A Burger, Shake and Some Statins

Emily Ferenczi, BMBCh, of Imperial College, London, UK, and colleagues calculated that most daily statin regimens would be enough to neutralize the increased cardiovascular risk associated with eating a quarter-pounder with cheese and small milkshake every day.

Because statins are cheap, relatively safe even at high doses, and effective for reducing cardiovascular risk across patient subgroups, offering them to individuals who choose to eat an unhealthy diet against best medical advice might make sense.

"It cannot ... be reasonably argued on safety grounds that individuals should be free to choose to eat lipid-rich food but not be free to supplement it with a statin," they wrote.

"It would be no more sensible than allowing individuals to drive without training or a license, but at the same time restricting access to seat belts and airbags," wrote the authors, who called for studies to evaluate the potential dangers of unsupervised statin use.

Ferenczi and her colleagues were not looking to give individuals a pass on unhealthy eating or to disregard traditional medical advice for lifestyle changes -- healthy eating, not smoking, getting regular exercise, and losing weight. But they argued that some people will continue to make unhealthy choices.

"Although no substitute for systematic lifestyle improvements ... complimentary statin packets would add, at little cost, one positive choice to a panoply of negative ones."

But statins would not counter most of the health risks linked to an unhealthy diet, commented JoAnn Manson, MD, DrPH, chief of preventive medicine at Brigham and Women's Hospital in Boston.

"Even if statins helped with the cholesterol part, they'd do little, if anything, to counter the increased risk of obesity, diabetes, hypertension, colorectal cancer, and other chronic diseases linked to this dietary pattern."

Because both the cardiovascular risk reduction with statins and the risk increase with excess dietary intake of fat have been quantified, Ferenczi and her colleagues set out to see whether they would cancel each other out.

They used a 2006 meta-analysis of seven randomized controlled trials of statins for primary prevention of major cardiovascular events for the magnitude of the statin benefit. The pooled relative risk with daily statins was 0.71 (95% CI 0.60 to 0.83).

The researchers turned to a 1996 cohort study of male health professionals to assess the increase in risk with high fat intake. For men with the highest intake, the relative risk of nonfatal myocardial infarction or fatal coronary artery disease was 1.23 (95% CI 0.96 to 1.57).

After plotting the two findings, Ferenczi and her colleagues concluded that daily use of most statins -- except for pravastatin -- was more than enough to cancel out the cardiovascular risk of eating a cheeseburger and milkshake every day.

But Melvyn Rubenfire, MD, director of preventive cardiology at the University of Michigan in Ann Arbor, said in an e-mail that offering statins with fast food may actually result in an increase in cardiovascular events if people alter their eating habits.

"If the consumer thinks it's safe [to eat fast food], he/she would likely increase to biggy fries and increase total calories, as well as increase fat intake at home," he said.

But Ferenczi and her colleagues wrote that the concept of providing complimentary statins with a fast-food meal should not be discounted because it is condoning unhealthy eating.

"It is providing a free opportunity for someone who has already decided to eat unhealthily, and may well already be rejecting medical advice for a healthier lifestyle, to remain alive for longer than they might otherwise," they wrote.

Rubenfire concluded that, "A much more logical approach to reduce cardiac events and healthcare costs would be for the healthcare system to provide risk-screening centers run by low cost non-physician health providers located throughout the communities that can prescribe very low cost and safe treatments for known risk factors and refer patients to physicians as necessary."

China Heart Congress and International Heart Forum: Whelton P, et al "Long-term Follow-up in the Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT)" CHC/IHF 2010.