Statins tomorrow or fiber today?

Cholesterol lowering drugs are among the most prescribed medicines on earth. The goal is to ultimately reduce cholesterol (LDL) and triglycerides and as a result, reduce cardiovascular disease and untimely death. The market for cholesterol lowering drugs is estimated to be over $30bn in 2020 with a growth rate between 2-4% annually (see transparency market research). And Statins make up a little over 60% of the market. Statins are therefore among the largest drug categories and a powerful tool to help reduce cardiovascular incidence.

But how do they compare to fiber?

To make a more fair comparison, I have looked at the situations in which statins have been used in a preventative manner (rather than for people with existing cardiovascular conditions). While not equivalent to the studies on fiber, which encompass generally a broader set of people, it is the closest one can come to a comparison. It also seemed more of a fair comparison to pick studies which looked at a single fiber, rather than a broader study involving different sources of fiber. In a sense comparing one drug to the other.

The reduction in all-cause-mortality for statins was found to be around 12-14% (as a preventative medicine, (i)) and the all-cause mortality for oat β-glucan (a soluble fiber) was 1-2-1.7% per gram of fiber consumed, which at ca 10g additional fiber a day (basically what most of us are lacking), we get 12-17% reduction in all-cause mortality (ii).

In other words fiber has the same order of magnitude preventative power as one of the most powerful tools in the arsenal of modern medicine.

When you then compare prices for fiber versus statins the picture gets even more interesting. Fiber per equivalent dosage as found in fruit, vegetables, nuts, and seeds grains etc. is cheaper than statins. As a fair comparison, since the drugs are pure compounds, I also include the cost for a single type of fiber (isolated from maize), which is even cheaper.

(i) These two meta-analyses show an all-cause mortality reduction of between 12 and 14%.

Taylor F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, Ward K, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD004816.

BrugtsJ J, YetginT, HoeksS E, GottoA M, ShepherdJ, WestendorpR G J et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trialsBMJ 2009; 338 :b2376

(ii) Meta-analyses show a 1.2-1.7% reduction of LDL Cholesterol per gram of fiber (β-glucan)

Ho, H., Sievenpiper, J., Zurbau, A., Blanco Mejia, S., Jovanovski, E., Au-Yeung, F., . . . Vuksan, V. (2016). The effect of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for CVD risk reduction: A systematic review and meta-analysis of randomised-controlled trials. British Journal of Nutrition,116(8), 1369-1382

Whitehead A, Beck EJ, Tosh S, Wolever TM. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014 Dec;100(6):1413-21.

12% reduction of mortality

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