Cholesterol: Big Problem or Big Business?

I'm sure you are frustrated as we are to keep reading about unfavorable research released years after patients have already been taking a drug. The most recent example is Vytorin, a combination of Zocor (statin that blocks cholesterol in the liver) and Zetia (blocks absorption of cholesterol in the intestine).

The makers of Vytorin announced recently that its drug had failed to reduce the growth of fatty arterial plaque, even though Vytorin users had lower LDL than those taking Zocor alone. These results have been interpreted to mean that LDL may not translate into measurable medical benefits. Whether or not that is true is up for debate. Unfortunately, this was not an event trial (one that focuses on reduction of cardiac events), because those did not start until 2006 (four years after the drug was approved) and will not be completed into 2011.

The reason this story received so much attention, like that of Avandia and Vioxx, is because Vytorin is a blockbuster drug. Cholesterol medications are the darlings of pharmaceutical companies and tens of millions of Americans are taking them. They are considered lifestyle drugs, those that are prescribed to be taken on a long-term basis, so the money to be made is vast...to the tune of $40 billion a year.

While still in the minority, a powerful group of researchers and cardiologists are beginning to recognize that the benefits of statin medication may not come from its intended purpose, to lower cholesterol, but for its ability to reduce inflammation. Most importantly, they realize that just lowering LDL will not solve the heart disease problem. If this is the case, there are many people taking statins who think they can eat anything they want and not worry about developing heart disease. Most importantly, there are countless Americans who are currently experiencing a host unnecessary side effects from statins.

According to cardiologist Jay Cohen of University of California San Diego, muscle symptoms occur in roughly 35% of statin users, even though the drug companies' claim incidence is only 5%. Furthermore, statins have been proven to cause numbness in the limbs, cognitive and memory problems, muscle pain, and severe muscle injury. This information is not surprising, as we have heard from many of our own clients who have had to go off statin medication because of similar complaints.

Unfortunately, because statins are believed to be so safe, doctors do not seem to be listening to their patients complaints. A UCSD research team, who investigated doctor's behavior when dealing with patient complaints of statin side effects, found that of 138 doctors, 62% dismissed the possibility of a side effect.

Many of you may be asking, what do I do? If you are currently on a statin, do not do anything until you speak with your physician. If you are considering going on a statin, you need to delve deeper.

Many progressive cardiologists believe that high risk groups and those with established heart disease still have a lot to gain by taking statins. However, for healthy men with high cholesterol, for women with or without heart disease and for people over 70, there is little evidence, if any, that taking a statin will make a meaningful difference in how long they live.

You must insist that your physician look at the whole picture, which means looking at numerous factors that go into evaluating heart health.

1. If your LDL (considered the bad cholesterol) is high, particle size makes a huge difference in risk. If you have a large number of small LDL particles, there may be some cause for concern. If you have a high number of large particles, they are not nearly as risky.
   
   
2. Familial Hypercholesterolemia - less than one percent of the world's population has this inherited condition in which too much cholesterol is produced regardless of lifestyle changes that are made. Most cardiologists believe that a statin is warranted in this case.
   
   
3. The good cholesterol, HDL, is finally getting the respect that it deserves for its importance in heart health. In this case, the higher the HDL level, the better. Pfizer was set to bring the holy grail, blockbuster drug torcetrapib, which helped raise HDL levels, to market but was derailed by numerous heart attacks and strokes during a trial. Merck is asking the FDA to approve its own version, Cordaptive, without waiting for the results of event trials (which will not end until 2013). Unbeknownst to much of the public, there already exists a very effective method for raising HDL. It is called Vitamin B3, or Niacin. However, Niacin is not profitable so that is why you rarely hear about it. Most well-researched cardiologists recommend Niacin to raise HDL.
   
   
4. Triglycerides are vital for heart health because from a nutritionist's standpoint, it is the indicator of how well you are metabolizing carbohydrates as well as how many of them you are eating. Some experts look at the HDL/Triglyceride ratio as the most potent predictor of heart disease. This means that the lower your triglycerides and higher your HDL, the less risk you have for heart disease.
   
   
5. C-Reactive Protein (CRP) reveals the level of inflammation and accounts for roughly 50% of cardiac risk according to some cardiologists. Statins can help with CRP, but should not be the first option because of potential side effects (muscle wasting, amnesia, cognitive problems, irritability and impotence) and the unnecessary blocking of cholesterol. Diet, nutrient, and lifestyle change are the first line therapy prescribed by preventive cardiologists for inflammation. Homocysteine levels should also be taken into account as an important inflammatory indicator.
   
   
6. Some experts believe that Blood Pressure is the most important number for heart disease risk in women. There is no data showing that women can benefit from lowering their LDL values with statin medication.

To recap, your beneficial levels when evaluating test results (labs are different in how they interpret optimal reference range) include:

• Low CRP
• Low Triglyceride
• High HDL
• Low number of small, dense, LDL Particles
• Optimal blood pressure (in women especially)
  

If your are at high risk for heart disease or have heart disease (males), have many small LDL particles, have genetic hypercholesterolemia, or have found no other way to reduce inflammation or raise HDL, then a statin may be an option for you to discuss with your physician.

If you begin statin therapy, make sure to supplement with at least 100 mg. of Co-EnzymeQ10, if your doctor fails to mention it. Statins deplete CoQ10, which is essential for energizing mitochondria, the powerhouse of the cell. CoQ10 was included in the first statin to be brought to market, but was quickly removed because it proved too costly for the drug to be profitable.

If you feel you may be on a statin unnecessarily, speak with your physician about weaning off of it while coming up with alternative methods to accomplish your optimal heart health goals. This is where we can help as well. For example, for many of our clients, simply lowering grain and simple sugar carbohydrate intake will positively reduce triglyceride levels quickly and dramatically. This, in turn, helps blood sugar, insulin levels, and promotes weight loss.

Have a happy, healthy day.