My mom went to the doc yesterday. As a Type 2 diabetic who controls it pretty well, she nonetheless still does regular visits. She's very low-carb Paleo-ish, and while she was able to be off insulin for a time completely, still finds she needs very small doses now and then.
To the endocrinologist's credit (a new doc), she did acknowledge being impressed with my mom's diet and supplement regime. But there was one little problem: mom's total cholesterol is 217. The doc asked her if she wanted cholesterol lowering meds. But my mom reads this blog and was thus prepared, indicating that for women, higher cholesterol is associated with increased longevity (lowest all-cause mortality and not just an overly reductionist tunnel vision, zeroed in on cardiovascular mortality).
But the doc retorted with something I can't recall reading or hearing about, specifically. She asked my mom if the studies and information she's relying on concerned women with diabetes and not just a general cross-section, as diabetes is associated with twice the heart disease and stroke as for non-diabetics (according to the doc).
Hmm.... So I did some initial digging around. I ended up writing this in a reply email.
The problem is: what level of diabetes? You control yours pretty well, so there is no comparison between you and someone who doesn't.
There is ZERO benefit to lowering cholesterol, especially in women (indeed, the greater chance is it's harmful). Cholesterol doesn't cause heart disease; inflammation does and this is how statins, when they work, work. But keeping grains, legumes, sugar, and vegetable/seed oils out of your diet has an even more anti-inflammatory influence I suspect. Actually, it simply allows your body to go back to its natural, non-inflammatory state.
I added links to an article by Dr. Duane Graveline at Spacedoc, as well as Chris Kresser's 2-part video series on statins at The Healthy Skeptic. The problem is, neither of those seemed to address the issue specifically, and moreover, there's this quote from the first link.
The fact that there is no statistically proven cardiovascular benefit from the use of statins for cholesterol reduction in women was first publicly disclosed by Uffe Ravnskov in his book, Cholesterol Myths and has been corroborated repeatedly by numerous longitudinal clinical studies.
The ASCOT study, the largest randomized clinical study of statin effectiveness in women, found that the women who took Lipitor, developed more heart attacks than women in the group given placebo.
While not statistically significant this finding hardly supports cardiovascular benefit. In this ASCOT study, 2,000 women were included among 10,000 patients having elevated blood pressure and at least three other cardiovascular risk factors.
Again and again, clinical studies have failed to show that the use of statins lowers cardiovascular risk in women who do not already have coronary heart disease or diabetes.
So just when you think it's all settled, there's that D word, right at the end. This is off the top of my head but as I recall, statins have only been shown statistically beneficial to men who have had a previous coronary event (statins reduce the rate of subsequent events). But is there another category of benefit out there I don't know about?
So I did more digging and came up with this:
Aims To determine whether patients with diabetes without prior myocardial infarction (MI) have the same risk of total coronary heart disease (CHD) events as non-diabetic patients with previous myocardial infarction.
Methods Using MEDLINE, EMBASE, Cochrane and MeSH in this systematic review and meta-analysis, extensive searching was carried out by cross-referencing from original articles and reviews. The study consisted of cohort or observational studies with hard clinical endpoints, including total CHD events (fatal or non-fatal myocardial infarction), stratified for patients with diabetes but no previous myocardial infarction, and patients without diabetes but with previous myocardial infarction. Studies with less than 100 subjects, follow-up of less than 4 years and/or without provisions for calculating CHD event rates were excluded. The review of articles and data extraction was performed by two independent authors, with any disagreements resolved by consensus.
Results Thirteen studies were included involving 45 108 patients. The duration of follow-up was 5–25 years (mean 13.4 years) and the age range was 25–84 years. Patients with diabetes without prior myocardial infarction have a 43% lower risk of developing total CHD events compared with patients without diabetes with previous myocardial infarction (summary odds ratio 0.56, 95% confidence interval 0.53–0.60).
Conclusion This meta-analysis did not support the hypothesis that diabetes is a ‘coronary heart disease equivalent’. Public health decisions to initiate cardio-protective drugs in patients with diabetes for primary CHD prevention should therefore be based on appropriate patients’ CHD risk estimates rather than a ‘blanket’ approach of treatment.
So on the one hand, statins are of no benefit to women, even those who have had a previous coronary event (unlike for men), and on the other, even men & women with diabetes who have never had a coronary event are far less likely to have one than non-diabetics who've had one.
While that's not a direct study of the question (do statins lower coronary events in women with diabetes?), putting 2 and 2 together seems to imply to me that given the rate of serious side-effects experienced by those on stains, combined with what seems like a very dubious benefit to a woman with well controlled diabetes, equals not much reason to take them and lots of reasons not to.
Anyone have anything contrary, or better. Either way.