excerpts
guardian.co.uk0,3605,1186456,00.htmlOpen ↗
In fact, a number of trials have found that, even though the
number of deaths from heart disease does fall when
cholesterol is reduced by a range of means among patients in
primary care - that is, at GP level - there is often an
increase in the overall death rate from other causes
Statins in primary prevention have not consistently reduced
the incidence of myocardial infarction [heart attack] or
stroke. Other studies have even found that over the age of
50, reducing cholesterol increases the death rate. only 50%
of people who develop heart problems have high cholesterol,
while a study in the BMJ in 2001 found no link between
changing fat in the diet and heart disease. Malcolm
Kendrick, a GP from Cheshire who is the most active Skeptic
in Britain. "For instance, in Russia at the moment, heart
attack rates are rising dramatically but their cholesterol
levels are the reverse of what we see in the US and the UK.
They often have high levels of the so-called "good" HDL
cholesterol and low levels of the "bad" LDL, but they still
keel over from heart disease." When you correct for age,"
he concluded "there is almost no correlation between high
cholesterol and heart disease." This month the New England
Journal of Medicine is due to publish the results of a
large trial reporting that the heart patients who reduced
their cholesterol down as far as two, had a 16% drop in
their risk of experiencing such "vascular events" as heart
attacks and strokes. One of the cholesterol-reducing drugs,
Lipitor, is among the best-selling prescription drugs in
the world with sales worth $16bn (£8.75bn). The message
from this trial is likely to be that when it comes to
cholesterol "you can't go too low".
But the fact that bringing down cholesterol can help some
male heart patients," says Kendrick "doesn't mean it's going
to protect otherwise healthy people whose cholesterol is
over five. Since the average level in the UK is 5.7, that is
an awful lot of people."
But what about trials showing that statins reduce the risk
of heart attacks and strokes by a quarter among healthy
volunteers? That sounds impressive. But how impressive, say
the Skeptics, depends on how you work out the percentages.
Heart attacks among healthy people are quite rare, so the
actual percentage of people having a heart attack while on
statins is just 3% compared to 4% on a placebo. That is
indeed a drop of 25% but it is also a mere 1% fewer heart
attacks over five years, which is not quite so wonderful. In
Sweden official advice is to reserve statins largely for
secondary care But the same report concluded that although
patients on statins had a 1.4% lower rate of heart attacks,
this was cancelled out by a 1.8% rate of "serious adverse
events associated with the drug", including cancer. That,
they say, is almost certainly an underestimate since only
two of the trials provided details of any serious side
effects. The researchers said they had asked the drug
producers for the missing data but received no reply.
To an outsider what is curious about this debate is that
both sides are using the same data Akey factor in developing
heart disease, say the Skeptics, is inflammation. This is
the defensive reaction produced by the body when it feels
under attack, the redness that flares up round a cut or
bruise. An inflamed point on an artery makes it more likely
that plaque will form The body produces inflammation via a
number of complicated pathways many of which involve a
molecular switch known as NF kappaB and recent studies show
that statins are pretty effective at dimming NF kappaB.
However this is what a number of other effective heart
treatments also seem to do, such as aspirin and omega three
fatty acids found in fish oils, not to mention garlic and
vitamin E.
If this turns out to be what is going on, and trials are
under way to test the idea, this seems likely to shunt
cholesterol reduction into a small corner of the overall
picture of heart disease and allow statins to be marketed as
"inflammation fighters". Other ways of reducing your C-
reactive protein level include stopping smoking, losing
weight and exercising.
The cholesterol hypothesis is unlikely to be abandoned in a
hurry, given the weight of financial and political muscle
behind it. But the Skeptics have raised questions that
could ultimately have an impact on the way we think about
heart disease.