cholesterol is the main culprit behind heart disease? For decades, Americans have said that to reduce the risk of a heart attack had to lower their cholesterol levels, especially LDL cholesterol, also known as “bad cholesterol” to distinguish HDL cholesterol, known as “good” cholesterol . Cardiology friend of ours likes to say he could never have lack of golf score or too low cholesterol.
A mystery of the American College of Cardiology:
Cardiologists around the world gathered in Chicago for the annual ACC (American College of Cardiology) meetings between April 2-4, 2016. The details of a large, randomized, double-blind, placebo-controlled trials were finally released and the results surprised the cardiology community.
The drug under review is a tongue twister called evacetrapib . It belongs to a class of compounds that lower cholesterol called CETP ( c holesterol and ster t RANSFER p rotein) inhibitors.
evacetrapib was the star in a study of 12,000 patients at 540 health centers around the world. Patients at high risk of cardiovascular complications were assigned to placebo or medication and follow-up of at least one year and a half. In addition, many patients also received prior art treatment for heart disease.
The drug was a great success, but failed miserably. Hey? How can that be?
Well, let’s explain. Evacetrapib reduced bad cholesterol phenomenally well. Patients averaged LDL cholesterol levels of 55 milligrams per deciliter (a reduction of 37%). Most cardiologists who would see it as an incredible achievement. In addition, this drug raises good HDL cholesterol an average of 104 (130% improvement over placebo). That was also a home run.
No other drug known to man has produced such extraordinary results. Both to reduce bad cholesterol and increase good cholesterol so high is truly unprecedented. If we are to believe the theory cholesterol heart disease, these numbers should have led to great results.
The Envelope Please:
When the data were analyzed it turned out that 255 patients who were at high risk of a cardiac event suffered a heart attack while taking evacetrapib . There were 256 heart attacks in the group of patients who received placebo. In other words, there was a difference! This is a bit like the surgeon telling the family that “the surgery was a great success, but the patient died.”
With respect to stroke, 95 patients receiving placebo had what is called a cerebrovascular accident (CVA) and 92 individuals receiving the active drug had a stroke. It means essentially no difference. When the last “end point” called death, came the results were not statistically significant. There were 434 high-risk patients who died while taking evacetrapib and 444 subjects who died while taking placebo. That was not enough to prove significant.
Gina Kolata, writing in New York Times (April 3, 2016) quoted a key research player:
” ‘we had an agent who seemed to do everything right,” said Dr. Stephen J. Nicholls, deputy principal investigator of the study and director of the Institute of Health and Medical Research South Australia in Adelaide. “It’s the most amazing question. How can a drug that reduces something that is associated with a benefit show no benefit?” He said in reference to the fall of 37 percent in LDL levels with the drug. “
is the Theory cholesterol crumbles?
in recent months there have been some dramatic changes in public health policy. on the one hand, the new Dietary Guidelines for Americans emphasize not avoid cholesterol in food. Instead, Americans are advised to limit saturated and trans fats, added sugars and sodium. the eggs are considered part of a healthy eating pattern. ( Dietary Guidelines for Americans, 2015 )
the American Heart Association (AHA) and the American College of Cardiology (ACC) issued its own guidelines in late 2013. These organizations recommend that if the diet does not lower cholesterol blood, statins are the solution. According to its guidelines , at least one third of American adults would be taking a prescribed statin. Almost all people between the ages of 66 and 75 would be in one of these drugs ( JAMA Internal Medicine January 2015 ).
but not all cardiologists agree that lowering cholesterol in the blood is the most important in preventing heart disease method. Robert Dubroff, MD, is a cardiologist and lipid specialist at the University of New Mexico. It has been noted that high-risk populations are not constantly benefit from statin therapy ( American Journal of Medicine March 2016 ). In his view, doctors do not have a good way of saying that could benefit from taking a statin to prevent heart disease. The clinical benefits, including survival, not quantity is well correspond to a statin reduces bad cholesterol ( Preventive Medicine April 2016 ).
Dr. Dubroff, along with the French physician Michel de Lorgeril, MD, who oversaw the study heart of Lyon pioneer in the 1990s, has written:
“We to the conclusion that the expectation that heart disease [coronary heart disease] could be prevented or eliminated simply by reducing cholesterol seems unfounded. on the contrary, we must acknowledge the inconsistencies of the cholesterol theory and recognize the proven benefits of a lifestyle incorporating a healthy Mediterranean diet to prevent heart disease “( World Journal of Cardiology on July 26, 2015 ).
What can patients do?
If cardiologists can not agree on the importance of lowering cholesterol with statins, it is not surprising that patients are confused. What else can people do to keep your heart healthy?
There are many non-pharmacological approaches that are beneficial. You can learn more about them in our Guidelines for controlling cholesterol and heart health . Anyone who wants a copy, please send $ 3 in check or money order with a long (No. 10). Stamped (71 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. C-8, PO Box 52027, Durham, NC 27717 to 2027. You can also download for $ 2 this website .
Physical activity is important for health. If statins cause muscle pain or weakness that interferes with the exercise, which could be counterproductive. So would elevations of blood sugar. Diabetes is a leading cause of heart disease and a known complication of statins.
A Mediterranean diet, such as Drs. of Lorgeril and Dubroff mentioned, it is also very good for the heart. A large randomized trial called PREDIMED showed that this type of diet with lots of olive oil or heart disease prevented nuts in high-risk individuals ( New England Journal of Medicine , April 4, 2013). Such a diet rich in vegetables and fruits is also useful in reducing (not increase) the risk of diabetes ( Journal of Nutrition line on March 9, 2016 ).
If you are beginning to appreciate that cholesterol is only one piece of the puzzle of heart disease can find our chapter on this topic in The best options People’s Pharmacy of great interest. It pointed out that cardiologists have known for decades that have not been finished 246 “risk factors” for heart disease ( New England Journal of Medicine , 14 November 2002) . You will discover that many of the other risk factors can be modified through better lifestyle, such as Drs. Dubroff and Lorgeril described above. The fact that doctors can prescribe statins does not mean they are the only or the best solution for heart disease. Find out about other strategies Best Medicine .
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