Five years of daily statins extends life by an average of 3.2 days for people with no diagnosed heart disease and 4.1 days for those who already have it. Those figures sit underneath Pfizer’s advertised claim that Lipitor “reduces risk of heart attack by 36%,” a relative number resting on a 1.1 percent absolute difference, and underneath the Heart Protection Study press release that promised a thousand lives saved every week. In A Statin Nation (2018), Malcolm Kendrick works through the trials that built the cholesterol hypothesis and finds the same result repeating. Drugs that drove LDL lower than statins ever managed produced no reduction in deaths. In the FOURIER trial of the PCSK9 injection evolocumab, 251 people died of cardiovascular causes on the drug and 240 on placebo, and total deaths ran 444 against 426.
Kendrick is a Scottish-born general practitioner working in Cheshire, a graduate of Aberdeen University, and the author of The Great Cholesterol Con (2007) and Doctoring Data, a dissection of how trial results are presented to doctors and the public. He writes as a clinician who has watched patients regain the ability to stand and walk after stopping statins, and as a member of The International Network of Cholesterol Sceptics, founded by the Swedish physician Uffe Ravnskov. By his own account, the arrival of statins briefly made him reconsider his rejection of the cholesterol hypothesis. He co-authored a BMJ Open review finding that people over sixty with higher LDL live as long as, or longer than, those with lower levels; it was the journal’s most-read paper for five consecutive months and drew a public rebuttal from Oxford’s Colin Baigent. Steven Nissen, among the most prominent figures in American cardiology, answered Kendrick and his colleagues in JAMA with an article titled “Statin Denial: An Internet-Driven Cult With Deadly Consequences.”
The book arrived as the treatment net was being thrown wider. UK guidance had cut the ten-year risk threshold for statins from 20 to 10 percent, a change the British Medical Association’s GP conference rejected unanimously, to no effect. In 2017 the American Heart Association redefined hypertension as a systolic reading of 130, reclassifying about half the population, and issued a Presidential Advisory against saturated fat. PCSK9 injections had been approved in 2015 at around $14,000 a year, and within two years the stated prevalence of familial hypercholesterolemia, their target market, had doubled from 1 in 500 to 1 in 250. A Lancet paper had declared statin side effects a nocebo phenomenon. Much of what contradicted this consensus was already on record and had been set aside: Framingham’s own 1987 finding that falling cholesterol predicted higher mortality, John Yudkin’s 1972 warning about sugar, the Sugar Association’s 1964 payment to Harvard researchers to blame fat, and G.C. Willis’s vitamin C experiments from nearly sixty years earlier.
Kendrick writes from inside conventional medicine, and his evidence converges with the terrain principle that the body repairs itself: he describes infarcted heart muscle as a tightly controlled conversion to scar tissue, and the macrophages found in plaques as cleaners arriving to remove them. The full summary sets out Willis’s finding that guinea pigs deprived of vitamin C developed human-type plaques within days, which disappeared within days once vitamin C returned. It traces how IMPROVE-IT nearly doubled its enrollment mid-trial, kept its revised calculations secret, recorded 1,215 deaths against 1,231, and still lost an FDA advisory vote 10 to 5. It examines the 1985 study of familial hypercholesterolemia in which patients with heart disease and those without had the same lipid levels and differed in their clotting factors. The largest trial ever run on replacing saturated fat with vegetable oil found that every 0.78 mmol/l fall in cholesterol carried a 22 percent higher risk of death; its data spent decades in a garage, and its lead researcher was Ancel Keys.
Other Books by Dr. Malcolm Kendrick
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