Great Smokies Medical Center of Asheville

Risk vs. Benefit of Cholesterol-Lowering Drugs

by John L. Wilson, Jr., M.D.

The German drug company Bayer AG withdrew its cholesterol-lowering drug Baycol from the market in August, 2001 after it was linked to 31 (now 52 and counting) deaths. An estimated 700,000 people in America were taking Baycol. Many more whose doctors prescribed other closely related drugs in the “statin” family of drugs (including Lipitor, Lescol, Mevacor, Pravachol, and Zocor) are left wondering if they are at risk. 48 million prescriptions were written last year in the US for Lipitor alone. Our television sets are abuzz with marketing of statin drugs, appealing to a huge market of potential customers.

All statin drugs are linked to a rare muscle inflammation condition called “myositis” which occurs in about one in a thousand patients, especially if taken with another drug, Lopid (gemfibrizol). Rarely, “rhabdomyolysis” can result, where muscle cells break down to the extent that kidney failure and death can ensue. People taking statin drugs who experience muscle pain and weakness should consult their doctor. The elderly and women seem to be more at risk, and the adverse effects are dose related, meaning the higher the dose, the greater the chance of adverse effects. An elevated blood test, Creatine Phosphokinase (CPK), is an indicator of this muscle damage. A CPK test should be done on all patients who are taking statin drugs.

Statin drugs are “HMG Co-A Reductase Inhibitors”, meaning they block a liver enzyme required for making cholesterol. This same enzyme is also necessary to make Coenzyme Q-10, a very important nutrient essential for energy production in our body, and especially for heart function. Doctors seldom address this other common downside of statin drugs that can be remedied by supplementing Coenzyme Q-10.

For years doctors focused on cholesterol as having a major causative role in heart disease. Because cholesterol is found in arterial plaque, scientists thought that reducing cholesterol levels through low fat diets and drugs would result in less plaque in arteries. The presence of cholesterol in coronary artery plaque no more proves that cholesterol causes heart disease than the presence of a fireman at a fire proves firemen cause fires. In fact, firemen and cholesterol are both on the scene putting out different “fires”. Recent analysis of the Framingham Heart Study data suggests that the “fires” of oxidation, infection, and inflammation, likely due to a resulting increased clotting risk, are better predictors of a future heart attack than are cholesterol levels. Every doctor has seen heart attacks in patients with low or normal cholesterol levels. In fact, too low cholesterol levels pose risks, a fact seldom recognized, much less mentioned to patients. The liver makes 80% of one’s total cholesterol; only 20% is from dietary sources. Cholesterol is the raw material needed by the body to make hormones, including cortisol, estrogen, progesterone, and testosterone. Increased risk of cancer occurrence, mood disorders including depression, suicide, and numerous and varied symptoms of hormone depletion are associated with too low cholesterol.

A balanced cholesterol ratio in the body is the optimal goal. Most people are familiar with “good” (HDL) and “bad” (LDL) cholesterol. Doctors generally agree that having a low ratio of total cholesterol to HDL cholesterol is highly beneficial for cardiovascular health.

I find excellent overall results in cholesterol and triglyceride reduction in my practice from strict reduction of carbohydrates (sugar and starchy foods). Exercise also remains one of the better prescriptions for overall heart health. And, both are very unlikely to be recalled by a pharmaceutical company anytime soon. Unfortunately, lifestyle solutions to health problems are somewhat unpopular in a population desiring quick fixes. There are no drugs that provide a quick fix without risk. It is almost always good advice to not look to drugs as a first line defense for health problems.

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