Though it is widely assumed that statins work by lowering cholesterol, other pills that also lower it, ezetimibe, for instance, show no benefit. So what is the extra ingredient that purportedly causes statins to reduce heart events?

Statins alone decrease heart “events” in some groups of people. There has been no overall benefit shown on any group though. They do reduce heart attacks, though increasing cancer and adult onset diabetes. As far as mortality goes, it’s about a tradeoff. Less cardio deaths, but an offsetting amount of other deaths. But why, exactly, do statins reduce heart attacks? Interestingly, the answer isn’t really known. It was assumed that they worked by reducing cholesterol. But this doesn’t seem to be the case.

Reducing Cholesterol Alone Does Not Prevent Heart Attacks

Many people do not tolerate statins well. The drug industry’s response was to develop a drug that reduced cholesterol, and cholesterol alone. And they succeeded! The drug was call ezetimibe, and hailed as a breakthrough drug, and the statin replacement. Such mirth was premature. Ezetimibe did indeed lower cholesterol, but it caused no decrease in heart events, and a 50% increase in cancer.

Amazingly, ezetimibe is still widely prescribed, as the idea that cholesterol causes heart attacks is so firmly grounded that physicians will prescribe to that end in spite of hard evidence they are harming their patients. (They are well meaning, don’t get us wrong, but they are acting on beliefs, not science.)

Despite the strongly held beliefs, the idea that cholesterol causes heart attacks is under considerable question in research circles. However, one well established fact at this point is that low cholesterol is strongly associated with Alzheimer’s. Now, as we are ever fond of saying, correlation is not causation. If it were, it would mean statins cause Alzheimer’s. As it is, we don’t know. We do know that statins cause adult onset diabetes (50% higher), and that adult onset diabetics have triple the rate of Alzheimer’s, so the dots are there, and seem to be starting to connect.

But how do statins work?

How do they reduce heart attacks? With cholesterol reduction apparently not the reason, researchers looked elsewhere. Statins appear to have anti-inflammatory properties. Baby aspirin, also anti-inflammatory, has about the same benefit as statins. So perhaps it was that property. (Peanuts also work as well as statins. You can read about all three here. )

However, it seems the mechanism that statins use is far more sinister than simple anti-inflammation. Researchers at Tulane University have discovered that statins appear to act on mesenchymal stem cells (MSCs). These amazing cells are produced in the bone marrow, and can differentiate (morph) into a very large variety of cells. For example, they can become cartilage, they can become arterial lining, and, important to the situation at hand, they can become immune cells. From the study:

“In this study, the Tulane research team found that long-term statin use prevented MSCs from turning into macrophages, which could decrease inflammation and improve plaque stability in patients with cardiovascular disease. However, statins also prevented MSCs from becoming bone and cartilage cells. Statins increased aging and death rate of MSCs and reduced DNA repair abilities of MSCs. “While the effect on macrophage differentiation explains the beneficial side of statins, their impact on other biologic properties of stem cells provides a novel explanation for their adverse clinical effects,” Our emphasis.

“The risks of statin use are associated with statins’ negative effects on stem cell function, according to the researchers. Statin therapy benefits individuals with atherosclerosis, but because of its effects on stem cells, it may not be appropriate as a preventive measure for those who do not have cardiovascular disease. Again our emphasis.

In atherosclerosis (hardening of the arteries) gunk, composed of fat and sugar products, gets behind arterial walls. If severe, this leads to heart attacks and strokes.

Immune cells invade these polluted regions and attempt to mop up the mess. However, if the junk product continues to pile up, and the Western diet is a major cause of this, then the immune cells become overloaded. It seems that the immune cells aren’t really equipped to deal with such a mess. Statins apparently curtail the production of such immune cells. This reduces the number of immune cell, but leaves a mess unattended. A questionable improvement. But that’s not the point.

We Don’t Want Our Immune Cells Restricted!

Restricting immune cells is a horrible idea. The immune system is our front line against cancer. If the immune system is compromised sufficiently, cancer is almost a sure thing. Plus, those MSC cells are helping out in tissue repair all over the body. Are statins fouling this up too? It would be more clever than likely of the statins to avoid this, so we suppose this risk is there as well. We already know that statins impair mitochondrial functioning so we will let Alfred E. Neuman have his say, “What, me worry?”

There is a better way of dealing with arterial plaque than trying to turn down the immune system. A proper diet alone will pretty much stop the buildup. Exercise will actually remove arterial plaque. See here for how all this works.

Yet again, a pill gets into widespread use without understanding its long-term consequences, and, astonishingly, without even understanding how it works.

We often wonder how certain drugs like statins, beta blockers, and ezetimibe get into such widespread use in spite of the apparent lack of benefit.

Of course, there was a time when learned practitioners applied goat dung to open wounds. It must have been obvious then that this wasn’t effective. But the belief that it ought to work apparently carried the day. We wonder how our era will be viewed, at least when it comes to preventive pharmacology.