Episode 4: Should You Take a Statin? (Cardiovascular Series: Part 4)

In this episode, we dive deep into statins—the most widely prescribed cholesterol-lowering drugs—and ask the hard questions:

Do they really prevent heart disease? Are the benefits worth the risks? What does the data really say?

Topics include:

• The history of statins and how they were discovered
• The role of LDL in healing vs. harm
• Risks: muscle pain, cognitive issues, diabetes, mitochondrial dysfunction, and more
• Benefit vs. risk by ASCVD score
• Major trials like JUPITER, FOURIER, and the CTT meta-analysis
• The role of PCSK9 inhibitors and anti-inflammatory effects
• Why relative risk reduction numbers can be misleading
• How to make an informed, individualized decision about statins

🔢 Start Here: ASCVD Risk Calculator
Use this tool during the episode to estimate your 10-year cardiovascular risk.
https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/

📚 References & Resources

Statins for Primary Prevention – NNT Review

Summary of evidence on statins for people without prior heart disease.

ASCVD Risk Calculator

Estimate your 10-year cardiovascular risk using standard clinical inputs.

CTT Collaboration – NEJM 2017 PCSK9 Trial (FOURIER)

Evaluated evolocumab’s impact on major cardiovascular outcomes.

Statins and Myopathy – PRIMO Study

Real-world observational study showing 10.5% statin-associated muscle problems.

Statins and Mitochondrial Dysfunction

Statins impair CoQ10 and heme synthesis, disrupting cellular energy production.

Therapeutics Initiative – Statins for Primary Prevention

Independent review finding no mortality benefit for low-risk individuals.

Dr. Kumar’s Breakdown – JUPITER Trial and Inflammation

How rosuvastatin lowered CRP and what that might mean.

ASCVD Risk Calculator Overestimation

Real-world data shows the tool often inflates predicted risk.

Statins and Cognition – Pilot Withdrawal/Rechallenge Study

Cognitive function improved in dementia patients after statin withdrawal.

LDL Lowering vs. CVD Risk – Regression Model Critique by Ravnskov

Analysis showing how excluding trials distorts the LDL-CVD link.

Statin Use and Mortality Trends in Europe

Statin utilization did not consistently correlate with mortality reduction.

JUPITER Trial Results

Reported a 44% relative risk reduction but only 1.2% absolute difference.

CTT Meta-Analysis – 2012 Lancet Paper

Meta-analysis of 27 statin trials, stratified by baseline risk.

JAMA Meta-Analysis – Statins in Primary Prevention

Found no mortality benefit from statins in low-risk patients.

Niacin and Statin Alternatives – JNRBM Review

Survey of other lipid-lowering therapies and their efficacy.

NNT Review – Statins for Low-Risk Individuals

Found minimal benefit and higher risk of side effects.

BMJ Open – Industry Bias in Statin Trials

Analysis of how pharmaceutical sponsorship shapes outcomes.

Dr. Kumar’s Review – Statin Effectiveness and Safety

A blog summary aligning with this podcast episode.

Dr. Kumar’s Blog – Cognitive Side Effects of Statins

Observational insight into brain fog and memory decline.

Mitochondrial Effects of Statins – Golomb 2006 Review

Review of mitochondrial dysfunction and muscle symptoms from statins.

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Thanks for joining me on this journey to cut through the noise and uncover the truth in medicine. I’ll see you in the next episode.