Research group proposes serving statins with some fast foods

Ferenczi EM. Am J Cardiol. 2010; doi:10.1016/j.amjcard.2010.03.077.

Issue: December 2010

The provision of statins along with a cheeseburger and a small milkshake is being proposed as a way to potentially offset the increased relative risk of cardiovascular disease resulting from the total fat and trans fat content of this popular fast-food meal option.

This approach, suggested by the authors of an article published in the American Journal of Cardiology, was proposed as as a viable condiment alternative to counter the backlash of an unhealthy, fast-food influenced lifestyle.

“The risk reduction associated with the daily consumption of most statins, with the exception of pravastatin (Pravachol, Teva Pharmaceuticals), is more powerful than the risk increase caused by the daily extra fat intake associated with a 7-oz. hamburger with cheese and a small milkshake,” the researchers wrote. “Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer CV benefits, opposite to the effects of equally available salt, sugar and high-fat condiments.”

Their analysis consisted of seven randomized controlled trials that included a total of 42,848 patients. The primary outcome measure was the relative risk for a major CV event, including nonfatal myocardial infarction and coronary artery disease death.

Most of the primary prevention stain regimes the researchers analyzed, including lovastatin (Mevacor, Merck), atorvastatin (Lipitor, Pfizer) and simvastatin (Zocor, Merck), were able to counteract the increased risk caused by an unhealthy diet or eating an additional 36 g of fat and 2.8 g of trans fat per day — the approximate fat content of a 7-oz. hamburger with cheese and a small milkshake.

“This does not mean that we should disregard nutritional education in prevention of CV disease,” the researchers commented in their study. “But it should be recognized that nonpharmacologic measures alone may sometimes be insufficient, thereby prompting us to move toward incorporating dietary advice and pharmacotherapy into a coherent strategy for primary prevention.”

I don't think we should look at this manuscript as a serious ‘scientific paper.’ It makes way too many assumptions (e.g. the effectiveness and safety of episodic single-dose statin use, use as intended by the patrons of the fast food restaurant, single dose for all consumers etc. etc.), many of which are not proven and probably incorrect.

However, I do like the paper because of the following:

In a tongue-in-cheek way, the paper points out the absurdity of many things we are doing in terms of lifestyle/prevention. In addition to the examples cited by the authors, who of us has not overeaten one night and then decided to ‘work out extra hard’ the next day under the assumption that this would neutralize the transgression? I have seen patients take it further and take an extra blood pressure pill after eating a lot of salt and I am sure there are people who take an extra statin right after the greasy all-you-can-eat-buffet.
I do think that we have to think ‘out of the box.’ The traditional counseling about healthy behaviors is clearly not working. Yes, we do it, and I am sure that we reach the occasional person, but as a public health approach, it has not worked — knowledge about a behavior and consistent implementation of the behavior are two different entities entirely. I also don't think that we can regulate everything. I thus welcome any and all creative thinking and hope that somebody will come up with a solution along the way.

– Vera Bittner, MD
Professor of Medicine, University of Alabama at Birmingham

This is an interesting concept. Concerns would be that saturated fat and cholesterol-laden fast food that could be ameliorated with statin medication ignore the multi-factoral etiology of CVD, such that addressing LDL confronts a relatively minor portion (20% or less), in addition to the non-LDL related dietary risks (trans-fatty acids, oxidative stress, excess calories, salt, etc) that are not addressed. This is hypothesis generating at best.

– C. Noel Bairey Merz, MD
Director, Women’s Heart Center,
Director, Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Medical Center

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