Statins: Are The Latest Cholesterol Reports Another Ploy To Promote Statins?

Are you rethinking the importance of your HDL level?

You might be if you listened to the news reports last week about the sudden 'confusion' surrounding high-density lipoprotein (HDL), also known as the 'good' cholesterol.

But guess what? The confusion is completely manufactured. And why is it manufactured?

Do you even have to ask?

Highs and lows
In a nutshell, here's how LDL and HDL work: LDL transports cholesterol from the liver to the rest of the body, and HDL returns cholesterol to the liver where it's disposed of.

According to the US National Institutes of Health (NIH), the optimal LDL level is anything less than 100 mg/dL (milligrams of cholesterol per decilitre of blood). The 'near optimal to above optimal' range is 100-129. 'Borderline high' is 130-159. And anything over 160 is considered 'high.'

The NIH guidelines call for HDL cholesterol to be 60 mg/dL or more in order to help reduce heart disease risk. HDL lower than 40 is considered dangerous.

All of that seems pretty clear. So where does the sudden confusion about HDL come from? Prepare to be not the least bit shocked: It comes from high-profile promoters of cholesterol-lowering statins drugs.

Freeform extrapolating
Last week a New York Times article reported that 'some scientists' point to 'new and continuing' studies suggesting that HDL may not effectively counteract the potentially harmful effects of elevated LDL. The Times article was picked up by a number of other newspapers and media outlets.

The primary scientist singled out by the Times is US physician Dr. Steven Nissen - a prominent cardiologist with the Cleveland Clinic, and an outspoken advocate of statins use. He's also a leading proponent of the statin-friendly concept that LDL should be lowered as much as possible - well below the NIH's 'optimal' mark. Last November, the Associated press quoted Dr. Nissen as saying, 'There is no such thing as too low an LDL.'

Remarking on the HDL question this past week, he told the Times that, 'There is so much confusion about this that it is unbelievable.'

Dr. Nissen cites a recent study that he headed up - a study I told you about in a recent e-Alert. The trial enrolled more than 4,260 subjects, each of whom had been hospitalised with 'an acute coronary syndrome.' In other words, these were not average Joes who merely had elevated LDL levels. Subjects were divided into two groups.

For two years, one group took 40 mg daily of a statins drug, and another group took 80 mg per day of a statin. Results showed that the higher dosage lowered LDL better than the lower dosage.

But one of several problems with this study is that there was no control group. Without a control group (that is; a group not taking statins to compare against the other subjects who all were), there's no way of knowing if the HDL and LDL outcomes are really as significant as Dr. Nissen is convinced they are.

Believability
So when the Times article refers to 'some scientists' pointing to 'new and continuing' studies, it's apparently referring only to Dr. Nissen and this single study of his that wasn't even designed to examine the effects of LDL vs. HDL on plaque growth in the first place.

The Times article does mention one other trial: the Framingham Heart Study, which is the ongoing, landmark study that has included many thousands of subjects since its inception in 1948. The Times notes that Framingham data clearly demonstrates how higher levels of HDL are actually associated with a decreased risk of heart disease.

NSPM!
When Dr. Nissen's study was released earlier this month, the media reported the results with fawning respect for the idea that 'superdoses' of statins should now be considered the norm in order to drive LDL as low as possible.

So with major news outlets getting out the message that statin super doses should be used, and then two weeks later reporting that you can't depend on HDL to help lower heart disease risk (but you CAN depend on statins), I don't think it's too much of a stretch to go ahead and officially declare March as NSPM; 'National Statins Promotion Month.'

Here's the best way to observe NSPM: Ignore the manufactured 'confusion' about HDL, and be deeply suspicious of the flawed study that encourages millions of people to start taking large, expensive doses of statins.

Because they're both unbelievable.