You’ve seen the antacid TV ads. People (why are they usually dorky-looking men?) stuffing overflowing forkfuls of sugary, fatty, spicy, fiery, salty, bacon-y, cheesy, food-like substances into their mouths as if they’re in training for the Nathan’s Famous Hot Dog-Eating Contest on Coney Island. Luckily for these hungry guys, and thanks to the miracle of modern pharmaceuticals, the ads promise that just popping a magic pill before mealtime will let them pig out with heartburn-free impunity.
That’s what came to mind when I heard of a group of British cardiologists who proposed a radical (and, I hope, tongue-in-cheek) strategy to neutralize the risk of cardiovascular disease caused by those pesky unhealthy eating habits of ours. We just need to pop a statin drug, they say, before scarfing down that Big Mac – the so-called McStatin protocol.
Published in the prestigious American Journal of Cardiology*, the article called “Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices?” was remarkable, coming as it did from a bunch of people with the letters M.D. after their names.
These cardiologists suggested that fast-food restaurants such as McDonald’s could offer customers a statin – a family of drugs designed to manage blood cholesterol levels – to go with their meal, perhaps one that could be found alongside the salt, sugar, ketchup, and mayonnaise.
The statin, they say, could be sprinkled atop customers’ burgers to offset the slimy grease found in these unhealthy meals. (Burger fans in the U.K. can already purchase the statin called simvastatin 10 mg without a prescription; it’s been available there as an over-the-counter drug for the past six years).
This study precisely calculated, in fact, that one dose of a statin can offset the potential coronary damage from a Double Quarter Pounder and a chocolate shake.
But even as a joke, this idea is just not that funny.
Tom Naughton, filmmaker and author of Fat Head wryly observes:
“An article about this study (ahem, ahem) in Science Daily was so full of bologna, I ingested three days’ worth of saturated fat merely by reading it.
“Here are some quotes: ‘Statins reduce the amount of unhealthy LDL cholesterol in the blood. A wealth of trial data has proven them to be highly effective at lowering a person’s heart attack risk.’
“But what ‘wealth of trial data’ would that be, exactly?”
That ‘wealth of trial data’ would not have been included in a study of over 65,000 subjects published in the Archives of Internal Medicine, in which researchers found that, contrary to widely held belief (a belief strongly promoted by the pharmaceutical industry), statins do not drive down death rates among those who take them to prevent a first heart attack.**
But Dr. Darrel Francis of Imperial College London, a senior author of the McStatin report, told Michael O’Riordan in a Heartwire interview:
“I am not crazy, and I do not tell my patients that they can eat unhealthily and get away with it.
“We’re simply providing a calculation for the medical community to think about the size of the effect of a statin tablet vs an unhealthy meal, and to also consider the irony that you can have harmful condiments provided free of charge, in unlimited quantities, and yet people think this one simple, potentially protective additive would be crazy to add.
“I don’t know why they would think that.”
Despite the questionable nature of the study, Francis noted that individuals engage regularly in harmful activities, such as sedentary behaviour, unhealthy eating, or immoderate drinking – and can do so without consulting a doctor.
If these people want to make a healthy decision like taking a statin for primary prevention, that decision must get the doctor’s go-ahead.
I’m assuming that this strange question is merely rhetorical, so I don’t have to explain here the bleedin’ obvious to Dr. Francis.
Just like the clever industry-funded campaign for pre-emptive antacid use, there is of course a concern that patients reading his study might justifiably conclude that they can eat whatever they want without consequences.
Dr. Dariush Mozaffarian at the Harvard School of Public Health has taken on the McStatin proposal head-on, saying he disagrees with the approach for a number of obvious reasons, the first being that cardiovascular disease is caused by multiple risk factors. He told Heartwire:
“Dietary habits don’t just affect cardiovascular risk through LDL-cholesterol levels or even inflammation. Dietary habits affect cardiovascular risk through more than a dozen different pathways, including effects on insulin resistance, endothelial function, and other cholesterol particles. Diet also affects arrhythmic risks, as well as satiety and weight gain. The list goes on and on.
“To try to block two pathways, LDL cholesterol and maybe inflammation partially, and to think you’re blocking all of the adverse effects of diet is incorrect.”
Dr. Mozaffarian added that our diet influences more than our heart disease risk; what we eat also affects the risk of diabetes, cancer and obesity, among other adverse outcomes. He argued that even compliance with drug therapy, such as statins, remains low in the primary prevention setting.
Which brings us to the famous cardiac polypill concept that’s been floating around for a long time.
Dr. Mozaffarian believes that inconsistencies in the McStatin strategy are also applicable to this polypill idea – for example, patients taking the polypill were notoriously non-adherent (an adjective that some savvy doctors now use to avoid using the more offensive non-compliant label they have until now slapped onto those who stop taking the drugs they prescribe).
The polypill is a very “downstream” approach to prevention, he explained: a combination of aspirin, a statin drug to lower cholesterol, and several different drugs to lower blood pressure – a one-stop shopping spree for the primary prevention of heart disease in otherwise healthy adults. Instead, primary prevention of cardiovascular disease should be focused “upstream” to help more people reduce their risk of cardiovascular disease by advocating a healthy lifestyle.
Or, as Kentucky cardiologist Dr. John Mandrola , an outspoken opponent of the cardiac polypill, likes to say:
“Pills should never be the basis of preventing heart disease.”
Dr. Mandrola, a fierce advocate for the cardioprotective benefits of regular exercise and heart-smart eating, also says:
“If you don’t have heart disease, the best way to avoid getting it is so simple, so easy to understand, and so not up to your doctor.”
I’m guessing that he also means sprinkling pharmaceutical drugs of questionable efficacy onto your food is not a good idea.
Q: What’s your take on this McStatin proposal?
* Ferenczi EA, Asaria P, Hughes AD, et al. “Can a statin neutralize the cardiovascular risk of unhealthy dietary choices?” Am J Cardiol 2010; 106:587-592.
** Ray, Kausik et al. “Statins and All-Cause Mortality in High-Risk Primary Prevention”. Arch Intern Med. 2010;170(12):1024-1031. doi:10.1001/ archinternmed. 2010.182