More on Cholesterol Forum

Article excerpt

Cholesterol, Statins, and Mortality: A Skeptical Look

Harriet Hall, M.D., takes Marshall Deutsch, Ph.D., to task for using mixed data from developed countries and undeveloped countries to show that low serum total cholesterol (TC) levels mean higher mortality. (1) In fact, within the four developed countries alone, lower TC was associated with higher death rate; and this was also so in the two undeveloped countries alone. Cholesterol is highly protective against cancer, infection and atherosclerosis. (2)

Hall also made the argument that, for adults, the medical propaganda recommending screening for cholesterol levels proves its value. There was never any scientific basis for such recommendations. (3) Among the elderly the lethal effects of low TC and low LDL were found to be pronounced. In a prospective study on residents of northern Manhattan, NY, 2,277 subjects were followed for 10 years. Subjects were 2/3 female and also about 1/3 each Hispanic, African-American, and white. Subjects were 65-98 years old at baseline, mean 76. The chance of dying was twice as great in the lowest quartile of TC or LDL levels, while HDL and triglyceride levels were not related to all-cause mortality in this age group. Women had higher baseline TC and LDL levels (206 and 124) than men (191 and 117), yet the women lived longer. Men with the same TC and LDL levels as women lived as long. Of the subjects, 1/5 were taking statin drugs to lower TC and LDL. (4) This is an excellent confirmation that high TC and LDL levels am beneficial, certainly in the elderly who are most likely to be prescribed a statin drug.

LDL levels both pre- and post-treatment with statin drugs in 176 patients with moderate atherosderosis were equally as useless as TC as predictors of atherosclerotic plaque progression. Patients with baseline LDL levels of 84, 117 and 158 mg/dL were given large doses of statin drugs to lower LDL levels to 76, 74 and 85 mg/dL After about 1.2 years electron beam tomography showed no difference between the groups in the amount of plaque progression. (5)

In the huge INTERHEART study on 30,000 subjects in 52 countries, the effect of many modifiable risk factors on heart attacks (MIs) was studied. Smoking led the list, but total cholesterol and LDL were not even listed, perhaps because the outcomes were not the ones desired by some of the sponsors of the study, which included AstraZeneca, Novartis, Aventis, Abbott Labs, Bristol-Myers Squibb, King Pharma and Sanofi-Synthelabo. (6)

The Japan Lipid Interevention Trial (J-LIT), a primary prevention trial utilizing simvastatin, was carried out on 47,300 Japanese patients. Since they are more sensitive to statin drags than occidentals, the dose was 5 mg/day for 90% and 10 mg/day for 10%. All were followed for 6 years, including those who stopped the drag, which was open-labeled. There was no placebo group. Those whose TC was most reduced bad the highest all-cause death rate. The statin makers often stress that the main "benefit" of statins is to reduce LDL rather than TC. Those with lowest achieved levels of LDL also had the highest all-cause death rate. Obviously, there is no reason to reduce TC below 250, or LDL below 130 mg/dL. Here is the best evidence yet that the tiny gains in lifespan shown in other trials on statin drugs with placebo groups are not due to TC or LDL lowering. (7)

Dr. Hall neglected to mention, in touting statin drugs, that in 3 older trials reporting gender-specific mortality, there was a 1% decrease, a 12% increase, and a 57% increase in women, so the omission of gender-specific data in most trials can have serious consequences for women. (8) If women are included in an RCT on a statin drag, the percentage of them is low, so that the known bad effects in women will not make the overall trial result negative for the statin.

Researchers at the University of Sheffield took a hard look at the earlier RCTs: AFCAPS, 4S, LIPID, WOSCOPS and CARE. …