Which statin drug is best?

8. February 2009 William Davis (7)
I re-post a Heart Scan Blog post from one year ago, answering the question: Which statin drug is best?

I still get this question from patients in the office and online, nearly always prompted by a TV commercial. So let me re-express my thoughts from a year ago, which have not changed on this issue.


The statin drugs can indeed play a role in a program of coronary plaque control and regression.

However, thanks to the overwhelming marketing (and lobbying and legislative) clout of the drug manufacturing industry, they play an undeserved, oversized role. I get reminded of this whenever I'm pressed to answer the question: "Which statin drug is best?"

In trying to answer this question, we encounter several difficulties:

1) The data nearly all use statins drugs by themselves, as so-called monotherapy. Other than the standard diet--you know, the American Heart Association diet, the one that causes heart disease--it is a statin drug alone that has been studied in the dozens of major trials "validating" statin drug use. The repeated failure of statin drugs to eliminate heart disease and associated events like heart attack keeps being answered by the "lower is better" argument, i.e., if 70% of heart attacks destined to occur still take place, then reduce LDL even further. This is an absurd argument that inevitably encounters a wall of limited effects.

2) The great bulk of clinical data examining both the incidence of cardiovascular events as well as plaque progression or regression have all been sponsored by the drug's manufacturer. It has been well-documnted that, when a drug manufacturer sponsors a trial, the outcome is highly likely to be in favor of that drug. Imagine Ford sponsors a $30 million study to prove that their cars are more reliable and safer. What is the likelihood that the outcome will be in favor of the competition? Very unlikely. Such is human nature.

If we were to accept the clinical trial data at face value and ignore the above issues, then I would come to the conclusion that we should be using Crestor at a dose of 40 mg per day, since that was the regimen used in the ASTEROID Trial that achieved modest reversal of coronary atherosclerotic plaque by intravascular ultrasound.

But I do not advocate such an ASTEROID-like approach for several reasons:

1) In my experience, nobody can tolerate 40 mg of Crestor for more than few weeks, a few months at most. Show me someone who can survive and tolerate Crestor 40 mg per day and I'll show you somebody who survived a 40 foot fall off his roof--sure, it happens, but it's a fluke.

2) The notion that only one drug is necessary to regress this disease is, in my view, absurd. It ignores issues like hypertension, metabolic syndrome, inflammatory phenomena, lipoprotein(a), post-prandial (after-eating) phenomena, LDL particle size, triglycerides, etc. You mean that Crestor 40 mg per day, or other high-intensity statin monotherapy should be enough to overcome all of these patterns and provide maximal potential for coronary plaque reversal? No way.

3) Plaque reversal can occur without a statin agent. While statin drugs may provide some advantage in the reduction of LDL, much of the benefit ends there. All of the other dozens of causes of coronary atherosclerotic plaque need to be addressed.

So which statin is best? This question is evidence of the brainwashing that has seized the public and my colleagues. The question is not which statin is best. The question should be: What steps do I take to maximize my chances of reversing coronary atherosclerotic plaque?

The answer may or may not involve a statin drug, regardless of the subtle differences among them.
Tags :

Comments (7) -

  • Anonymous

    2/8/2009 5:04:00 PM |

    For those with atherosclerosis, I would think the most important question is how to stabilize existing plaque to prevent emboli. Then worry about the minimal reversal that is possible. But perhaps the solution to both problems is the same.

  • Anonymous

    2/9/2009 3:58:00 PM |

    K1f6 can predict who will respond favorably to statins and who will not benefit. Available from Berkely Heart Lab and other places.  Dr Davis, do you test?

  • Rick

    2/17/2009 11:01:00 AM |

    It would be great if you could follow-up this post sometime with another version, where the question is interpreted as meaning something like: "My doctor and I have agreed that I should take Vitamin D, niacin, and fish oil, eat walnuts everyday, and get more exercise, and that I also need a statin to get my cholesterol down as quickly as possible. Which statin drug would be best?" This could help us understand some of those subtle differences you mention.

  • Anonymous

    7/27/2009 10:40:04 AM |

    Statins are good for cholestrol but really should only be used for at risk patients Drug Companies have encouraged statin use for more patients than is neccessary

  • Rick

    7/29/2009 5:09:36 AM |

    Thanks, Anonymous, I understand that point. But I'd like to find out, for people who do need statins, how the statins differ, how one fixes dosage, whether there are targets beyond which doctors should withdraw the drug or reduce dosage, and so on. Any pointers to that kind of info would be great.

  • buy jeans

    11/3/2010 8:27:47 PM |

    However, thanks to the overwhelming marketing (and lobbying and legislative) clout of the drug manufacturing industry, they play an undeserved, oversized role. I get reminded of this whenever I'm pressed to answer the question: "Which statin drug is best?"

  • Anonymous

    2/1/2011 12:09:18 PM |

    Some people have already had one or more heart attacks, and even statin sceptics seem to accept that these people can benefit from a statin. So it would be very useful if there were a post which actually compared statins from this point of view.

Add comment

Loading
Track Your Plaque reduces healthcare costs 35%

Track Your Plaque reduces healthcare costs 35%

29. May 2010 William Davis (12)
Allow me to wear my Track Your Plaque hat for this post.

Mr. Richard Rawle is CEO of Utah company, Tosh, Inc. Mr. Rawle has been an avid follower of the Track Your Plaque program and has introduced the program to company employees. Here's what he has to say about the experience:

“Our company has been utilizing the principles of TYP [Track Your Plaque] for over a year and has experienced great results that have positively impacted the lives of our employees and our health care costs.

Since we began our wellness program, we have presented the TYP diet and lifestyle guidelines to all of our employees and their families. Although the overwhelming majority of our employees do not have cardiovascular issues, the preventative nature of TYP is too important not to be utilized. The TYP principles along with our increased focus on healthy living have already changed our group’s blood chemistry. HDL levels in particular have increased significantly and resulted in a large percentage of our employees having HDL levels of 60 or higher. Vitamin D levels have substantially increased and LDL levels have significantly decreased in the majority of our employees. Subsequently, in the 12 months just ended, our health care costs are some 35% less than other groups of comparable size and age.

I believe the TYP program has been an integral part of the success of our company's vast improvement in employee health/wellness, resulting in significant health care cost reductions."

Richard Rawle
CEO Tosh Inc.

Track Your Plaque saves lives. Track Your Plaque also saves money . . . lots of it. Despite the upfront costs of some additional blood testing and a heart scan, the dramatic reduction in need for medications, reduced heart attack, diabetes, and many other chronic conditions add up to a huge cost savings, much as Tosh, Inc. employees have enjoyed.

The Federal government has been looking towards large hospital systems to lead the way in healthcare delivery, systems that employ their physicians and possess economies of scale. But I say the answer to reducing healthcare costs will NEVER be found in hospital systems. Healthcare cost savings will be realized by delivering truly effective health solutions directly to people themselves, much as we do in Track Your Plaque.
Tags :

Comments (12) -

  • Jim Purdy

    5/29/2010 1:14:10 PM |

    QUOTE --
    "Healthcare cost savings will be realized by delivering truly effective health solutions directly to people themselves"

    Very true. Empowering the individual is powerful.

  • Anonymous

    5/30/2010 12:04:34 AM |

    Congratulations to you, Dr Davis!

  • Anonymous

    6/1/2010 3:21:20 AM |

    I just had my first heart scan done this week for $99 at a local hospital. I've been following a low-carb eating plan for several years. My score was 0 in three of my arteries and 18.38 in the left circumflex. Since this is my first scan, I don't know how it compares to before I began eating low-carb, but I'd like to think this is not a bad starting score and probably better than it would have been back when I was eating that "healthy" diet that is slowly killing so many. I will have another scan in a year, and see if I can tweak the diet a little to eliminate the small build-up I have. I am very motivated to avoid the prescription-drug, expensive procedure path that so many take as they age.

  • Cheers to empowerment!

    6/9/2010 8:16:28 AM |

    Wow Brilliant blog Dr. Davis i stumbled on it 3 days back and took time off from work and went through all your articles from april 2006 till now in 3 x 16 hour shifts. Stupendous stupendous work. By the way im a 25 year old attorney. I lost my father and grandfather to inexplicable health issues and your blog has lifted the veil on the cause - low fat high carb and high sugar diet, nutritional deficiencies especially k2 us being strict vegetarians. My mom is showing arthritic symptoms very young in her early 50s. For my parents (being high up in the government) there is no medical facility or procedure out of reach, but curative medicine is a huge drag when prevention is possible. Being bed ridden for years is hugely taxing on nuclear families whatever be the status or financial pull of a person. I Being the only child of my parents and having gone through all the trauma of attending law school caring for my father and moving houses simultaneously, your blog is endlessly empowering and valuable.

  • Indian Surgical Industries

    7/19/2010 8:12:26 AM |

    Best surgical instruments medical supply in all India- Delhi based surgical medical manufacturer and suppliers company provide all kinds of medical equipment on wholesale like Sterilization Equipment, hospital furniture, suction unit, baby care products and many more.

  • Resume Writing Service

    7/24/2010 12:27:27 PM |

    Nice discussion very informative.

  • Indian Surgical Industries

    8/12/2010 11:40:56 AM |

    Best surgical instruments medical supply in all India- Delhi based surgical medical manufacturer and suppliers company provide all kinds of medical equipment on wholesale like Sterilization Equipment, hospital furniture, suction unit, baby care products and many more.

  • mike V

    10/4/2010 2:31:47 PM |

    FYI:
    Radiology, November 2010
    CT Scans and Cardiovascular Health

    http://www.ivanhoe.com/channels/p_channelstory.cfm?&storyid=25336

    Mike V

  • Physician in India

    10/19/2010 9:30:12 AM |

    Thanks for sharing the informative post.

  • Savion

    7/10/2011 8:42:01 AM |

    Super jazzed about gteting that know-how.

  • Dilly

    7/11/2011 7:11:56 PM |

    You know what, I'm very much inlcnied to agree.

Add comment

Loading