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American Heart Association’s Calculator Overestimates Need for Statins

Statin Drug

Story at-a-glance -

  • Cholesterol is necessary to optimal life and found in almost every cell in your body; it’s used to protect your nervous system, produce hormones and digest your food
  • The American Heart Association (AHA) developed an online tool used by consumers and physicians that is recommending statin medication using factors that are unsupported by research
  • Statin medications have been linked to a reduction in neurological and cognitive function, increased aggression and mood swings in women and calcification of your coronary arteries, increasing your risk of heart disease

By Dr. Mercola

Cholesterol is a wax-like substance found in almost every cell in your body, including your brain and neurological system. Your body requires cholesterol to make hormones, vitamin D, digest your food, protect your nerves and produce cell membranes.

Your liver produces much of the cholesterol your body requires from the nutrients you get from your food.

Like your own body, the cells of all mammals contain cholesterol, which means the fat cells in beef contain the same amount of cholesterol as the lean meat. In fact, most meat averages about 25 milligrams (mg) of cholesterol for every ounce.1

However, while the amount of cholesterol in your food is relatively stable, the amount you absorb from your diet varies between 25 and 80 percent, depending on your individual constitution.2 Your body regulates the amount you absorb based on the amount you lose in bile salts and how much is needed to maintain optimal health.

This may explain why eating cholesterol affects cholesterol levels differently in different people. Individual requirements are not taken into account in the guidelines developed to determine recommendations for cholesterol lowering drugs. The cholesterol ratios that best determine your risk are also not included in the equation.

Guidelines to Lower Cholesterol Linked to Big Pharma

Any time new guidelines are issued that may increase the number of prescriptions written by physicians, it is likely the drug companies that produce those pills will be weighing in on the decision making.

In a perfect world, health and wellness recommendations would be centered on the ultimate needs and benefits of the consumer, not companies that might benefit from the guidelines.

The authors of the new cholesterol guidelines declared conflicts of interest that should have removed them from either writing or voting on the guidelines, but didn't. Of the 15 panelists who authored the cholesterol guidelines, six revealed ties to drug companies that produced cholesterol-lowering medications.3

Of the 10 expert reviewers for the guidelines, five listed relationships with drug makers. In response to conflict of interest concerns while developing guidelines, the Institutes of Medicine updated their standards in 2011 to direct expert panels.4 Lisa Cosgrove, associate professor at the University of Massachusetts, said:

"When individuals have commercial ties they are vulnerable to developing subtle, but sometimes powerful, pro-industry ways of thinking. But the fact that so many panelists have ties is deeply problematic.

As you know, there's been a lot of discussion — professionally and publicly — about transparency, which can actually worsen the problem, because some people think simply disclosing a tie relieves any moral concern."

American Heart Association Clinical Calculator Overestimates Recommendations for Statin Drugs

A popular online tool produced by the American Heart Association (AHA) based on those guidelines has contributed to an increase in physician recommendations for statin medications. According to the American College of Cardiology, more than 7,000 people access the calculator every day.5

The tool, released by the AHA in 2013, uses your age, gender, blood pressure, total cholesterol, high density lipoproteins (HDL), race and history of diabetes to predict the likelihood you'll experience a heart attack in the coming 10 years.6

The recommendations are that those with a risk profile over 7.5 percent should take statins and those with a profile near 5 percent should discuss their options with their physician.

To compare these predictions against a group of people, researchers evaluated the medical records of over 307,000 non-diabetic individuals between 2008 and 2013.7

The results demonstrated the tool overestimated the number of people who would have a cardiovascular event by nearly 500 percent of the original number of participants.

Those whose risk was estimated to be between 2.5 and 5 percent by the tool had a 1.25 percent risk in reality. Those whose risk was measured above 5 percent by the tool experienced a 1.85 percent risk.8

The actual cardiovascular disease (CVD) risk was only close to the estimate made by the tool when the individual suffered from diabetes. Another study in 2015 concurred with the overestimation of cardiovascular risk potential by the calculator, finding the overestimation reached 86 percent in men and 67 percent in women.9

Although the study in 2015 included people taking statins, leading to criticism the statins were the reason for the reduction in CVD events, the first study excluded these individuals.

Although there are criticisms by heart groups for both studies, evidence continues to demonstrate U.S. citizens are being told they have a greater chance of facing CVD than they actually experience.

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Do Statin Drugs Really Prevent Heart Attacks?

Total Video Length: 16:54

In these two short videos I explain the history behind the cholesterol theory of heart disease. The effect statins have on your risk profile may not be the result of lowering your cholesterol, but rather from other lesser known effects of the medication.

Specifically, the modest reduction in inflammation and blood clotting statins have on your body may be the source of reduction in CVD risk in patients with a previous history of heart disease.

It seems that confidence in the ability of the pill to prevent disease may be at the root of rising prescriptions and patient requests for medication.10 However, the absolute benefit of using statins to prevent cardiovascular death is rather small, measuring one prevented death after 1,000 people take the medication for at least one year.11

Yet, while those statistics have been available since at least 2011, they have not been well publicized. In another review of 11 studies, researchers found no lives were saved from the medication, 1 percent developed diabetes and 10 percent developed muscle damage.12

Statins May Increase Your Risk of Heart Disease

Not only has the research not supported the use of statins to prevent CVD in an otherwise healthy population, research has found that the use of statins accelerates coronary artery calcification (CAC) and type 2 diabetes.13

A review of previous studies associated statins with calcification of the aortic and coronary arteries.14 Other researchers, finding the same CAC in individuals with atherosclerosis, claim:15

"These findings provide insight as to how statins may stabilize plaque beyond their effects on plaque regression."

The implication is that calcification of your coronary arteries and aorta is a step toward better heath. However, CAC reduces the ability of the arteries to function, and increases your risk of coronary heart disease and your risk of complications during heart surgery to repair the damage.16

Lowering Nutrient Levels Also Linked to Cardiovascular Disease

Statin medications also play a role in reducing the levels of nutrients in your body important in the prevention of heart disease and stroke. Two major nutrients affected by statins include vitamin D and coenzyme Q10 (CoQ10).

In the first case, vitamin D is created in your body using several precursors, one of which is 7-dehydrocholesterol.17 Statin drugs are designed to reduce the amount of cholesterol in your body, and thus affect the precursors to the development of vitamin D.

Research has demonstrated a reduction in muscle pain caused by statins through supplementation with vitamin D.18 Vitamin D also plays a significant role in the prevention of coronary heart disease, increasing risk for heart attack, congestive heart failure, peripheral vascular disease, strokes, high blood pressure and diabetes.19

CoQ10 is vital for energy production, especially in your muscle cells. A deficiency may result in muscle pain, fatigue and weakness.20 In a recent survey online, cardiologists recognized the nutrient value of CoQ10 but not that statins increase the risk of deficiency.21 Yet, for 25 years scientists have known statins lower your level of CoQ10.

Merck, then producer of lovastatin,22 applied for a patent in 1990 to combine their statin drug and CoQ10.23 However, although it appeared they recognized the effectiveness of combining the drug and supplement, they have not marketed the combination.

CoQ10 is an important component in the prevention of heart disease, and researchers have demonstrated that supplementation with the nutrient is safe, effective and beneficial.24,25 Symptoms of deficiency include heart failure, chest pain and high blood pressure.26

These Are the Cholesterol Numbers to Watch

Big Pharma wants you to use statin medications to reduce your total cholesterol to under 200 milligrams per deciliter (mg/dl). The AHA has also begun recommending treatment based solely on one part of your cholesterol numbers, namely your low density lipoprotein (LDL) levels.27

The reality is that neither your total cholesterol level nor your LDL tells the whole story. Your body is a complex organism that uses many different component parts to create a whole picture. Using only one number to estimate your potential CVD risk is highly improbable, no matter which number you choose.

Instead, I advocate looking at a number of different lifestyle factors that may help you develop a plan to improve your overall health and reduce your risk of CVD simultaneously. Overall the major risk factors for heart disease include:

  • Smoking
  • Metabolic disease, insulin resistance and type 2 diabetes
  • Obesity
  • Nutrient deficiencies
  • Cholesterol ratio imbalances

Use these ratios while evaluating your cholesterol levels for potential risk:

  • Your HDL to total cholesterol ratio should ideally be above 24 percent. If your ratio is below 10 percent it indicates a significant risk for heart disease. Divide your HDL by your total cholesterol and multiply the result by 100 to get your percentage.
  • Your triglyceride to HDL ratio is the second important number in evaluating your risk for CVD. Divide your triglyceride number by your HDL number and the result should ideally be less than 2.

Statin Use Linked to Reduction in Neurological and Cognitive Function

Multiple studies have linked statin use with a reduction in neurological and cognitive function, leading to poor health outcomes. Past studies have apparently supported a theory that statin medications protected individuals from developing Parkinson's disease (PD).

However, recent research has demonstrated the opposite effect.28 A previous study by senior author Dr. Xuemei Huang, vice chair for research at Penn State College of Medicine, demonstrated an increased risk associated with the use of statin medications. A new study to explore this finding was developed using a much larger cohort of participants.

The new study evaluated over 21,000 people identified as having PD. In their analysis they found using statin cholesterol-lowering drugs was associated with a higher prevalence of PD. Statins work in the body by blocking an enzyme responsible for producing cholesterol in the liver. This same enzyme also produces adrenal hormones, sex hormones and memory proteins.29 Huang said:30

"We identified 20,000 Parkinson's disease patients and looked at whether using statins was associated with a higher or lower risk, and we found people using statins have a higher risk of the disease, so this is the opposite of what has been hypothesized."

Although your brain represents less than 3 percent of your total body weight, it uses 25 percent of the cholesterol your body produces. An overall decline in memory, cognitive skills and a rise in the diagnosis of dementia has been noted in the past decade. However, researchers have discovered that the elderly with the best cognitive skills have higher levels of cholesterol.31

Reducing cholesterol levels in your brain may be damaging your future cognitive ability and increasing your risk for developing dementia. Every 66 seconds someone in the U.S. develops dementia, which is killing more people each year than breast and prostate cancers combined.32 Estimates are that mid-century a new diagnosis will be made every 33 seconds, doubling the number of people diagnosed with the disease.

Statin Use Also Linked to Other Health Problems

Statin drugs don't just cause neurological and cognitive side effects, but have also been implicated in the development of type 2 diabetes, damaging myopathies and mood changes. Johns Hopkins calls the immune-mediated myopathy rare and dangerous, yet cautions their patients to continue taking their statin medications.33

Researchers have found statins trigger a range of myopathies, from a serious autoimmune muscle disease that does not resolve after the medication is withdrawn, to statin-induced mild myalgia, which does resolve once the medication has been discontinued. The more dangerous and permanent immune-mediated necrotizing myopathy is responsive to long-term immunosuppressive therapies,34 which have their own list of side effects.

Statin medications reduce your level of LDL cholesterol in your blood and are associated with an increased risk of developing type 2 diabetes.35 Research published by the American Diabetes Association found the incidence of diabetes increases when the patient adheres to the medication schedule.36 This sparked thousands of lawsuits against drug makers.37,38,39

Further investigation has found the medication may also be causing aggression and mood swings in women. Over 1,000 people participated in a study that demonstrated men taking Zocor or Pravachol experienced reduced mood swings and aggression, but it increased those symptoms in women.40

Use Natural Methods to Normalize Your Cholesterol Numbers

Comparing the risk/benefit ratio of using statin drugs to reduce the potential for a heart attack, it appears you may want to strongly consider implementing lifestyle changes. Although it may be more challenging than popping a pill, the results come without the significantly dangerous side effects and potential risks associated with statin medications.41,42

As you consider your options for controlling your risk of heart disease, remember to evaluate the cholesterol ratios I discussed above as a means of tracking your results. These are four simple lifestyle changes you can use to start making an impact on your risk of CVD.

Vitamin C

When your blood vessel walls are not damaged, plaque cannot adhere and damage commonly associated with heart disease does not happen, no matter how much cholesterol is floating around in your blood. A study published in the American Journal of Cardiovascular Disease demonstrated that low vitamin C levels would trigger atherosclerosis and vascular damage.43

As you are unable to produce vitamin C, it must come from your food or supplements. Although your diet usually contains enough vitamin C to prevent scurvy, it isn't often enough to maintain stable arterial walls.44 Foods you may associate with vitamin C, citrus fruits, have been bred to be high in sugar to tempt the palate of the consumer. However, other foods high in vitamin C include dark colored berries, dark leafy greens, garlic and onions.

Insulin Resistance

Multiple studies have linked metabolic disease and insulin resistance to a significantly increased risk of developing CVD,45,46,47 even in individuals who are not diabetic.48 Insulin resistance is often fueled by your dietary choices. You can read more about this factor in my previous article titled, "Research Proves Causation — Sugar Consumption Increases Risk for Chronic Disease."

Optimize Vitamin D

The association between vitamin D deficiency and an increased risk of CVD has been studied for nearly a decade.49 Low vitamin D levels are associated with your geographical location, gender, weight, age and skin pigmentation.50 By following some simple recommendations in my previous article, "How to Get Your Vitamin D Within to Healthy Ranges," you can help to improve your own vitamin D levels and make an impact on your potential cardiovascular risk.


Aerobic physical activity has a positive impact on the "pathogenesis, symptomatology and physical fitness of individuals with dyslipidemia, and to reduce cholesterol levels" according to research published in Sports Medicine.51 Exercise significantly impacts your triglyceride levels,52 just one predictor of metabolic disease and CVD.

In my previous article, "The Exercise Mistake Which Makes You Age Faster," I explain why the aerobic exercise you choose may slow your aging process or speed it up and how you can choose the right program for your individual lifestyle the Heart

+ Sources and References