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Generic Lipitor is not the answer to our heart disease epidemic

The cholesterol-lowering drug Lipitor (atorvastatin) is the best-selling drug on the planet. Nearly a million Americans filled their prescriptions the first week after it went generic this month. Over the past 25 years, this one drug raked in $100 billion in sales.

Although as a class, the statin drugs are remarkably safe, there is concerning new evidence I reviewed in my video Statin Muscle Toxicity that even people who don’t experience pain or weakness on cholesterol-lowering statin drugs may be suffering muscle damage, which may increase the risk of falls in older men and women. This is nothing, though, compared to the risk of elevated cholesterol, the primary risk factor for our primary cause of death, heart disease.

Is that our choice, though? Taking drugs for the rest of our lives to reduce the risk of damage to our heart muscle at the risk of damaging our skeletal muscles? No, according to the editor-in-chief of the American Journal of Cardiology, Dr. William Clifford Roberts. In my video-of-the-day on Wednesday, Heart Attacks and Cholesterol: Purely a Question of Diet, I profile his new editorial “It’s the Cholesterol, Stupid!”. “For the build-up of plaque in our arteries to cease,” Dr. Roberts writes, “it appears that the serum total cholesterol needs to be lowered to the 150 area. In other words the serum total cholesterol must be lowered to that of the average pure vegetarian. Because relatively few persons are willing to abide by the vegetarian lifestyle, lipid-lowering drugs are required in most to reach the 150 level.” He concludes: “Whether or not we are willing to alter our diet sufficiently and/or to spend the money necessary to obtain the lipid-lowering drugs, and then take them religiously to achieve this goal is up to us.”

In my Heart Attacks and Cholesterol videos on Monday and Tuesday, Dying Under Normal Circumstances and Agribusiness Sees It Differently, I cover new data from hundreds of hospitals on people admitted for heart attacks, suggesting that the current cholesterol guidelines are too lax. The average LDL (“bad cholesterol”) of those hospitalized was under 130, in the official normal range, but well above the LDL limit recommended by Dr. Roberts (under 60). Having a “normal” cholesterol in a society where it’s normal to die of heart disease is not necessarily a good thing.

In Convergence of Evidence, Dr. Dean Ornish talks about the advantages of choosing diet over drugs to reach cholesterol goals. Unlike statins, a plant-based diet can prevent and treat other chronic conditions such as diabetes and obesity at the same time. His research shows that living and eating healthy can actually change us on a genetic level, up-regulating disease-preventing genes and down-regulating genes that promote breast cancer, prostate cancer, inflammation, and oxidative stress. Drugs can’t do that, but diet can.

Cardiologists are realistic, though. They know not everyone is going to shift to a more plant-based diet, which brings us to yesterday’s video-of-the-day, Fast food: Do You Want Fries With That? Lipitor? “We envisage a future in which fast food restaurants encourage a holistic approach to healthy living,” wrote a group of prominent cardiologists. “On ordering an unhealthy meal, the food will arrive labeled with a warning message similar to those found on cigarette packets (‘This meal increases your risk for heart disease and death’), and on the tray, next to the ketchup, will be a new and protective packet, ‘McStatin,’ which could be sprinkled onto a Quarter Pounder or into a milkshake. This could easily be provided at no extra charge, just as sugar and salt.” That’s modern medicine’s idea of a “holistic” approach, drugs with every Happy Meal.

Others advocate for a more aggressive approach: the “polypill,” 5 drugs wrapped into one, a statin, three blood pressure medications—a thiazide, beta blocker, and an ACE inhibitor—and some aspirin. The balance of benefits versus risks of life-threatening side-effects continues to be hotly debated within the medical community. I’m sympathetic to the drug-pushers’ arguments. Look, we have filters on cigarettes for people who continue to smoke, why not have drugs for people who continue to eat unhealthfully? Though the ideal, of course, is for people to quit their bad habits.

In this morning’s video-of-the-day, Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero, I detail how to prevent heart disease naturally by avoiding the three things that increase bad cholesterol: 1) trans fats, which come mostly from junk food and animal products, 2) saturated fat, mostly from dairy products and chicken, and 3) dietary cholesterol, the leading sources being eggs and poultry. Any intake above zero appears to increase LDL cholesterol, so consumption of meat, eggs, dairy, and junk food should be as low as possible.

The highlight of my holidays is family. Some years it’s the only time I get to see all of them. Sometimes I worry it may be the last time. My great (in more ways than one) aunt Pearl is nearly 100. We need to inspire each other to live as healthy as possible to maximize the quality and quantity of the time we all have left with each other. I hope has helped your family in some small way this year. Blessings from my family to yours this holiday season with hopes for a happy, healthy new year.

-Michael Greger, M.D.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

25 responses to “Generic Lipitor is not the answer to our heart disease epidemic

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    1. I have been on a vegan diet for 9 months and my cholesterol is still over 200. I am not overweight, exercise everyday and do not eat junk food. So what can I do to bring it down?

      1. Keep your saturated fat intake to 5 grams or less, this would mean to watch your nut intake. Also, do not consume any oils. Even olive or canola oil. A low fat, whole foods plant based diet with exercise will successfully lower your cholesterol.

  1. Dr. Greger – what would you recommend for a patient whose cholesterol went UP, not down, on a vegan diet? Since I cut out essentially all animal products, my cholesterol has risen to 210 from the mid-180s, though my weight has gone down (to the low range of healthy for my height) and my blood pressure is normal. Am I consigned to 60-70 years on statins, even though by all accounts I am healthy (ran a marathon this year) and have no family history of heart disease, though I have a family history of high cholesterol?

  2. Generally when people cut out animal products their cholesterol’s drop. Total cholesterol = LDL + HDL + 1/5 Triglycerides. You didn’t note your LDL, HDL and Triglycerides which might help explain what is going on. Given that it is important to cut out all animal products… dairy, eggs and fish as I have had some patients continue those but assuming you are avoiding those some comments. Certain foods and fiber are important in holding cholesterol down so you should make sure your fiber intake is good see: is possible that you are consuming processed foods with high fructose corn syrup in many products including fruit juices(these can drive up Triglycerides which can elevate total cholesterol. I would make sure you eliminate those and carefully check the labels of any processed foods that you are consuming. There are patients who need to be on treatment for high lipids so you need to work with your physician(s). There are alternatives to statins for treating lipid disorders as statins have side effects not well appreciated by many physicians see: For information which might be useful for you in working with your physician you might want to check out Dr. McDougall’s website, click on “Hot Topics read more” link and read his newsletters on Cholesterol and Triglycerides. Good luck on your journey to improved health… sounds like you are making progress.

  3. Dr Greger – what does your great aunt Pearl eat? And I’d really like to hear what sort of food she ate in her early and middle years too! Thank you.

  4. A vegan doc told me there is a study that shows as the LDL is driven down quite low as some docs feel below 70 with a history is good medicine by the statins, they plug up with plaque faster and have heart attacks sooner.  I have a patient with Lipitor still at 20mg and the LDL was 48.
    Where is that study?

  5. I am 55 and have been a lacto-ovo vegetarian for over 30 years.  I have no risk factors such as hereditary, cholestrol, diabetes that are associated with heart illness yet I had a myocardial infarcation earlier this year.  Based on his research and knowledge the cardiologist put me on Lipitor to get my cholestrol below 70.  This is a value I don’t think is achievable even on a vegan diet.  What would you recommend?   What are the alternatives?

  6. Hi Eitan, I am a plant based MD who is helping Dr. Greger with questions like yours. I’m really sorry to hear about your heart attack – and, unfortunately, your story is common.  Check out this video: Most people understand that red meat is associated with heart disease – but, don’t realize that dairy is ‘liquid red meat’ – very high in saturated fat. It is possible to get LDL cholesterol levels down to your goal of <70 with a plant based diet – but, be very careful not to jump off your statin too quickly. Since you have already had a heart attack, chances are you have other arteries that are also near critical blockage or prone to plaque rupture. Read Dr. Esselstyn's book "Prevent and Reverse Heart Disease", or anything by Dr. Dean Ornish,

  7. Interesting that Dr. Joseph Mercola emphasizes the “paleo diet” which is high in animal protein, fats, vegetables and “paleo-carbs” and low in “neo-carbs” like grains and their products cultivated these past 10,000 years. […] There is now substantial empirical and clinical evidence to indicate that many of these deleterious changes are directly related to the predominately cereal-based diets of these early farmers. Since 99.99% of our genes were formed before the development of agriculture, from a biological perspective, we are still hunter-gathers.

    Thus, our diet should reflect the sensibilities of this nutritional niche: lean meats; fish; seafood; low glycemic vegetables and fruit, (modern agriculture has significantly increased the sugar and starch content of vegetables and fruits over their Paleolithic counterparts), nuts and seeds – the evolutionary diet. […]

  8. Hello,
    I am currently taking a fibrate to lower cholesterol. Does this have the same effect as a statin? If different, is one treatment method considered better than the other (i.e. statin vs fibrate)?

  9. I have heard many people say that cholesterol is not the cause of heart attacks, etc as commented by Boris earlier. what’s upwiththat? have you addressed this somewhere before? Could you direct me or plan something for the future? I really appreciate all the education you do. thank you so much!

    1. People will think and say a lot of things to rationalize unhealthy habits. But one doesn’t get much stronger epidemiological evidence for the correlation of cholesterol and cardiovascular mortality than this:

      Prospective Studies Collaboration, et al. “Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths.” Lancet (London, England) 370.9602 (2007): 1829-1839.

  10. Nathan Pritikin and Dr. Ornish could reduce total cholesterol in heart patients to about 170 mg/dl using only low-fat vegan or near-vegan diet. Dr. Esselstyn added lovastatin (and sometimes cholestyramine) to push cholesterol below 150 mg/dl, the magic number conferring virtual immunity to heart attack in the Framingham study, and his outcomes are better.

    I monitor TC bimonthly after blood donations, and for 3 years after adopting a low-fat vegan diet it remained stubbornly around 165 mg. Since, supplemental niacin (as immediate release nicotinic acid) has helped, and I’m almost at the threshold. I’m hoping further body fat reduction will help.

  11. I haven’t heard anything from Dr. Greger on CoQ10 which is thought to counter some of the muscle-related issues with statins. Statins prevent the production of this important enzyme. The studies are sporadic but the theory seem pretty solid. Why no mention???

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