Details of the 2020 Systematic Review
- Authors: Robert DuBroff, Aseem Malhotra, and Michel de Lorgeril.
- Published: August 4, 2020, in BMJ Evidence-Based Medicine.
- Objective: The review aimed to evaluate whether lowering LDL cholesterol (LDL-C) through various interventions, including statins, consistently reduces the risk of cardiovascular events (e.g., heart attacks) and mortality.
- Methodology: The researchers analyzed 35 randomized controlled trials that reported LDL-C reduction and cardiovascular outcomes. They assessed whether the degree of LDL-C lowering correlated with reductions in cardiovascular events or death.
- Findings: The review concluded that there was no consistent association between the extent of LDL-C reduction and a decrease in cardiovascular events or all-cause mortality. Specifically, they argued that statins’ benefits might not be primarily due to LDL-C lowering but could relate to other effects (e.g., anti-inflammatory properties). This challenges the conventional view that LDL-C reduction is the primary mechanism by which statins prevent heart disease.
- Implications: The authors suggested that the benefits of statins may have been overestimated, particularly for primary prevention (in people without existing heart disease), and called for a re-evaluation of cholesterol-focused guidelines.
Context and Controversy
- Dr. Malhotra has been vocal about these findings, often framing them as evidence of a “cholesterol con” perpetuated by pharmaceutical interests. He argues that lifestyle interventions (e.g., diet and exercise) are more effective and safer than statins for most people.
- This review has been controversial. Critics, including mainstream cardiology experts, argue that it contradicts large-scale evidence from trials like those analyzed by the Cholesterol Treatment Trialists’ (CTT) Collaboration, which show statins reduce major vascular events by about 25% per 1 mmol/L reduction in LDL-C. Critics also point out potential biases in the selection of trials and the interpretation of data in Malhotra’s review.