If I eat healthy, can I avoid statins?

Recently, I gave a talk to a group of participants who are following an unprocessed, plant-based diet for thirty days.  I spoke about what heart disease is, the risk factors for heart disease, and how to prevent it.

Interestingly, the most popular topic was statin medications.  Several of the participants wanted to know why statins, which are cholesterol-lowering medications, could be needed if an ideal healthy plant-based diet is followed. 

Yes, diet is very potent at lowering cholesterol.  In fact, a plant-based diet can be as potent as the highest dose of statin medication in lowering cholesterol levels.  However, in spite of a "perfect" diet, they may still be recommended.

Diet is powerful, but there are certain circumstances where statins are indicated:


- When diet and exercise are not enough to lower the LDL cholesterol to goal, which may be the case even in people who are following a pristine diet

- Coronary artery disease, history of heart attack, diabetes, peripheral arterial disease, and stroke -- even if the LDL cholesterol is low, statins have pleiotrophic effects, which means that they do more than just lower the LDL level. They reduce progression of arterial disease, improve the lining of the arteries, and reduce occurrence of heart attacks and strokes.

There are randomized controlled studies of hundreds of thousands of patients that definitely support the use of statins to prevent arterial disease in patients who have risk factors but do not yet have arterial disease and also in patients who already have disease.

I wholeheartedly support a plant-based diet and exercise to get cholesterol to goal, especially since I am a vegan and avid exerciser. But some people simply cannot get to that goal, and others have risk factors that indicate a strong benefit from a statin medication.