No, they do not. Statin drugs have zero impact on the 25% per year increase in CT heart scan scores.
A CT heart scan that yields a coronary calcium score is the best test available to determine cardiovascular risk—far better than useless total cholesterol values, better than the wildly inaccurate and semi-fictitious LDL cholesterol, detects coronary atherosclerosis years before it becomes detectable by a stress test, and reveals coronary atherosclerotic plaque before symptoms—such as heart attack—appear. In other words, it empowers you in your efforts to prevent heart attack and avoid need for procedures such as stents or bypass surgery.
Let’s say you get your coronary calcium score because, as a male at age 49, you are concerned that you might follow in your father’s footsteps who had a heart attack at age 53. You feel fine, exercise regularly, and take no prescription drugs.
Your heart scan score: 500. You are told that this puts you at increased risk for heart attack of about 5% per year. Your doctor tells you that you are a “walking time bomb” and that you must take a cholesterol-reducing drug, aspirin, a beta blocker drug, and cut the total and saturated fat in your diet, what my colleagues call “optimal medical therapy.” He also refers you to a cardiologist who advises you that you need a nuclear stress test (e.g., stress Myoview, Cardiolite, thallium) or CT coronary angiogram (a non-invasive angiogram performed on the same device that performed the heart scan). You opt for the nuclear stress test and pass. The cardiologist then suggests that you should consider the “real” test, i.e., a heart catheterization in which catheters are inserted in the arteries and an angiogram is performed to assess whether you need stents or bypass surgery.
What if you did nothing, but repeated the heart scan one year later? The score will be 25% higher: 625. A year after that: 781. As the score increases, so does your risk, such that a score of 1000 or greater carries around a 10-15% per year risk of death or heart attack. Obviously, something must be done. If nothing is done, CT heart scan scores increase at the average rate of 25% per year until catastrophe strikes.
What if you follow the advice of your primary care doctor and take Lipitor 40 mg per day, aspirin, metoprolol, and reduce fat? How rapidly will your heart scan increase? 25% per year—“optimal medical therapy” has no impact on the rate of progression of coronary calcium scores. This has been demonstrated repeatedly in clinical studies. Unfortunately, intensive marketing efforts of statin drug manufacturers trumps clinical studies and doctors commonly force statin drugs on their patients with positive heart scan scores. “Optimal medical therapy” can reduce the abrupt rupture of atherosclerotic plaque that causes heart attack by a minor degree over several years, but it has no impact on progression of disease as tracked by CT heart scans.
But there’s more wrong with this common medical scenario. Among the problems:
- Stress tests are almost never abnormal in this situation, i.e, an active person who exercises without limiting symptoms. It can serve a purpose, e.g., assess the safety of exercise. But the reason that nuclear stress tests (i.e., stress tests that including imaging of the heart with a radioactive material and thereby exposes you to about 300 chest x-ray equivalents of radiation, all internally) are preferred is that they pay better. A stress echocardiogram is a non-radiation form of stress testing that is at least as helpful as nuclear stress tests, but pay only about 25% of the fees of a nuclear stress test. You should ALWAYS insist on a stress echocardiogram before undergoing exposure to radiation that you cannot undo.
- A CT coronary angiogram, while it yields beautiful images, is unnecessary. Why is it performed? CT coronary angiography is notorious for overestimating the severity of blockages and provides a way for the cardiologist to strong-arm your way to the cath lab. A 70% blockage is detected, say, in the left anterior descending artery by CT coronary angiography that your doctor describes as a “widow maker,” who then frightens you into a heart catheterization. “Good news: the blockage is only 30%. Just take your Lipitor.” This happens everyday. The substantial fees of performing a CT coronary angiogram followed by heart catheterization are the motivating forces.
- Heart catheterization and prophylactic stent placement or bypass—This has been clearly shown in clinical studies to be of NO benefit. Taking someone who has no symptoms, is active, and install stents does not prevent heart attack, does not prevent sudden cardiac death, has zero impact on health except to expose you to substantial hospital costs and procedural risks. Yet this is done all the time.
So what should you do if you find yourself in this situation? This is what the Undoctored program is all about. Before I called it “Undoctored,” we called it “Track Your Plaque” because the program was built on tracking CT heart scan scores over time. And the program succeeds in the majority in stopping the progression or even reversing the score. But you will not find statin cholesterol drugs, aspirin, or advice to reduce dietary fat. You will find strategies such as wheat/grain elimination that prevents the formation of small LDL particles and reduces the flood of postprandial lipoproteins, vitamin D that reduces inflammation, iodine and thyroid optimization that removes the contribution of thyroid dysfunction to cardiovascular risk, magnesium replenishment for its effects on blood pressure and insulin, and efforts to cultivate a healthy microbiome. You can find more extended discussions on the how’s and why’s of this program in the Undoctored book and in our Undoctored Inner Circle website.