A statin does not remove cholesterol. It switches off an enzyme near the top of a pathway, and cholesterol is only one of the things that pathway makes.
Here is the rest of the list.
Coenzyme Q10, which your mitochondria use to turn food into ATP. Muscle levels fall by 20 to 35 per cent.
Dolichols, which the cell uses to attach sugars to its own proteins.
Heme A, part of the last enzyme in the respiratory chain.
Prenylated proteins, which the pancreas needs in order to release insulin.
Selenoproteins, including the glutathione peroxidases that handle oxidative stress.
Squalene, and downstream of it the vitamin D your skin makes from sunlight.
And cholesterol itself, raw material for testosterone, oestrogen, cortisol, bile acids and every cell membrane you own.
One enzyme, seven outputs, and the drug is named after one of them.
Now the label, which concedes more than the marketing does.
28 February 2012: the FDA adds raised blood sugar and type 2 diabetes to the label of every statin sold in America.
2010: the Lancet meta-analysis of thirteen trials behind that decision found a 9 per cent rise in new diabetes.
28 February 2012: the same announcement adds memory loss and confusion.
28 February 2012: and quietly drops routine liver monitoring, on the grounds that serious liver injury is rare, unpredictable, and was not being caught by the monitoring anyway.
August 2001: Bayer pulls Baycol from every market on earth except Japan. Thirty-one American deaths from rhabdomyolysis on the FDA's desk, later linked to around a hundred. Fatal cases reported at forty times the rate of the other statins.
Lipitor went on to become the biggest selling drug in human history. Over 130 billion dollars.
The two tissues that burn the most CoQ10 are heart and skeletal muscle.
Which is why the man with the aching legs and the fresh diabetes diagnosis gets told his cholesterol is beautifully controlled.
It is. That was the only thing anyone measured.
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