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I’ll have a statin with that burger, please

When I first read in the British press last week about a London cardiologist’s proposal that statins — drugs used to lower the risk of heart disease — be freely offered along with ketchup and other condiments at McDonald’s and other fast-food restaurants I thought, “This must be a story from The Onion that somebody in the press just didn’t recognize as a joke.”

But it wasn’t. Dr. Darrel Francis and his colleagues at the National Heart and Lung Institute of the Imperial College in London, are apparently quite serious. As they outline in their editorial in the current issue of the American Journal of Cardiology, they’ve done the math modeling and have concluded it would be a good idea if consumers of Quarter Pounders were given the opportunity to counter the fat-laden food’s known bad effects on the cardiovascular system with a free statin pill.

“Statins do not cut out all of the unhealthy effects of burgers and fries,” said Francis in the Guardian newspaper. “It’s better to avoid fatty food altogether. But in terms of your likelihood of having a heart attack, taking a statin can reduce your risk to more or less the same degree as a fast food meal increases it.”

Francis has dubbed this fast-food/statin combo “The MacStatin.” And, no, he isn’t funded by a drug company — or a fast-food franchise. When asked by a New Scientist reporter if he had any financial conflicts of interest, Francis quipped, “No, the only conflict of interest would be that I quite like hamburgers.”

(By the way, the idea of offering free statins doesn’t sound as far-fetched in Britain as it does here in the U.S. The Brits can apparently already purchase a low-dose generic statin, simvastin, over the counter from their local chemist, or pharmacist.)

Naturally, other heart experts immediately jumped all over Francis’ proposal. Sometimes quite vehemently. Here’s a Guardian quote from Steve Field, the current chairman of Britain’s Royal College of General Practitioners: “This paper just amazes me. Let’s get real; we should be encouraging healthy lifestyles, to pill popping. This is an unwelcome addition to the ‘pill for every ill’ attitude that’s already much too common. The danger of this research is that some people will become even more complacent about eating fatty food and high calorie food, and might even increase their intake of them.”

There’s also the problem, Field added, of potential side effects from the statins, including, in rare cases, cataracts, muscle weakness, liver problems and even kidney failure.

Francis anticipated these arguments in his editorial:

[T]he documented safety record of statins is substantially better than that of fast foods, which carry not only direct cardiovascular risks but other risks due to obesity. It cannot therefore 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. It would be no more sensible than allowing individuals to drive without training or a license but at the same time restricting access to seatbelts and airbags.

But there’s another major underlying problem to Francis’ proposal that, to me at least, makes his whole proposal moot. He takes it as a given that statins are effective in reducing cardiovascular risk in people with no previous history of heart attack or stroke. But that’s now a highly controversial assumption. Recent research, including a major study published earlier this summer, has found little evidence that statins reduce the risk of premature death in anybody other than those who have already experienced a heart attack or stroke.

Ah, but you’ve got to smile at Francis’ utopian vision of the fast-food restaurant of the future:

We envisage a future in which fast food restaurants encourage a holistic approach to healthy living. On ordering an unhealthy meal, the food will arrive labeled with a warning message similar to those found on cigarette packets (“This meal increase your risk for heart disease and death”), and on the tray, next to the ketchup, will be a new and protective packet, “MacStatin,” which could be sprinkled onto a Quarter Pounder or into a milkshake. This could easily be provided at no extra charge, just as sugar and salt currently are (despite being harmful). To prevent individuals from believing that the packet is a “cure-all,” it should be accompanied by a leaflet stating, “No table can counteract the full spectrum of harm that comes from [eating] unhealthily. Better ways to reduce your risk for death from heart attack include eating healthily, exercising, maintaining a healthy weight, and not smoking.”

And what is the fast-food industry’s response to all this focus on its unhealthful foods? “We are not pleased,” as the Queen herself might say. Here’s a McDonald’s spokesperson’s no-smiling, no-nonsense response to Francis’ editorial:

We provide a good range of meal options which include porridge, bagels and salads, as well as providing the nutritional information to ensure people can make dietary choices that are right for them. It would not be appropriate or safe for any restaurant chain to offer medication of any kind to its customers.

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Comments (4)

  1. Submitted by Paul Scott on 08/17/2010 - 12:55 pm.

    The burger is fine. It’s the bun will give you a heart attack. But statins don’t do anything about the buns, do they.

  2. Submitted by Bernice Vetsch on 08/17/2010 - 03:16 pm.

    But, Mr. Scott, the hamburger is the part of a burger that contains saturated fat and a big serving of salt.

    According to what I’ve read, saturated fat is what produces the LDL (low density lipids) that clog arteries, while good fats (poly- and mono-unsatured ones) help raise HDL (high density lipids) levels, which actually help keep arteries clear.

    Substitute that bun for real bread (whole grain) and peanut butter and you have a “fast” food meal that is actually good for your heart.

  3. Submitted by Lance Groth on 08/17/2010 - 04:38 pm.

    It’s actually high glycemic carbs that are at the root of most diet-induced problems. Combining high glycemic carbs with saturated fats specifically is not a good idea with respect to the clogging of arteries.

    In a fast food meal, it’s mostly the white flour in the bun, the sugar in the beverage and/or dessert (and salad dressing, *sigh*), and the french fries (high glycemic potatoes) that are a health problem. Go on a low carb diet and watch your blood serum cholesterol numbers improve – mine did, LDL dropped over 20 pts. And I mean while eating bacon, burgers (sans bun), steak, cheese (mmmm, brie!), etc.

    That said, it’s best to stick with “good” fats where possible. I use olive oil for everything. There is also a choice to be made with the burger itself. Grain fed beef is a poor choice – higher in omega-6’s, lower in omega-3’s. Grass fed beef or bison is much healthier – higher in omega-3’s, lower in omega-6’s. It all depends on how the animals are raised and what they eat. This is true even of salmon, which most suppose to be unequivocally healthy. Wild salmon eat what they’re supposed to eat, and have the desired ratio of omega-3 to omega-6. Farm raised salmon are fattened on grain, and guess what, they end up being similar to grain fed beef.

    Dr. Francis seems focused on “fats are bad”, which is rather old school and not supported by recent research. The situation is far more nuanced – which fats, from which sources, and in combination with what kind of carbs – that’s what you need to consider. One simple thing that would improve the dietary landscape for all of us would be to ban high-fructose corn syrup as a food additive. I’m convinced that the obesity epidemic is as much due to that one simple thing – infusing nearly everything in the grocery store with corn syrup – as anything else.

  4. Submitted by Darrel Francis on 08/18/2010 - 06:59 am.

    I am the medical researcher responsible for this study.

    Thank you to everyone for their thoughtful comments. Something about our modern life makes us get heart disease much sooner than our genetically-equivalent counterparts living in subsistence economies. This might be taking too little exercise, or eating too much.

    If it is eating too much, I do not know, and cannot think of a way of being certain, which element of what we eat is mostly to blame (and it may vary between individuals). In the paper we explain why we choose fat to do the calculation, but it can be done based on other elements of unhealthy food.

    I am happy to send a copy of the full paper to anyone who wants to read it in detail: just email me at my Imperial College address. I have had a lot of somewhat aggressive commentary against me as a scientist, and indeed personal threats, for reasons which are not clear: they seem to be from people who have not read the paper, but do not like the result of the calculation.

    And dear Susan – writer of this column – Thank you for an excellent and balanced assessment. Of course nobody should eat junk food. But I am only thinking why we give harmful freebies, and not helpful ones, to people who have already ignored your and my advice to give the whole shop a miss.

    As for whether statins prevent heart attacks in people who have not had them: if they do not do so, then 4S, ASCOT LLA, WOSCOPS and several other gigantic studies of tens of thousands of patients, are a tremendous fluke.

    Respectfully yours,

    Darrel Francis
    London, UK

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