On October 3, 2006, after extensive review of all studies relating to cholesterol-lowering benefits by statin drugs, scientists reporting in the Annals of Internal Medicine pulled the rug out from under the current government-sanctioned cholesterol levels for reducing cardiovascular disease. Their conclusion: "current clinical evidence does not demonstrate that titrating lipid therapy to achieve proposed low LDL cholesterol levels is beneficial or safe."
To make matters worse, several years ago the government-funded National Cholesterol Education Program promoted new guidelines for the use of these drugs. It was recommended that individuals at high cardiovascular disease risk attain LDL levels < 100 mg/dL and individuals at very high cardiovascular risk attain LDL levels < 70 mg/dL.
These are abnormally low levels of cholesterol, demanding high doses of powerful statin drugs if they are to be met. These artificially low levels of LDL cholesterol are unnatural to the human body.
On July 13, 2004, these experts published their recommendations for new cholesterol guidelines in Circulation of the American Heart Association. Circulation failed to disclose that six of the nine authors had direct financial ties to the makers of statin drugs. Those drugs include Pfizer's Lipitor; Bristol-Myers Squibb's Pravachol, Merck's Lovastatin, and AstraZeneca's Crestor.
For example, Newsday.com reported on 14 July 2004: "Dr. H. Bryan Brewer, a physician-scientist at the National Heart, Lung and Blood Institute, was one of the guidelines' authors. He was the subject of a letter to the director of the National Institutes of Health last week from a consumer watchdog, Public Citizen's Health Research Group.
The advocacy organization charged that Brewer had failed to disclose his ties to AstraZeneca. Brewer, according to the letter, had written a glowing report in a medical journal about Crestor without disclosing that he is a paid consultant and had presided over a company-sponsored symposium."
These guidelines immediately boosted the sales of statins from fifteen billion per year when the report was released in 2004 to over twenty-two billion in 2005. And now we come to find out there is not a shred of scientific evidence to support that lowering cholesterol in this manner will reduce cardiovascular disease.
The October 3, 2006 review in the Annals of Internal Medicine tears this "solid science" to shreds, something that should have been done two years ago. The review explains the deceitful manipulation of statistics and how not one study proves that lowering LDL cholesterol to the super low levels recommended has any benefit in reducing cardiovascular disease. Simply put, this report is shocking.
The bottom line: there is no credible science, and there never was, that offered proof that lowering cholesterol levels to physiologically abnormal levels reduced cardiovascular risk. Thus, basing a broad governmental public health program on such findings was and is terribly wrong. Why does this happen?
Now that side effects associated with the use of statin drugs have occurred the media, supported by millions of dollars worth of statin advertising, is understandably reluctant to support a wake-up to the public.
For 40 years the cholesterol bandwagon with the enthusiastic support of our food and drug industries have guided clinical medicine. Throughout this time period physicians have written uncountable numbers of prescriptions for whatever anti-cholesterol medication was in vogue at the time and have earnestly counseled their often skeptical patients about the evils of whole milk, eggs and butter. Now forty years later, careful analysis of all available data including randomized trials, indicates that, contrary to widespread opinion, cholesterol lowering does not appear to have a significant role in cardiovascular disease control.
Michel de Lorgeril and Patricia Salena are the latest in a growing trend of skepticism among practicing physicians for all that Ancel Keys started back in the mid-fifties with his emphasis on cholesterol as the culprit. The concept was easily sold at national levels and has guided health care for four decades. This well-meaning Pied Piper and his flock of cholesterol groupies have been like the Titanic, once in motion difficult to stop. And has this growing doubt had any appreciable effects on statin sales? None that you would notice and the focus on cholesterol reduction has never been stronger.
And show me a physician who is happy to admit they have been wrong for four decades, the same physicians who have been denying serious side effects of the powerful statin drugs. They are now awakening to the fact that they, like their disgruntled patients, may be victims themselves, duped by the incredible economic power of the food and drug industries. These words are harsh but I have been saying these words for years now and feel much like a broken record.
The title of the paper by Longeril and Selena says it all: Cholesterol lowering and mortality: Time for a new Paradigm? Published in Nutrition, Metabolism and Cardiovascular Diseases, 2006; 16:387-390.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor