New Cholesterol Guidance Could Drastically Reduce Statin Use

Analysis by Dr. Joseph Mercola

• July 24, 2024

Story at-a-glance

• New American Heart Association guidelines could reduce the number of adults eligible for statin therapy from 45.4 million to 28.3 million, potentially improving public health by decreasing unnecessary statin use
• The 2023 PREVENT equations provide a more comprehensive cardiovascular risk assessment than previous guidelines, removing race as a factor and including additional health indicators like kidney disease and obesity
• Statins have been linked to various health risks, including diabetes, dementia, and cancer. The correlation between cholesterol levels and heart disease is weaker than commonly believed
• Statin drugs deplete CoQ10 levels in your body. Supplementation with CoQ10 or ubiquinol may be necessary, especially for statin users, with dosage depending on age and health status
• Improving gut health is crucial for heart health. Certain gut bacteria, like Oscillibacter, are associated with lower cholesterol levels and reduced heart disease risk. Maintaining a diverse gut microbiome is essential for overall health

Statin cholesterol-lowering medications are among the most-prescribed drugs in the U.S., but the number of people taking them may soon decline significantly. Based on previous guidelines, 45.4 million adults meet the criteria to take statin drugs, but if updated guidelines from the American Heart Association are adopted, this will drop to 28.3 million.¹

This is welcome news, considering statins don’t protect your heart and most people do not need these drugs to lower cholesterol. At the population level, it’s very possible that public health will improve if fewer people receive statin prescriptions, as they will wreck your health long term.

Past Statin Guidelines Increased Usage by 149%

The last cardiovascular disease risk calculator was released in 2013. Known as the Pooled Cohort Equation (PCE), it primarily estimated the 10-year risk for heart attack and stroke among people ages 30 to 79 to guide statin use.²

Following the publication of the 2013 statin guidelines, the number of people who used statins increased by 149%, from 37 million in 2012 to 2013 to 92 million in 2018 to 2019. Further, from 2008 to 2019, the annual number of statin prescriptions rose from 461 million to 818 million.³ Meanwhile, as statin use has risen, heart disease has remained the leading cause of death in the U.S. since 1921.

Deaths attributed to heart diseases have also been increasing from the later 2010s to 2020, according to the American Heart Association’s (AHA) 2024 Heart Disease and Stroke Statistics report.⁴

In November 2023, the American Heart Association (AHA) and American College of Cardiology (ACC) updated their guidelines for assessing cardiovascular risk, potentially leading to significant changes in statin therapy recommendations. In contrast to the 2013 guidelines, the 2023 AHA Predicting Risk of Cardiovascular Disease Events (PREVENT) equations provide a more comprehensive risk assessment.

Among the differences, the new calculator removes race and replaces it with an individual’s zip code to represent socioeconomic status. PREVENT also separates risk calculations for men and women and includes factors linked to heart disease risk, such as kidney disease, obesity and hemoglobin A1C,⁵ which provides information about a person's average blood sugar levels over the past two to three months. According to AHA:⁶

"The calculator estimates the risk of heart attack, stroke and — for the first time — heart failure. The equations are sex-specific and race-free, acknowledging that race is not a biological factor, and can include an index of social determinants of health.

This is the first risk calculator that combines measures of cardiovascular, kidney and metabolic health to estimate risk for cardiovascular disease. The calculator was developed using health information from more than 6 million adults, including people from diverse racial and ethnic, socioeconomic and geographic backgrounds."

Under New Guidelines, About 40% Fewer People Will Meet Criteria for Statins

A cross-sectional published in JAMA Internal Medicine suggests that, if the PREVENT equations are adopted into national guidelines, about 40% fewer people would qualify for statin drugs.⁷

The study, which analyzed data from the National Health and Nutrition Examination Survey (2017-March 2020), included a weighted sample of 3,785 U.S. adults aged 40 to 75 years without known atherosclerotic cardiovascular disease (ASCVD).

Researchers found that the mean estimated 10-year ASCVD risk using PREVENT equations was 4.3%, nearly half of the 8% risk calculated using PCEs. This difference was particularly pronounced among Black adults and individuals aged 70 to 75 years. The adoption of PREVENT equations could potentially reduce the number of adults meeting criteria for primary prevention statin therapy from 45.4 million to 28.3 million — a decrease of approximately 17.3 million individuals.

Among people currently taking statin drugs, about 4.1 million would no longer meet the criteria for the medications based on PREVENT, meaning health care providers may tell patients to stop taking them.

"The prior risk equations and the PREVENT equations that we focus on in this study really seek to give doctors and patients sort of a starting percentage to say, is it worth having a conversation about statins?" lead study author Dr. Timothy Anderson, with the University of Pittsburgh Medical Center, told STAT. "When we’re seeing risk rates cut in half, I think that really is something that’s likely to impact how doctors and patients talk about these meds."⁸

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Statins Aren’t the Answer for Heart Health

Even with new guidelines that slash the number of people eligible for statins, these mediations will continue to cause more harm than good for the majority who take them. Statin drugs have not derailed the rising trend of heart disease, and instead have put users at increased risk of health conditions linked to their use, such as diabetes,^9,10 dementia¹¹ and others, including:

• Cancer¹²
• Cataracts¹³
• Musculoskeletal disorders, including myalgia, muscle weakness, muscle cramps, rhabdomyolysis and autoimmune muscle disease¹⁴
• Depression¹⁵

Increased health risks aside, widespread myths about lowering your cholesterol with statins to improve your heart health still permeate modern medicine and drive inappropriate statin drug use. The Framingham Study, which began in 1948, involved 5,209 people from Massachusetts.¹⁶ It was instrumental in starting the myth that high total cholesterol is a major risk factor for heart disease.

However, the correlation only existed if cholesterol was over 300 milligrams per deciliter (mg/dl). "Very few people have total cholesterol that high," Dr. Aseem Malhotra, an interventional cardiologist consultant, explained on The Joe Rogan Experience.¹⁷

What also wasn’t widely publicized about the Framingham Study was what occurred in people who were in their 50s, 60s and beyond. In this age range, as cholesterol dropped, mortality rate increased. "So, the association of cholesterol and heart disease is quite weak, first and foremost," Malhotra says.¹⁸

Malhotra and colleagues conducted a study to determine if a correlation exists with lowering LDL cholesterol and total cholesterol and preventing heart attacks and strokes, and no clear correlation was found. "This is based upon randomized, controlled trial data, so this is the most robust evidence you can get," he says.¹⁹

Statins Deplete Your Body of CoQ10

Coenzyme Q10 (CoQ10) production in your body peaks around age 25 and then begins to decline. By age 65, your body typically produces only about half the amount it did at 25.²⁰ Aging isn't the only factor that can reduce CoQ10 levels; statin drugs are also known to deplete CoQ10.

Statins work by blocking an enzyme in your liver called HMG coenzyme A reductase, which reduces cholesterol production. However, this same enzyme is involved in CoQ10 production, leading to depletion. The reduction in CoQ10 may contribute to muscle-related side effects often associated with statins. It's also worth noting that LDL cholesterol, which statins aim to reduce, is a major carrier of CoQ10 in the bloodstream.²¹

So, if you’re taking statins, be aware that they deplete your body of CoQ10 and inhibit the synthesis of vitamin K2. Younger individuals can generally utilize CoQ10 supplements effectively, while older people may benefit more from ubiquinol, a more easily absorbed form.

If you're taking a statin, you may need at least 100 milligrams (mg) to 200 mg of ubiquinol or CoQ10 daily, or possibly more. It's best to consult with your doctor to determine the right dose for you.

Generally, healthier individuals may only need 30 mg to 100 mg per day, while those with health conditions might require 60 mg to 1,200 mg daily. If you lead an active lifestyle, exercise frequently or are under significant stress, you may benefit from 200 to 300 mg per day.

Gut Bacteria Linked to Lower Heart Disease Risks

To protect your heart health, you’re better off targeting your gut health than relying on prescription drugs. Evidence suggests an altered gut microbiome is involved in cardiovascular disease. Researchers from the Broad Institute, Massachusetts General Hospital and Harvard pinpointed certain gut bacteria that influence cholesterol levels, triglycerides, blood glucose levels and heart disease risk.^22,23

After analyzing bacterial genomes in stool samples, they found that bacteria called Oscillibacter were associated with lower cholesterol levels, lower triglycerides and glucose, and higher high-density lipoprotein (HDL). The scientists also revealed that Oscillibacter broke cholesterol down into smaller molecules that don’t raise heart disease risk.

"The reductions in cholesterol by Oscillibacter appeared to be related to genes for enzymes that break down cholesterol in the intestines. This might lead to less cholesterol making its way into the bloodstream," they explained.²⁴ In fact, improving your gut health is an essential part of avoiding heart disease, as a diverse and balanced gut microbiome is essential for overall health.

Fostering beneficial oxygen-intolerant bacteria, such as the important species Akkermansia, enhances your intestinal defenses and helps create an environment that supports general well-being. These beneficial bacteria break down dietary fibers to produce short-chain fatty acids (SCFAs), especially butyrate.

This compound nourishes colonic epithelial cells, strengthening the intestinal barrier. SCFAs also stimulate mucin production, forming a protective layer against harmful bacteria.

When oxygen-intolerant bacteria decrease, it can lead to increased intestinal permeability, often referred to as leaky gut syndrome. This condition allows toxins, undigested food particles, and harmful microbes to enter your bloodstream, potentially triggering systemic inflammation and chronic health issues.

Optimizing Your Gut Health Is a Key Strategy to Protect Your Heart Health

Oxygen-intolerant bacteria are essential for converting indigestible plant fibers into beneficial fats. They thrive in an oxygen-free environment, which requires adequate cellular energy to maintain. However, modern factors like seed oil consumption and exposure to toxins like endocrine-disrupting chemicals in plastics can compromise this energy production, making it difficult to maintain the ideal no-oxygen gut environment.

This can cause a shift from oxygen-intolerant to oxygen-tolerant species. Importantly, oxygen-tolerant bacteria produce more potent endotoxins. As a result, individuals with more oxygen-tolerant gut bacteria may experience stronger negative reactions to plant carbohydrates due to increased endotoxin exposure.

Many aren’t aware, meanwhile, that septic shock is a leading cause of death, and endotoxemia is often its underlying cause. In my view, the No. 1 cause of death, that exceeds heart disease and cancer, is endotoxemia resulting in septic shock, as what is written down on the death certificate is not necessarily the true cause of death.

Heart disease or heart failure, for instance, could frequently be a trigger for endotoxemia. Improving mitochondrial function and maintaining a healthy gut ecosystem are therefore instrumental in preventing heart disease.

In addition, if you’re interested in learning more about your individual heart disease risk, don’t rely on total cholesterol or LDL on their own. You can get a more accurate idea of your risk of heart disease with the following tests:

Omega-3 index	HDL/total cholesterol ratio
Fasting insulin level	Fasting blood sugar level
Triglyceride/HDL ratio	Iron level

The potential reduction in statin prescriptions, based on AHA’s updated risk assessment tools, further highlights the importance of personalized medicine instead of one-size-fits-all approaches. A holistic approach to heart disease prevention is necessary, as your heart health is not isolated but deeply intertwined with your overall well-being.

It’s important to consider not only certain conventional risk factors but also gut health, mitochondrial function and the complex interplay of various health indicators. This shift in perspective may lead to more effective, less invasive strategies for maintaining cardiovascular health and reducing heart disease risk in the long term.

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