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Book Review: Triumph Of The Heart, The Story Of Statins

Triumph of the Heart, as its name does not suggest, is about science. The book’s author, Jie Jack Li, is a medicinal chemist who meticulously reviews the history relevant to the discovery of lipid-lowering drugs. He spares no details, even recounting the amusing quarrels and quirks of the scientists engaged in the “apocryphal showdowns” leading to the manufacture of cholesterol in a laboratory.

The personalities of the various scientists and Nobel laureates described in the book are highly entertaining. From beating one another with umbrellas, to insisting on wearing blue clothing only, to egos so large and unappealing as to empty an entire academic center of all its promising young recruits, one has the distinct impression that brilliance does not go hand-in-hand with grace.

That being said, each of these scientists did seem to share a common approach to research: carefully testing hypotheses, repeating peer study results to confirm them, and patiently exploring complex biochemical pathways over periods of decades. The physicians, physicists, and chemists showed an incredible ability to doggedly pursue answers to specific questions – understanding that the results might influence human health. But even more importantly, they were each willing to invest their careers in analysis that may never lead to anything more than a dead end. In fact, the book is full of examples of great ideas, developed over decades, that did not lead to a marketable drug. In some cases the research was halted due to lack of efficacy, in others political forces or personal whims influenced the course.

What strikes me about the scientists described in Triumph of the Heart, is how rare it is nowadays for people to have the sort of patience required for laboratory work. In an age where kids suffer from iPhone and video game addictions, young adults expect a relaxed work environment with high salaries and no accountability, and adults are flummoxed by stores that are not open 24 hours… who has time for the hard work of science? Even The Onion, my favorite spoof newspaper, mocks modern attention spans calling science “hard.”

Triumph of the Heart is about much more than the discovery and development of statins. It traces the historical development of the first antibiotics, pain medicines, diuretics, and steroids, the rise, fall and merger of drug companies, patent wars, the unethical conduct of some researchers, and the financial pressures that shaped the industry, both in the U.S. and abroad. Other than Mr. Li’s inability to resist his chemist’s urge to delve into advanced concepts in organic chemistry (around mid-book) as a physician I found Triumph of the Heart to be quite interesting, and well researched.

The most important take away, however, is that science is about hard work, attention to detail, innovative thinking, advanced analytic skills, serendipity, and the patience of Job. These qualities are rarely found in alternative medicine practitioners (or their research) – which is why they have contributed very little, beyond placebo, to the advancement of medicine. Triumph of the Heart reminds us all what good science is about, and how life-saving discoveries are made.

Posted in: Book & movie reviews, Pharmaceuticals

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20 thoughts on “Book Review: Triumph Of The Heart, The Story Of Statins

  1. Esteleth says:

    That sounds like an excellent book!
    Of course, I read this sentence:
    From beating one another with umbrellas, to insisting on wearing blue clothing only…
    and said to myself: R.B. Woodward for the WIN!
    Woodward was an egotistical ass, but he was a great scientist.

  2. daniel says:

    Statins definitely lower cholesterol, but do statins improve health?

    Last I checked, statins were good only for men under 65 who had already had a heart attack, but they are given to lots of people who don’t meet all (or any!) of those criteria.

  3. weing says:

    daniel,
    That just means you haven’t been keeping up to date. Try checking out the Jupiter study released last fall for a relatively recent one.

  4. daniel says:

    Thanks for the pointer, the paper is here http://content.nejm.org/cgi/content/full/NEJMoa0807646

    This graph summarizes their results: http://content.nejm.org/content/vol359/issue21/images/large/04f1.jpeg

    It seems that statins have an effect, but are they worth it? For every 170 people who take a statin, about 1 will be saved from a bad event (ranging from non-fatal MI up to death).

  5. Harriet Hall says:

    Daniel,

    I have been watching the research on statins, and I wrote about it in my post about The International Network of Cholesterol Skeptics http://www.sciencebasedmedicine.org/?p=22
    There is good evidence that statins reduce the risk of heart attacks and strokes for people at high risk, including women and the elderly. It is more effective as secondary prevention (for those who already have cardiovascular disease), but is also clearly effective for primary prevention in high risk groups. There is good evidence that they reduce cardiovascular mortality and also evidence that they reduce all-cause mortality, at least in some groups. The Cholesterol Skeptics deny this, but it is getting harder and harder to deny, as more studies keep pouring out showing benefits from statins.

    That said, they are being overprescribed, and the NNT (number needed to treat) is relatively high. The JUPITER study suggested that they might benefit people whose cholesterol is normal but whose CRP is high. We are still trying to pin down who should get statins, but it is clear that some of us should, and not just men under 65 with previous disease.

  6. Harriet Hall says:

    Daniel,

    The NNT varies with risk group, and is as low as 50 for some groups. Whether that is worthwhile is a value judgment.

  7. daniel says:

    Harriet,

    Thanks for the post, I’ll read it closely and take it seriously. (Looks like it got a _lot_ of comments, too.)

  8. Harriet Hall says:

    Val,
    I already have too many books to read, but the umbrellas and the blue clothes are too intriguing to miss. My library doesn’t have the book, but I’ve put in a request for inter-library loan.

  9. Peter Lipson says:

    Commenter: Statins aren’t as effective as everyone says.

    When corrected: Ok, I guess they are, but is it worth it?

    The real question for someone like this is what level of evidence would it take to convince you? Do you have a NNT in mind? For example, if, say, you had to treat 50 people with a statin to avoid one fatal MI, is that good enough? Assuming, based on the clinical evidence, that statins are very well tolerated, and that the outcomes they prevent are important, we should be willing to accept a relatively high NNT, but how high?

    (writer currently taking rosuvistatin)

  10. daniel says:

    I’m sorry if I stirred up a hornet’s nest.

  11. weing says:

    daniel,
    Actually the NNT in the Jupiter study was about 25 for 5 years. My problem with that, because of the cost of rosuvastatin, is that it comes to about half a million dollars per event. That’s a lot of mullah. I’d much prefer the cost be closer to fifty thousand per event prevented.

  12. marilynmann says:

    NNT is mostly a function of baseline risk and relative risk reduction. For primary prevention the NNT is relatively high, as previous commenters have pointed out. However, some people have a high baseline risk, and people put different values on the same absolute risk reduction. If I have 10 percent chance of developing having a heart attack in the next 10 years, is it worth it to reduce that risk by a few percentage points by taking a statin? Reasonable people could differ on that.

    With statins, the picture is complicated by the fact that the most potent statins, atorvastatin (Lipitor) and rosuvastatin (Crestor), are still on patent, and quite expensive. There is a some incremental risk reduction in going from a less potent statin to a more potent statin.

    I think everyone needs to look at their own individual risk (usually this is calculated on a 10 year basis) and decide if reducing it by 25-30 percent by taking a statin is worth it to them. It is a question of weighing the risks and benefits.

    I agree that statins are overprescribed for primary prevention. They are also underprescribed for secondary prevention.

    My mother-in-law just had her second heart attack recently. She was on 40 mg simvastatin. I convinced the hospital to put her on 80 mg atorvastatin, which is the correct treatment post-MI. They would not have done it if I had not insisted.

  13. friday says:

    This sounds like a fine book for me to read! However this quote is making me question the reviewer’s review and this website.

    “What strikes me about the scientists described in Triumph of the Heart, is how rare it is nowadays for people to have the sort of patience required for laboratory work. In an age where kids suffer from iPhone and video game addictions, young adults expect a relaxed work environment with high salaries and no accountability, and adults are flummoxed by stores that are not open 24 hours… who has time for the hard work of science?”
    /startrant
    Whaaa? Do you have any evidence to support this viewpoint? This is clearly cranky old person talk! Take a pill. Is this”science based?”
    You claim that young adults expect …no accountability… have you not seen the news lately? Baby boomers sat in front of the TV all day when they were kids. And they are the ones with POWER or mentored the newer persons with POWER now… they are the ones with no accountability.
    And by the way, I want gamers to do all my lab tests with the fancy machines and computers. kthanksbai
    /endrant

  14. DanaUllman says:

    Daniel correctly noted, “For every 170 people who take a statin, about 1 will be saved from a bad event (ranging from non-fatal MI up to death).”

    When you consider all of the side effects (some minor and many which are not so minor), the cost-benefit analysis requires a view of not just those small number of people who have benefited.

    Doctors and patients must also consider what other drugs the patient is taking or may take in the future…and what interactions these drugs have on statins. Where is the research here?

    An Institute of Medicine special report, “Informing the Future: Critical Issues in Health” (published in 2007), noted that 1/3 of Americans today take five or more medications. And yet, even if all of these drugs have been proven “scientifically” to work, each drug was tested individually, not in combination with one or two, let alone five, drugs.

  15. quiact says:

    Some years ago, I heard Roy Vagelos, CEO of Merck Pharmaceuticals, give a presentation at Washingtion University in St. Louis. He said the first statin was made by a Japanese company in the early to mid 1980s, but proved to be too toxic. So, Roy and Merck came out with the first marketed statin, in 1987, which was Mevacor. This was followed by Zocor sometime afterwards by Merch. I sold both of these statins in the mid to late 1990s at the same time.

    Statins, I believe, are very beneficial medications as a class. I also believe there are no significant differences between the ones that are available as far as their cardioprotective abilities. Statins stablize cornorary plaque, which we all have after our mid-20s in age. They remove the lipid filled core of these plaques, and therefore reduce the risk of myocardial infarctions by securing the plaques to the coronary interior walls.

    Yet I also believe that they should be prescribed ONLY with those with dyslipidemia. Other disease states abstractly associated with statin benefits require further study,

    Dan Abshear

  16. farside says:

    A University of Alabama at Birmingham physiology professor, Dr. Thalacker-Mercer, has found that simvastatin (Zocor) inhibit muscle repair and regeneration. The title of her work is ““Simvastatin Reduces Human Primary Satellite Cell Proliferation in Culture” and was publish at the September 2008 meeting of the American Physiological Society.

    A synopsis of her work can be found here http://www.the-aps.org/press/journal/08/32.htm

    In addition, Yeon-Kyun Shin, a biophysics professor at Iowa State University, has found that statins that inhibit the liver from making cholesterol may also keep the brain from making cholesterol, which is vital to efficient brain function.
    Professor Shin said, “If you try to lower the cholesterol by taking medicine that is attacking the machinery of cholesterol synthesis in the liver, that medicine goes to the brain too. And then it reduces the synthesis of cholesterol which is necessary in the brain,”
    Source — http://www.public.iastate.edu/~nscentral/news/2009/feb/shin.shtml

    Kind Regards,
    Farside

  17. Oooh, thanks for the review, Val! It just so happens I love this kind of book, so I’ll be picking up a copy, for sure.

  18. Winfield J. Abbe says:

    See these articles critical of statin drugs:

    “The failure of Vytorin and Statins to Improve Cardiovascular Health: Bad Cholesterol or Bad Theory”, Brian Peskin E.E. and David Sim M.D., Journal of the American Physicians and Surgeons, Vol. 13, No. 3, 82 (2008)
    “Statins and Increased Cancer: The Hidden Story and a new Solution” by Brian Peskin, Townsend Letter for Doctors and Patients, Feb./March, 2008.
    “Failure of Statin Crestor (Rosuvastatin) in the ‘Justification for the Use of Statins i Prevention & Intervention Trioal Evaluating Rosuvastatin” (Jupiter) Study” by Brian Peskin, http://www.CAmbridgeMedical Science.org.

  19. weing says:

    Not credible. All by an electrical engineer with money to make by selling you his snake oil. Just an example. He deliberately misleads the reader by his explanation of NNT. An NNT of 24 does not mean that 23 were harmed by the drug and 1 one was helped.

  20. Eric Jackson says:

    Winfield, JPandS has been mentioned numerous times before, this being one of the more notable examples: http://www.sciencebasedmedicine.org/?p=99

    The publication is so bad that merely publishing in it establishes a complete lack of credibility, and that whatever you’re saying in there is basically made up bunk. It’s a place to vomit up politics and opinion and pretend it’s science.

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