Does Lowering Cholesterol Save Lives?

Spot the Trick Pt 2. How relative risk transforms mediocre into outstanding.

See “Spot the Trick Pt 1 here.

Our bodies are our most precious property. James Madison said, “a man…has a property very dear to him in the safety and liberty of his person.”

Today, all of our rights are being stripped because we have allowed manufactured dissension to distract us. The autocratic COVID response opened a window on the whole of government manipulations that threaten us all. Perhaps, when more realize the enormity of the agencies working against us, it will spark a survival desire all parties can unite behind before it is too late.

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Does Lowering Cholesterol Really Save Lives? The Percentage Trap.

(The following is not medical advice but the telling of my own experiences and research. Health issues are unique for each individual, so always speak with a doctor you trust for personal advice.)

It’s become conventional wisdom that lowering cholesterol extends lives in those with heart disease. For 25 years doctors have advised me to lower my LDLs (“bad cholesterol”) and keep a healthy ratio of the “good” to “bad”. I am told, I would likely be on statins or PCSK9 inhibitors (Repatha) for the rest of my life. Conversely, other doctors explained that lowering cholesterol makes the numbers look good, but does little to help you live longer.

Which is it? Before committing to a lifetime of medication, I decided to investigate the claims.

I began by asking three Ai programs the question that concerns me most, then analyzing their sources.

The question:

Find me a study that proves that lowering LDLs with statins or anti-PCSK9 monoclonal antibodies will extend the life expectancy of a 65-year-old male patient with mild to moderate heart disease.

Below are the responses:

Alter Ai:

“No study has ever proven that lowering LDL with statins or PCSK9 monoclonal antibodies extends life expectancy in a 65‑year‑old male with mild to moderate heart disease.”

The clear answer is, no study has proven that.

Duck Ai:

“Current studies suggest that while statins and PCSK9 inhibitors like evolocumab can significantly lower LDL cholesterol and reduce the risk of cardiovascular events, their impact on overall life expectancy in patients with mild to moderate heart disease is modest. Specifically, evolocumab has shown benefits in reducing heart attacks and strokes, but it does not demonstrate a clear reduction in mortality rates for all patients, indicating that the benefits may vary based on individual risk factors and health status.”

Duck Ai agrees there are some benefits to cholesterol-lowering drugs, but studies only prove a modest effect in some patients.

Then I turned to Google’s Ai.

Google Gemini has a reputation for advancing institutional bias over sober analysis in their answers. If you ever wanted to see support for lowering cholesterol, Google is the place to go. Gemini didn’t disappoint.

Google Gemini:

Extensive clinical research, including large-scale randomized controlled trials and meta-analyses, supports the finding that lowering LDL cholesterol (LDL-C) with statins or PCSK9 inhibitors significantly reduces cardiovascular mortality and can extend life expectancy in patients approximately 65 years of age with heart disease (Gencer et al., 2020; Lee et al., 2018; Sucato et al., 2024).

Google claims many studies prove that lowering cholesterol “reduces cardiovascular mortality and can extend life expectancy in patients approximately 65 years of age with heart disease.”

I investigated the Gencer, Lee, and Sucato studies, Google’s referenced sources.

Gemini’s quoted sources:

Gencer, analyzed 29 studies concluding that "Lipid-lowering therapies reduced cardiovascular death in older patients by 15% per mmol/L reduction in LDL cholesterol, myocardial infarction by 20%”.

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Lee analyzed Amgen Pharmaceutical’s Fourier Trail concluding “No cardiovascular or total mortality benefit was seen; nonetheless, there is a possibility that lowering of LDL levels by PCSK9 inhibitors such as evolocumab may reduce mortality over time.”

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Sucato concludes: “Lipid-lowering therapy has been shown to be effective in preventing cardiovascular disease; however, reluctance to prescribe an intensive regimen and limited adherence to treatment still pose significant barriers to therapeutic optimization.”

What these conclusions actually mean

Lee concludes no cardiovascular or mortality benefit was seen when adding Repatha to statins and neither Lee’s nor Sucato’s conclusion claims lowering cholesterol will extend life expectancy.

Gemini’s claim lowering lipids can extend life are based on Gencer’s marked drop in LDL levels.

But Gencer’s 15% cardiovascular death reduction does not mean if you take the drug your chances of dying from a heart attack are reduced by 15%. Here’s what it does mean.

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The Relative Risk Sleight of Hand

Gencer’s 15% is a Relative Risk Reduction (RRR). RRR tells how large the ratio of improvement is, not how many people will actually benefit. That’s called the Absolute Risk Reduction (ARR) and is the number that concerns most.

The ARR is so important the FDA in its document, “Communicating Risks and Benefits: An Evidence-Based User’s Guide” says:

“When information is presented in relative terms rather than absolute terms, the risk reduction seems larger and treatments are viewed more favorably. Patients are unduly influenced when risk information is presented using a relative risk approach… Thus, an absolute risk format should be used.”

Understanding Relative Risk Reduction and Absolute Risk Reduction

Though both are legitimate figures, they have much different uses. RRR is helpful for comparing different drugs during trials. ARR is needed for patient awareness and medical recommendations.

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Here’s an example: Assume the risk of catching a disease is 2%, but with treatment the risk is reduced to 1%.

Here’s the math:

ARR = 2% - 1% = 1% That’s the actual chances of the catching disease after treatment.

In other terms, if my risk was reduced from 2% to 1% you would have a 50% reduction. That’s the RRR.

Here’s the math:

RRR = (2% - 1%) / 2% = 50%

Here’s a visual:

Suppose a group of 10,000 people took a drug for 5 years and these were the results.

The risk of getting the disease is cut in half (from 200 to 100) or 50%. But out of 10,000 people in the study only 100 or 1% were prevented from catching the disease.

In plain English:

You would have to treat 100 people for 5 years for 1 of those people to benefit from the treatment. The other 99 would receive no benefits, but still be subject to all of its side effects, costs, and drug burdens.

That’s the Absolute Risk Reduction (ARR). This is the number patients need to decide if they are willing to take the drug and doctors need help them decide which treatments to recommend.

“Cuts risk in half” versus “reduces your risk by one percentage point” both share the same baseline, but have far different perceptions and ethical meanings.

Now you can see why pharmaceutical companies who sponsor and often have full control over initial studies, use relative rather than absolute risk formats. It’s much easier to convince the public to take a drug that is 50% effective than one that is 1% effective. (See Pfizer’s 95% effective claim.)

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Here’s what Gencer really proved

The roughly 5-year Gencer study had 10,746 people 75 years of age or greater in both the treated and the control groups. 723 of the treated died from cardiovascular death and 799 died from CVD in the non-treated control group.

Control group = 799 ÷ 10,746 = 7.44%

Treated group = 723 ÷ 10,746 = 6.73%

ARR = 7.44 - 6.73 = .71 Less than 1% of the people avoided the CVD. In simplest terms:

You would have to treat 141 people over 75 years of age for approximately 5 years to prevent 1 cardiovascular death.

While treating 141 people may prevent one CV death, tens of them will experience non‑fatal yet clinically meaningful harm including (according to the study) myocardial infarction, stroke, or stent. But they also faced the additional risk of side effects including myalgia, diabetes, cognitive/memory decline, and raised liver enzymes.

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Note* Why did Gemini show me a study at age 75+ rather than age 65? Because older ages tend to display greater benefits in the studies. However, no study, at any starting age, in any patient group, has proven that LDL‑lowering extends total life expectancy.

Even at the ages 75+ Gencer illustrated, once you include non‑CVD deaths (cancer, infection, dementia, accidents,) plus the treatment’s own side-effects, it more than offsets any life-extension advantage of the LDL-lowering treatment.

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By knowing the true people benefits (ARR) and harms drugs may cause, you are better informed for a conversation with your doctor about your history and your best treatment options.

In the next Spot the Trick Series we discuss:

If the FDA warns doctors to use absolute risks, why do they approve drugs based on relative risks and why do so many doctors agree?

The answer may surprise you.

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