Cholesterol: Statins - Wonder Drugs Or Simply Hype?

An article in a US newspaper, USA Today, was sent to me by a colleague from Baltimore recently, which ran with the headline: 'Statins Gain Wonder Status.'

As soon as I saw that, my immediate thought was 'Here we go again'.

But unlike the headline, the article that followed turned out to be surprisingly balanced. Rather than just falling in line with the mainstream concept that virtually everyone could use a cholesterol-lowering statin drug (even if your LDL level is already low), the article examined the validity of statin's emerging wonder drug status.

And then there was the clincher. The article quoted Dr Christie Ballantyne, a cardiologist with Baylor College of Medicine, who said that most of her heart disease patients have a total cholesterol level of less than 240. And she added: 'The majority of people who end up having heart attacks or stroke don't have high cholesterol.'

It's a stunning remark, isn't it? And I'm afraid that Dr. Ballantyne will never get appointed to the National Cholesterol Education Programme (NCEP) in the US if she continues to make comments like that. Because the cholesterol cowboys over at NCEP really have only three basic points to make concerning cholesterol: 1) Lower. 2) Lower. 3) Lower.

Round 'em up!
I recently sent you an e-alert about the new NCEP guidelines for cholesterol levels that call for a target LDL of 70 for heart patients who are considered to be at very high risk of a heart attack. High risk or not, 70 is an extremely low LDL. And it will be almost impossible for anyone to hit that level without using statin drugs, which the NCEP recommends as a course of action.

All of this would be business as usual, except for a little controversy that erupted when a New York newspaper called on the NCEP expert panel to reveal their financial ties to drug companies that make statin drugs. As it turns out, those ties run deep and wide, with eight out of nine panellists reporting consulting work, honoraria for speaking engagements, and other perks from drug companies.

Dr. James Cleeman - coordinator of the NCEP - told WebMD that, in spite of the controversy, 'Nobody is quarrelling with the substance of the message.'

Let's go back once more to that quote from Dr. Ballantyne: 'The majority of people who end up having heart attacks or stroke don't have high cholesterol.'

That may not be a quarrel, but it couldn't be more contradictory. And Dr. Ballantyne is not alone. Not in the least.

Photo op
If you wanted to give someone an idea of what the Grand Canyon looks like, you could stand on the rim and take a wide-angle photo, or you could take a close-up shot of the Colorado River rushing past a boulder on the riverbank. And while both photos could be called photos of the Grand Canyon, only the wide-angle shot would convey just how vast the canyon is.

Trying to assess heart attack risk by looking at LDL alone (without also taking into account triglycerides, homocysteine, c-reactive protein and a few other important heart health markers) is like representing the Grand Canyon with the photo of the river boulder. There's no way you can get the big picture. And yet, the medical mainstream - while acknowledging other heart risk markers - continues to insist that lowering cholesterol should be the paramount goal.

I asked HSI Panellist Dr Allan Spreen, to comment on this concept that LDL cholesterol should be lowered as much as possible, and he immediately cited the Framingham Heart Study: 'The largest, longest, and most prestigious heart disease study showed that total cholesterol levels ('total,' now, mind you, they didn't talk a whole lot about LDL) that went below 160 caused heart disease problems to go back up! So it's a curve that bottoms out at 160 instead of a line that gets better and better as you get lower and lower.'

Dr. Spreen's comments are echoed in a US article in Red Flags Daily by Dr Malcolm Kendrick, which offers this quote about the Framingham results as published in the Journal of the American Medical Association: 'There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years.'

And from the National Heart, Lung and Blood Institute's Honolulu Heart Programme (an ongoing study that began in 1965 with more than 8,000 men), Dr. Kendrick presents this quote as it appeared in the Lancet medical journal: 'Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol, and show that long-term persistence of low cholesterol concentration actually increases the risk of death.'

So while the medical mainstream chants, 'Lower! Lower! Lower!' - the better mantra would be, simply, 'Moderation. Balance.' But of course, a call for cholesterol moderation doesn't make a good sales pitch for statin drugs.

Education crisis
When the new NCEP guidelines were released last month, Dr. Cleeman told the Associated Press that, in addition to taking drugs, heart patients should exercise and keep their weight under control. I don't believe anyone will quarrel with the substance of that message. But to this, Dr. Cleeman added that patients should eat a diet low in cholesterol.

I'm sorry - coming from someone who's the spokesman for the National Cholesterol EDUCATION programme - that's just a flabbergasting comment. Because study after study has shown that dietary cholesterol does not raise blood serum cholesterol in the overwhelming majority of people. By some estimates, that majority is well over 80 percent. So most of us can eat a three-egg omelette every morning without any change in our cholesterol levels at all.

In tomorrow's e-Alert I'll turn again to Dr. Spreen for some natural ways to effectively address elevated cholesterol and other heart disease markers without the use of drugs.