same degree or better than statin therapy.
A great anecdotal example from the former president of the American College of Cardiology Kim Williams, MD, can be read here. His LDL dramatically reduced by changing to a plant-based diet and he avoided the need for statin therapy completely. Health care providers should place greater emphasis on lifestyle change instead of just prescribing a statin without having the patient commit to dietary changes.
Whether the DASH diet, Mediterranean diet or a whole-foods plant-based diet — as seen in the documentary "Forks Over Knives," which I refer patients to regularly — anything is better than the standard American diet. Practitioners should know, however, that the only diet ever shown to cause regression of atherosclerosis is the whole-foods plant-based diet, as seen on quantitative angiography, which you can read about here and here. While data are limited on mortality benefit and plant-based nutrition, unlike the data for statins, the rates of cardiac events and cardiovascular deaths were near zero with this nutritional approach, even in a high-risk patient population in these small studies.
Statins are not the cure for heart disease, but perhaps diet and lifestyle changes are. Focus on diet and lifestyle changes, including a whole food plant-based diet as an option. As the saying goes: turn off the faucet, do not just mop the floor.
– by Steven Lome, DO, RVT