Cholesterol drugs for the masses is simply not ready for prime time. Very careful consideration should be undertaken before you start these drugs.
Thus might read the headline for the recently reported results of the “HOPE” trial.
Cholesterol drugs have been pushed with religious fervor by doctors for decades. They are looked at as an essential “standard of care” for anybody with heart disease, or the potential to get heart disease. So complete is the medical establishments indoctrination into the use of these drugs that doctors are sent warning letters from insurance companies advising them to start many of their patients on these drugs.
Now comes the latest study published in the prestigious “New England Journal of Medicine” suggesting that even more patients should be on cholesterol lowering drugs. The study included men 55 and older and women 60 and older who have no history of any type of heart disease. They were randomly assigned to either take cholesterol lowering drugs or not.
BIAS IN REPORTING
The authors of the study concluded that there was a 25% reduction in risk of heart disease for the people who took the drug. They conclude that the study “provide(s) support for the use of statins as a safe and effective intervention to prevent cardiovascular events in such patients.” Don’t be surprised if your doctor will have a renewed enthusiasm to push these drugs on you. After all, most busy doctors barely have time to read the headline let alone dissect the details of such studies.
“ABSOLUTE vs RELATIVE RISK”
To better understand the results of such studies you need to know the difference between “absolute” and “relative” risk. To put relative vs absolute risk in perspective let’s use the example of getting hit by lightning. Let’s say that the absolute risk of getting hit by lightning is 2 in 1 million if you are outside in a storm. Now let’s imagine that by putting on rubber boots you will reduce your risk from two out of 1 million, down to one out of 1 million. That could be reported as “50% reduction” in the risk of getting hit by lightning. However, the absolute reduction of risk would be one in 1 million. If you’re in the business of making rubber boots, how do you think this result would be reported?
Now let’s go back to our study. It turns out that if you take Crestor 10 mg a day your absolute reduction of risk is approximately 1%. The small reduction of absolute risk is because the overall risk for heart disease to the people in the study was low to begin with.
SIDE EFFECTS IGNORED
An editorial accompanying the study reported that there was “no evidence of harm” in those using Crestor during the study. It has long been known that cholesterol lowering drugs can increase the risk of muscle inflammation and pain. They have also been implicated in increasing diabetes. This most recent study uncovered a new, previously undocumented adverse effect of cholesterol drugs; increased risk of cataracts. While this new side effect deserves further scrutiny before it can be conclusively ascribed to the drug, the fact that the authors chose to ignore it in their summary is curious.
FOLLOW THE MONEY
For reasons that are not explained, the designers of the study chose to use one of the most expensive cholesterol lowering drugs. Crestor has an average retail cost of $300 per month. Compare that to pravastatin at five dollars per month. One can only question why the cheaper drug wasn’t used for the study?
Even if you’re willing to risk cataracts, muscle pain and diabetes for the sake of a 1% reduction of heart disease risk, you would be doing so at a cost of $3600 per year on average. Since the new study also dramatically expands the amount of patients considered appropriate targets for the drug, the total cost if the new recommendation are fully implemented would exceed $1 trillion per year nationally.
All this for 1% reduction. Not to mention the cost of all those cataract surgeries, treating the muscle pain, and managing the diabetes. There must be a better way.
CONSIDER THE CAUSE
Cardiovascular disease is an epidemic in United States. The same epidemic does not occur in other countries. Rather than carpet bomb the nation with cholesterol lowering drugs, there may be a better way to achieve 1% reduction of risk without spending $3600 per patient and exposing people to side effects and increased risks.
Adjustments in nutrition, modest weight loss, lifestyle change, thoughtful use of supplements, and targeted application of “chelation” therapy can achieve profound health benefit with no side effects at a fraction of the cost. Sadly, the majority of healthcare providers in the United States are poorly educated in such approaches. Furthermore, the changes in the delivery of healthcare have deprived providers of precious time. It is all they can do to write a prescription for a drug and get you out of the office and on to the next patient. Thoughtful reflection and global disease management is beyond the scope of their time constraints and outside the limits of their training.
A BETTER APPROACH
Take it upon yourself to do some basic research on the Internet. Research the drugs that are being proposed, study the alternatives that are available. Consider enrolling with a “concierge doctor.” Providers who have taken the concierge approach have made a decision to see fewer patients, provide expanded time, offer more detailed conversations and take a more holistic approach to managing patients care. Yes, it may cost you a bit more than the traditional insurance approach, but if you value a thoughtful interaction rather then a knee-jerk prescription this is your best approach.
In summary, cholesterol drugs for the masses is simply not ready for prime time. Very careful consideration should be undertaken before you start these drugs. On the other hand, people with high-grade heart disease or multiple risk factors are more likely to achieve benefit that may make the risk and expense worth the exposure. If you are currently on a cholesterol lowering drug, do not stop taking it until you have had a conversation with your doctor and considered all the implications. Prescription drugs have their place, but good health does not come in a pill.
To your best health,
Dr. Stephen Petteruti
Photo: Getty Images