[Rhonda]: What do you think about dietary changes compared to using statins?
Like if a person, I know not everyone's going to do a dietary change.
So statins obviously have their place, and they are probably saving, you know, a few
years on people's lives that wouldn't otherwise make any dietary change.
But what are your thoughts or, you know, on dietary changes in that modulating heart disease
risk as opposed to taking statins?
[Ron]: So I have to have a disclosure here, you know, spending a lot of my time and still
doing a lot of work in nutrition, it's been frustrating to observe how limited the evidence
is that making a dietary change reduces heart disease risk.
The strongest evidence that we have for any kind of treatment is based on randomized control
trials.
And as I mentioned, dietary studies, even measuring lipids, let alone heart attacks,
required an enormous investment of time and energy and funding.
So there's been very little basis for concluding that a dietary modification, lower fat, lower
carbohydrates even reduces heart disease risk.
And it partly is because the studies haven't been done and partly because the studies that
had been done had been limited by a number of issues, compliance to these studies, it
always decays over time.
You need to be on these diets for long periods of time to see an effect, plus which the actual
dietary effects are not huge.
They vary among individuals, so there's people that are really responsive to diet, and I
see these in my practice, for whom diet is extremely important.
But if you average it out over the population, the effect on markers of heart disease risk,
lipid, small LDL, or blood pressure, even, they're measurable.
But in terms of the magnitude of those effects across the population, they are much smaller
than what can be achieved with statins and their effects on LDL levels.
It's disappointing to have to say that because I'm a firm believer in lifestyle and lifestyle
intervention, both diet and exercise, for reducing heart disease risk and promoting
health overall.
But when it comes to people who are at high risk for heart disease, diet alone is frustratingly
difficult to show if there can be a long-term benefit, not because there isn't such a benefit,
but the studies just aren't there to help support that.
Statin trials supported by industry, big studies, tens of thousands, hundreds of thousands,
we have assembled data from 40,000 people in statin trials looking at genetic effects
and response, huge amount of data, beautiful data.
Millions that have been used to support these studies.
[Rhonda]: That's disappointing to me, I mean.
[Ron]: Yeah, right.
Well, that's right.
So the money has been coming where the profit comes in.
And fortunately, in the case of statins, it's been okay because the statins, by and large,
have fulfilled their expectations.
With the proviso that there's a huge variation in response, and even though there's a 30%
to 40% reduction in heart disease risk in patients who are at risk, or even in the general
population, it's been implied since that happens to just huge segments in the population, men,
women, different ethnic groups, different lipid levels, and they seem to have a similar
benefit across that population, but it's not 100%, and it's not even 50% for the most part.
So there is that residual risk on statins that we still have to solve how we best approach
that.
I think lifestyle is important.
I think if we were all fit and lean, a lot of that residual risk would go away, very
hard to prove that, but that seems like a very plausible and certainly, in my case,
actionable advice to give to patients is to work on things that you can control in your
lifestyle.
But if you remain at risk for heart disease, as a physician, I'll write a statin prescription
if I felt it was needed, not to guarantee that people are going to live forever or anything
close to that.
But it has a statistically real effect on risk, and we haven't gotten there with diet.
We don't have that kind of data for diet.