Magazine article Nutrition Health Review

Useful Insights on Cholesterol and Drugs

Magazine article Nutrition Health Review

Useful Insights on Cholesterol and Drugs

Article excerpt

[ILLUSTRATION OMITTED]

The magnitude of consumption of cholesterol-lowering drugs is illustrated by the surge in sales of Lipitor[R] [atorvastatin] to $6.45 billion for the year 2001. Using the recommendations from the third report of the National Cholesterol Education Program (NCEP III), an estimated 36 million persons would qualify for lipid-lowering medication.

Some insightful cartoonists have had a field day with cholesterolophobia. One featured the warning to a friend that he avoid contact with his father because "his cholesterol was 280."

The serious side effects of statins can be readily found in the Physicians Desk Reference and the fine print of ads that appear daily in newspapers. Such therapy could be harmful when other likely causes of elevated cholesterol (e.g., hypothyroidism; testing errors) are ignored. I again re-emphasize the dictum: cholesterol should be understood before being lowered.

Dr. John B. Thomison, editor of the Southern Medical Journal, editorialized: (1)

"'Under no circumstances should you ever trust the manufacturer to protect either you or the patient, even though in most instances they do this adequately. Their motivations have to be different from yours, all the disclaimers in the world to the contrary notwithstanding. They are, after all, in the business of selling; what's more, their stockholders require that they give it their best shot... Because doctors, it is you who will be held accountable, and if anyone gets sued, you will be that one.

The dubious statistical significance of purported benefits attributed to cholesterol-lowering agents is exploited in marketing blitzes discussing the selective citation of evidence, Jefferson (2) warned, 'Misinformation in health care...may cost lives.'

Vigorous attempts to reduce cholesterol concentrations in older individuals deserve skepticism. Schatz et al. (3) studied this issue in older persons within the Honolulu Heart Program. They concluded: 'These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations in elderly people.'

Dr. Donald Fedder, (4) lead author of the NCEP III report, cautioned: 'With this huge increase in the younger population eligible for these drugs, we need rigorous surveillance for unwanted and unexpected events.'"

There are expanding indications for statin therapy. One of the paradoxes posed by the suggested use of statins for Alzheimer's disease is the frequency of memory problems and personality changes in patients taking them for other disorders. These complications can be understood in light of the fact that cholesterol is the most common organic molecule within the brain, and the secretion of cholesterol by glial cells is crucial to the process of synaptogenesis--and therefore learning and memory (Science 2001;294:1354-57).

These issues underscore the legitimacy for outrage when pharmaceutical companies have interlocking interests with university-based researchers and the NIH [National Institutes of Health]. Indeed, it is now a virtual Herculean task to challenge the lipid hypothesis of atherosclerosis/coronary heart disease, and the conclusion that lowering one's cholesterol favors life extension. The challenger has to contend with impressive data and figures derived from the Framingham studies that rendered these attitudes a sacred cow in contemporary medical teaching and practice ... coupled with the fact that they generate enormous profits for several industries. A few credentialed brave souls have independently elected to share my anguish--such as Dr. Uffe Rasvnakov, author of The Cholesterol Myths (New Trends Publishing).

I am still not convinced that lowering cholesterol below the NIH guidelines offers real benefit. Moreover, I have difficulty evaluating the efficacy of cholesterol-lowering drugs, especially the alleged benefits of one agent over another relative to greater LDL [low-density lipoprotein-cholesterol] reduction. …

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