Cholesterol Confusion: Avoidance and Denial Obscure the Facts

Cholesterol Confusion:  Avoidance and Denial Obscure the Facts

So once and for all, how important is lowering LDL cholesterol for lowering cardiac risk?  The common dogma still asserts it matters.  Yet it is also common knowledge that nearly 50% of all first heart attacks have “normal cholesterol”.  In fact, a study from UCLA appearing in this month’s American Heart Journal showed that 75% of heart attack patients have normal “guideline” cholesterol levels. (Fonarow et al) 

I still vividly recall the night I admitted two patients with heart attacks. One was an elderly woman in her 70′s with an LDL in the 80s having her first heart attack.  The other was a gentleman in his late 60s on a cholesterol lowering “statin” drug and an LDL below in the 70s.  This was his second heart attack.  Both survived the evening and did well with standard treatment.

LOWERS CHOLESTEROL, FAILS TO PREVENT HEART ATTACKS                                                                                                     What about this?  Zetia (ezetimibe) lowers cholesterol by inhibiting its absorption in the small intestine.  Bowing down to the prevailing “lower is better” approach to lipd management, doctors burned through billions of dollars prescribing it to patients.  Then along came the ENHANCE study in 2008, which compared Vyorin, a statin-ezetimibe combo, to a statin alone.  

Although Vytorin dropped cholesterol more than Zocor (simvastatin) by itself, there was no difference in hard outcomes that matter — death and non-fatal heart attack.  In addition, Vytorin failed to reduce atherosclerotic plaque build-up, compared to Zocor.  In another study, the, ABITER 6-HALTS study, it actually increased plaque build-up.  So Zetia fails to reduce 1) deaths  2)non-fatal heart attacks  and  3) plaque build-up . . . although it lowers cholesterol.

These less than stellar results created quite a hullabaloo.  Drug giant Merck/Schering-Plough is now paying out millions of dollars in a class action suit, in which they are accused of making false efficacy claims for Zetia.  Some doctors have quit Zetia – prescriptions dropped by about 35% by 2009.  But many doctors, enamored with the cholesterol myth, continue to push this apparently useless drug on their patients. So much for “scientific medicine”.

SAY GOOD-BYE TO REASON                                                                                                                                                                                   So we have a drug that lowers cholesterol but confers no clinical benefit.  You’d think this would trigger more debate about the value of lowering cholesterol to reduce cardiac risk.  Not the case.  Here’s an example of the convoluted reasoning that prevails, taken from the January 2010 issue of Prescriber’s Letter, a monthly drug newsletter that serves mainstream physicians.

 ”Ezetimibe (Vytorin, Zetia) is controversial because there’s no evidence that it reduces atherosclerosis or improves outcomes . . . Consider ezetimibe only to further lower LDL . . . when HDL and triglycerides are OK.”

So what’s going on here?  Why should exetimibe be used at all?  And why isn’t the role of lowering cholesterol  subjected to more intelligent criticism?  Dogma dies hard, especially when its driven by a 30 billion dollar annual worldwide statin drug bonanza. Such is the hold that drug companies and their well paid MD “thought leaders” hold on the rank and file MDs in the trenches.

CREEPING FACISM?                                                                                                                                                                                  One aspect of facism increasingly cited in the current economic conditions is the promotion of private corporate interests in government over public interest . . . along with the overturning of rational discourse.  Hmmm . . . are we already be there in health care?