Statins are among the most widely prescribed drugs in the world. Yet many report serious side effects and a US survey revealed that 75 per cent of respondents stopped taking them within a year.
So what is the evidence for their benefits? Dr Aseem Malhotra, author of the bestselling The 21-Day Immunity Plan and co-author of the bestselling The Pioppi Diet , examines the claims for statins and their role in lowering cholesterol and preventing heart disease. He introduces us to his targeted heart-health plan, which, with a diet plan, recipes and advice on reducing stress and increasing movement, can help us to live statin-free and take control of our own health.
I love this book. My doctor put me on statins in 2005 right after I had open- heart surgery. I bought the big lie and stayed on statins for 16 years. Over that period of time, my heart problems went from bad to worse. The take home from this lesson is that Statins do not protect you from heart disease. In 2021, against my doctor's orders I stopped taking Statin drugs. During the past 5 months my health has improved dramatically. I lost over 40 pounds by adopting the Keto meal plan by eating only two meals a day and cut sugar from my diet. AND I FEEL GREAT!
The first sentence in the Foreword written by Dr Ross Walker Consultant Cardiologist is: “Your genes load the gun, but your environment pulls the trigger.” I liked the follow up sentence a few lines down, “But we are the master, not the victim, of our genes.”
Dr Walker recommends these five principles: 1. Quitting all addictions 2. Cultivating a good-quality sleep habit 3. Following sound nutritional habits 4. Performing 3 to 5 hours of moderate exercise per week 5. And most importantly, nurturing peace, happiness and contentment in your life.
Overall, the message is that to enjoy good health you need to invest time and effort into maintaining a healthy lifestyle. It’s much easier to pop pills but the effort is worth it.
In the Introduction the author writes of how, “the four-decade campaign to curb heart disease by lowering cholesterol through diet and drugs has sadly failed,” and explains how little is truly understood about cholesterol and the part it plays in heart disease and how overprescribed statins are. As patients we need to question what we are being prescribed and why and ask whether the benefits of a drug outweigh the side effects. The pharmaceutical industry is driven by financial gain rather than patient health.
Ultimately, I am responsible for myself, and I am the one who will live with the consequences of any medical decision, so it is worthwhile to consider carefully the options before me. I was motivated to pick up this book as I was sure my doctor was going to recommend a statin when my test results came back in the high range for total cholesterol. However, my doctor ordered a more granular test and my results fell in the acceptable range, thankfully.
Chapter 1: The great cholesterol con. Key point: Statins have been prescribed to many millions of patients, however there is no proof that they have had any effect on reversing the high rate of deaths from heart disease.
Chapter 2: What is cholesterol and how is it related to heart disease? Believe it or not, this was an interesting chapter, and I learned that “the best predictor of heart disease is in fact reached by looking at the total cholesterol divided by HDL, in order to produce a ratio.”
Chapter 3: What is the evidence for lowering cholesterol? The short answer is none. I learned that “there is no consistent correlation between lowering LDL cholesterol and reduction in heart attacks, and that in fact it could even prove harmful. Additionally, “LDL cholesterol plays a crucial protective role in the immune system” and a higher LDL means a longer life in the over 60s.
Chapter 4: Statins and their side effects. A case study is included in this chapter. Side effects are common and about 50% of people taking a statin will experience them. Statins effect the entire body, however “the most common side effects are muscle pain and fatigue.”
Key point: for someone without heart disease the benefit of taking a statin “is less than 1-in-100 for preventing a non-fatal heart attack or stroke over a 5-year period with no life extension,” and for someone with heart disease, “the benefit is 1-in-39 for preventing a further heart attack and 1-in-38 for delaying death.”
Chapter 5: What actually causes heart disease? Heart disease is common; we all know someone who has experienced it. A heart attack involves a disturbance of the electrical system of the heart and can cause the person to lose consciousness, whereas in a cardiac arrest their heart stops beating altogether and it needs to be restarted. Sometimes a heart attack leads to cardiac arrest.
Key points: The majority of heart attacks occur “at blockages that are not severely narrowed.” To truly reduce your risk of having a heart attack, change your lifestyle to correct insulin resistance, as “heart disease is a chronic inflammatory condition fueled by insulin resistance.”
Chapter 6: The coronary calcium score: a new hope for the detection and management of heart disease. “Coronary calcium is the most validated predictor of heart attack and stroke in the medium to long term.” Coronary calcium is the plaque that may line the arteries and can cause narrowing, or even a blockage, increasing the possibility of a heart attack.
Key point: statins are not an effective aid in lowering someone’s calcium score.
Chapter 7: Diet and heart disease. Following the Mediterranean diet, “consuming extra virgin olive oil as the main source of fat, an abundance of whole fruits and vegetables, oily fish, nuts and seeds and dairy from cheese and yoghurt” provides the most benefit against heart disease.
Key points: “heart disease is a chronic inflammatory disorder influenced by metabolic risk factors.” Also, “ultra-processed foods and low-quality carbohydrates consumed in excess worsen insulin resistance.”
Chapter 8: Exercise and heart disease – what is the optimal amount? “Exercise is not effective for weight loss and you can’t outrun a bad diet.”
Key point: “150-300 minutes weekly of moderate activity, such as walking, cycling or swimming, is best for preventing heart disease.”
Chapter 9: Stress: the not-so-silent killer. “Stress can be defined as ‘a mental state in which the internal and external pressures exceed the inner strength (coping mechanisms) leading to sympathetic over-activity and the release of stress hormones, which in turn triggers a vicious cycle of mental and physical disease.’”
Key points: chronic stress has an equal value of risk as high blood pressure or type 2 diabetes. Reducing stress decreases the risk of heart disease. High stress is usually a result of work or relationship challenges.
Chapter 10: Can heart disease be reversed? “It takes more to reverse disease than it does to prevent it” – Dean Ornish, Clinical Professor of Medicine, University of California, USA, 2001.
Key points: “heart disease can be stabilized, and potentially reversed, with a combination of diet and lifestyle changes.” Statins are not an effective tool for slowing the progress of heart disease. Addressing insulin resistance and reducing stress is the best strategy for reversing heart disease.
Chapter 11: The heart-disease prevention plan. This chapter includes a 28-day plan for lifestyle change. It takes several weeks to break an old habit and imprint a new one. The plan includes information on eating, moving, breathing, socializing, and sleeping.
Chapter 12: What do I do after 28 days? “If the plan is going well and you’re starting to see results, just carry on.”
Brilliantly informative analysis supported by data. Personally I think this a “must read” for anyone with high cholesterol, heart disease or a family history of either. Not only does Dr Malhotra set out the case for the ineffectiveness of statins but he also tells you what you can personally do to decrease your risks of suffering a shortened or limited life.
worth the read… very educational regarding heart health. Including lots of researched information for many scenarios (including People with genetically very high levels of LDL cholesterol diagnosed with FH familial hyperlipidaemia)~ definitely recommend
Use of statins is different for people who have experienced a heart attack and this book touches on that as well
end of each chapter is summarized with key notes presented w/bullet points
explains statins, including how they work, historical use & current data
also explains cholesterol, it’s role in our bodies etc. *”rather than looking at total cholesterol levels, the best predictor of the risk of heart disease is in fact reached by looking at the total cholesterol divided by HDL, in order to produce a ratio”
particularly interesting is the discussion on metabolic syndrome/ insulin resistance
AND… “ LDL cholesterol has an important role in the immune system and likely protects against death from some infections” including cancer and The higher the LDL cholesterol in people over age 60, statistically the less likely they were to die based on a study of over 70,000 people
Note: optimal metabolic health (including Low levels of insulin and a normal waste circumference achieved through diet and lifestyle) means the risk of developing heart disease is markedly reduced
includes a 28 day nutrition plan w/many options and lots of recipes
Essential reading .. Big Pharma doesn’t want you to get you healthy and Big Food wants to keep you hungry … heart disease beckons .. all avoidable if you read this book
There is a lot of anti-statin propaganda in this book. The first half of the book goes into great detail the conspiracy to make statins the default for any cholesterol issue. But I've already taken statins and hated the fatigue and ache they caused.
So I skimmed the first half of the book that showed the evidence to argue against statins. When I got to the solution I found it to be 1/2 hour of moderate exercise (walking) and the Mediterranean Diet. That's it. The second half of the book is filled with recipes to create an adequate nutritional plan.
EDIT: Update. My electrolytes had been testing very high, so a cardiovascular specialist prescribed 2-1000mg capsules of Omega 3 twice per day. Yep. 2 grams of Omega 3 twice per day to get the fish oil I would have needed from the Mediterranean Diet. My electrolytes plummeted back to normal which pulled my cholesterol back down to the safe level.
For anyone concerned about their health this is an easy read with some very great clues on how to understand what your doctor is telling you. Makes me happy I said no thanks to the statin my doctor offered me.
Big Pharma should be in prison. Informed consent should be the bare minimum requirement before a doctor starts you on any type of medication. Do the doctors not know, or is it the path of least resistance? Thank you so much!
The reason I'm giving the book 4 stars instead of 5 is only because the second half of the book is simply a diet plan and a collection of recipes which would have made more sense to publish separately in an accompanying volume for those who are interested, much like other authors have done with similar nutrition books. Not only that, but the diet plan and recipes are weirdly an exclusive regimen of Indian food: Indian breakfast, Indain lunch, and Indian dinner. I know the author is Indian and he's proudly sharing his culture and showing us how what he specifically eats works, but maybe a more culturally-neutral diet plan would have made more sense where he states the product but not a specific preparation method. Also, what matters is the principle behind food choices, not a specific list of recipes, which confuses more than helps, as well as take over half the pages in the book.
Having said that, the first half of the book is brilliant in that it is able to succintly state the problem with statins backed with plenty of evicence, which essentially boils down to ineffectiveness and negative side effects. He patiently explains concepts such as relative risk that allows the reader to understand why the way statins are presented by doctors and the press can be misleading. He also introduces another way of understanding doctor-patient relationships whereby the patient is informed of the exact risk that not taking a given pill represents and compares it to the drawbacks of taking it and then decides freely, as opposed to a doctor dictating what to take and fear-mongering the patient into compliance.
If the author were to print a new edition, I would suggest dropping the diet plan & recipes and slightly extending the debate on statins, as it was really interestinng and I was left longing to know more.
Has your doctor said that your cholesterol is high, so you need to take statins to avoid a heart attack? And if you’re already on statins, are you experiencing muscle pain and fatigue? Dr. Malhotra explains that for most people, high cholesterol alone may not pose a significant risk for heart disease, and he questions the studies that have made statins so widely prescribed. Lowering the ‘bad’ cholesterol will not reduce the likelihood of a heart attack, and most people won’t benefit from taking statins. He examines the roles played by poor diet (he includes recipes in his ‘Heart Disease Prevention Plan’), exercise, and particularly stress, and stresses the importance of ‘shared decision making’ between doctor and patient to assess both benefits and risks of treatment. As is common with this type of book, I give it only 3 stars, since I have no medical expertise. That being said, this agrees with other authors I’ve read, and is important reading for anyone taking statins, or simply evaluating their own heart health.
I recently had statins offered by my GP because my cholesterol level was slightly raised. I did some reading around the subject, and was interested to find this book which expresses doubt about the benefit of statins for many people. It's a controversial topic, and there are many diametrically opposed views, but personally I was persuaded by a lot of what the author says. Interestingly (for me!), when I subsequently saw a consultant cardiologist she said that she wouldn't recommend statins for me based on the results of my blood tests, and I am continuing to try to manage my risk factors through diet/exercise/reducing stress, etc. As others have mentioned, the only thing I didn't like about the book was all the space given to 'healthy' food recipes!
Anyone over the age of 60, or those who have been prescribed statin drugs, need to read this book. As cardiologists worldwide are beholden to the pharmaceutical industry, patients are left holding the bag of rather ineffective healthcare. Not to say that you should not trust your physician, but to educate yourself and go in with eyes wide open and armed with critical questions. Dr. Malhotra exposes the Good, Bad, and the Ugly of this family of drugs in plain and simple English. I can only hope that statin drugs are given the same scrutiny and exposure worldwide as the botched Covid vaccines have recently received. Dr. Malhotra is sounding the alarm! I highly recommend this book!
Well having read this I feel pretty confused as the information has thrown my admittedly basic knowledge of statins! I thought these were to aid a person who has a healthy diet, follows a fair amount of exercise, someone who tries to have a lowered stress life, to avoid a stroke or heart attack. Looks like they may help a few but not all and in a lot of cases are perhaps taken by many as default meds given after a health episode. Information perhaps controversial and think statins may benefit some but perhaps not as many as widely thought!?
Hard to know if this guy is a crank, but the advice seems sound and consistent with Jason Fung's book The Obesity Code, saying that metabolic syndrome and insulin resistance are the factors underlying heart disease and type 2 diabetes. They both advocate for an improved low-carb diet with extensive vegetables and whole fruits, as well as exercising more. As somebody who was just put on a low dose of statins by my doctor, I am considering the benefits of this more holistic approach compared to drugs that target cholesterol directly.
Excellent information about the powerful effects of lifestyle on health, and the limited value of medication. An eloquent plea for informed consent and transparency between doctors and patients. Sadly, large chunks of the book were censored out and left blank. At least it was available on Amazon. Another seller didn't have it in stock at all. Malhotra's 21-Day Immunity Plan (which came with as a set) is unadulterated.
Very informative book. He challenges the idea that a pill will fix all. I was surprised the data shows that Statins minimally decrease risk of stroke and heart attack, when the perception is quite the opposite. Factors such as diet, exercise and stress are more effective in decreasing the overall risk of heart disease. An interesting read for sure, especially for those working in health care.
As one who has been using a statin for a decade, I found this book very helpful in dispelling a lot of apparent myth and misinformation. The author brings a great deal of impressive medical research and experience to bear, all questioning the value and effectiveness of statins for preventing heart disease. While his diets and recipes at the end of the book are probably helpful, I think it might have been helpful to have at least added some general principles and guidelines.
I got into this book because of my nursing background, but also because I experienced side effects of statins after being put on them for a total cholesterol of 220. The findings of Dr. Maholtra seem sound and he backs up all his statements with study references. It’s definitely worth a read if you worry about heart disease or have had issues with statins. Still, talk to your physician before making changes!
Flat, repetitive and slow in some parts but overall a great critique of the general cardiology population singing to hymns hypnotically that are likely interpreted sans nuance and without what the patient presents with clinically.
Good, and full of useful information, but I find that if you follow the Dr on instagram and listen to podcasts you probably will already know almost everything in the book.
I do recommend it for people trying to make the ‘statin decision’. Dr Malhotra is a well respected cardiologist.
If you are taking a statin If your doctor is pushing a statin on you If you have never had a heart attack If you have had a heart attack If you have a stent(s) in you cardiac arteries If you are stressed If you are too round If it’s time
Interesting. Guess I will have to do more research if I end up needing statins in the future. I do feel inspired to refine my dietary habits even more than I have.
Clearly explains how cholesterol is produced. Fascinating to see how pharmaceutical companies manipulate data. Shocking. I have high cholesterol, but will try the plan before taking medication.