If you spend a lot of time on Twitter (and I do at the moment), you can end up reading some very odd claims. Apparently smoking protects against Covid-19, the virus is using the 5G mobile-phone network to spread, and eating raw garlic will keep corona at bay.
Needless to say, many of the claims are clearly mad.
But a recent one circulating online did catch my eye: that people on cholesterol-lowering statins should stop taking them, because having high cholesterol might help fight the coronavirus.
It seems to have been sparked by a letter published recently in the British Medical Journal (BMJ) which pointed out that Chinese studies have shown that many patients who have ended up in intensive care have lower levels of cholesterol than normal.
I’d much rather be controlling my cholesterol through healthy eating, exercise and staying stress-free. But my LDL cholesterol levels have stayed stubbornly high, says Dr Michael Mosley
It went on to claim that ‘low cholesterol predisposes to infectious diseases’.
According to the letter, lab studies had also shown LDL – the type of cholesterol we called ‘bad’ because of its links to heart disease – ‘inactivates almost all types of micro-organisms and their toxic products’. On reading this, one concerned Twitter user even asked: ‘What is the best way to quickly increase cholesterol?’
I was intrigued, because although it wasn’t a peer-reviewed study, it was at least in the BMJ. I have a personal interest because I take statins. I’d much rather be controlling my cholesterol through healthy eating, exercise and staying stress-free. But despite everything I’ve done over the years, my LDL cholesterol levels have stayed stubbornly high.
I wasn’t that bothered until a few years ago, while researching modern medical tests, I underwent something called a coronary artery CT scan.
You are injected with a harmless dye, and the scan uses X-rays to create highly detailed images of the blood vessels supplying the heart. They’re not routinely offered on the NHS and can cost many hundreds of pounds privately.
The scan can help doctors spot whether these heart arteries are blocked with fatty, cholesterol-containing deposits called plaques, which is a sign of impending heart disease.
At the time, I’d already done quite a lot to turn my health around. In 2013, having been told I had high blood pressure, high cholesterol and raised blood sugars – putting me in the diabetic range – I went on the 5:2 diet. I lost weight, and everything got better, except my LDL levels. But, because my HDL ‘good’ cholesterol were also high, I wasn’t worried. And I was hoping for a clean bill of health after my CT scan. Not so, as it turned out.
The charming cardiologist, Dr Duncan Diamond, told me that he had seen an ominous dark shadow in one of my main coronary arteries. ‘That is a deposit of soft, cholesterol-rich plaque,’ he told me.
Few of us wants to take tablets every day, so when people discover the benefits are modest, they often decide not to take them, writes Dr Michael Mosley (file photo)
Was this bad, I asked?
‘Possibly,’ he replied.
These soft or ‘unstable’ plaques are the ones that are dangerous because of their propensity, unpredictably, to cause heart attacks in otherwise healthy-seeming people. Or, as Dr Diamond summed it up: ‘You’re well, living a normal life. You go to work one morning, and don’t come home.’ That’s why cardiologists call these plaques ‘widow-makers’.
He recommended that I start on statins as soon as possible. Which I did. Now, I know there are lots of people who are sceptical about the health benefits of statins. But, having looked at lots of studies, I am convinced that they can be a life-saver. Many factors, not just LDL, influence our risk of a heart attack – our age, gender, ethnicity, how much excess fat we are carrying, and our blood pressure.
If you have a first degree relative who’s had a heart attack or angina before the age of 60 (I do), then that can significantly raise your risk. But studies consistently show taking statins lowers LDL, and helps reduce inflammation inside the arteries, stabilising those soft ‘widow-maker’ plaques. These things reduce the risk of a heart attack. So it makes sense, for me, to take them.
Much of the controversy around statins stems from the fact that, alongside lifestyle changes, they are routinely recommended to anyone with a ten per cent risk of having a heart attack within ten years – which, by the age of about 50, is most people.
The benefit of statins seems to be pretty small for this group – roughly a one per cent reduction in heart attack risk over five years. Few of us wants to take tablets every day, so when people discover the benefits are modest, they often decide not to take them.
Others, however, are put off due to fears about their side effects, which, like the benefits, can often be overstated.
Statins can have serious side effects, but they’re rare. Despite this, surveys show lots of patients on them complain of things such as muscle pain. So what’s going on? In studies of statins where some patients are given the real drugs, and others dummy pills, similar numbers of patients in both groups complain of minor side effects.
As far as I can see, there is no evidence that giving up statins or boosting your cholesterol will protect you against Covid-19 (file photo)
If you’re told that a drug has side effects, you are more likely to have them. It’s called the nocebo effect.
Which takes me back to that Twitter thread, and the letter in the BMJ about statins and Covid-19. The letter, it turned out, had been written by Uffe Ravnskov, a Swedish doctor who founded The International Network of Cholesterol Skeptics, or THINCS – and who campaigns against statins and the idea that LDL causes heart disease. So he clearly has an agenda. As far as I can see, there is no evidence that giving up statins or boosting your cholesterol will protect you against Covid-19.
While cholesterol might interact with pathogens in a test tube or Petri dish, it doesn’t mean this translates to what goes on in the human body.
More plausibly, the reason why some people with Covid-19 have lower levels of cholesterol is because the infection causes a fall in cholesterol, rather than the other way around.
We see this in other illnesses.
While the coronavirus can infect any of us, some people are much more vulnerable.
Apart from age, people who are most at risk are those with conditions such as heart disease, high blood pressure and high blood glucose levels. These often co-exist and exacerbate each other – they’re sometimes referred to under the umbrella term metabolic disease. At least third of adults in the UK over 50 are metabolically unhealthy.
Losing weight and changing your diet away from one that is high in processed food to one more like the Mediterranean diet is the best way to combat this.
But if you are on statins, then I really wouldn’t be thinking of giving them up in the middle of this pandemic, in the hope it’ll somehow make a difference.
Hand-washing and social distancing are more likely to save your life, and someone else’s too.
Do you have a question for Dr Mosley? Email firstname.lastname@example.org or write to him at The Mail on Sunday, 2 Derry Street, London W8 5TT. Mr Mosley can only answer in a general context and cannot give personal replies.