Cholesterol Guidelines A Gift For Merck, Pfizer
Matthew Herper, 07.12.04, 4:30 PM ET
Forbes Magazine
http://www.forbes.com/healthcare/20...mh_0712mrk.html

NEW YORK - New guidelines issued by the United States government could increase the number of people who take cholesterol-lowering medicines; already the top-selling medication in the world with $26 billion in annual sales.

The new guidelines were predicted here months ago. (See: "Is Lipitor The New Aspirin?")

Under previously existing guidelines, 36 million people should be taking cholesterol-lowering pills such as Lipitor, Zocor, or Pravachol to prevent heart attacks. In reality, only about 11 million do. Changes issued today by the National Cholesterol Education Program (NCEP), to be published in tomorrow's issue of the journal Circulation, advocate lowering cholesterol in even more patients. Moreover, patients at the highest risk should receive even more aggressive treatment--meaning higher, more expensive doses of these drugs. Now, that figure will increase by millions of people, as the new guidelines suggest treating diabetics and people who at one time would have been considered healthy. Those at high risk, or who have had recent heart attacks, should be treated even more aggressively.

The NCEP did not release an estimate of how many patients should now take cholesterol-lowering drugs, called statins. Christopher P. Cannon, a cardiologist at Brigham & Woman's hospital, says 50 million people should take the drugs. Another cardiologist, Steven E. Nissen of the Cleveland Clinic, said that number looked reasonable, although James I. Cleeman, a researcher at the National Heart Blood and Lung Institute and a co-author of the report said it was "a little high." The cost of treating that many people with even the lowest dose of Pfizer's (nyse: PFE - news - people ) Lipitor could approach $40 billion.

But an even more important facet of the guidelines is that many people would not be on low doses of these drugs. For patients at the highest risk of heart attack, the new guidelines suggest that "bad cholesterol," or low-density lipoprotein (LDL), be reduced to 70 mg per deciliter--although the new guideline is optional. Previous guidelines suggest that LDL of 100 mg was good enough. Many patients will not be able to get to those levels at starting doses of most current drugs. "It may be that reducing cholesterol to levels that are consistent with what used to be found in rural china is where we need to head," says Sydney Smith, a cardiologist at the University of North Carolina, Chapel Hill, and a co-author of the new guidelines.

Even for patients at modest risk of heart attacks--meaning that they have heart disease, diabetes, or a combination of some risk factors--the new guidelines suggest lowering cholesterol at least 30-40%. With weaker statins, such as Pravachol from Bristol-Myers Squibb (nyse: BMY - news - people ) or lovastatin, available as a cheap generic, that requires the second-highest dose. That could encourage doctors to use stronger drugs--a big boost for Lipitor. Crestor, an even more powerful statin from AstraZeneca (nyse: AZN - news - people ) could also benefit, but may be held back because it does not have the same track record of safety as Lipitor.

Another big winner could be Vytorin, a new cholesterol pill from Merck (nyse: MRK - news - people ) and Schering-Plough (nyse: SGP - news - people ) that is expected to hit the market soon. It combines Merck's Zocor with another drug, Zetia, to lower cholesterol even more at lower doses.

Some say the new guidelines do not go far enough. "It's very disappointing to me that NCEP couldn't get it right given the data," says Eric Topol, a cardiologist at the Cleveland Clinic. He points out that two clinical trials have shown that many patients would benefit from more cholesterol lowering. Says Topol: "To make an LDL of 70 an optional strategy is ignoring the trials."

This is just scary

This stuff really gets my goat. These kind of large epidemiological studies prove absolutely nothing. We have no idea about risk factors or any other factors that were or were not controlled for. The only thing that was looked at was absolute LDL numbers. There are seven different kinds of LDL, some can be harmful, others not. Which types are they talkling about. There are many subtle, yet important, elements in the human cholesterol management system, and this study accounts for none of them. To put 36 milliion people on statin drugs because of this kind of garbage study is highly unethical.

If people would control their insulin resistance, a large portion of the disorders for which we take prescription drugs would be eliminated. Unfortunately, there's only one way to control insulin resistance--controlling carbohydrate intake. Since there's no way for drug companies to make money off of this, don't expect to see any studies demonstrating the connection between insulin resistance and cholesterol anytime soon.

That is scarey!

". . . . It may be that reducing cholesterol to levels that are consistent with what used to be found in rural china is where we need to head. . ."

Where the leading cause of death was stroke.

You took the words right out of my mouth!

<slaps cheek> Gosh...I just WONDER who put money into the studies under the table? Big drug campanies would never, EVER stoop that low....

Remember the source, too. This was written in a financial magazine letting its readers know that these companies are a good buy at the moment because of this news. The reporter is their pharmaceuticals analyst.

Of course, we're all aware of the wonderful record these analysts had during the late 1990's.

Plane Crazy

Until the public is willing to tell big pharma and the Dr. to go Dick Cheney themselves, they deserve this crappola. Utter bunk.

Many low carbers will watch with amusement as an enormous class action is taken one day when all the statins kills or disables lots and lots of people. The average doc is still not advising people to take CoQ10 when on statins.

Val

Want to reduce your cholesterol?

1) eat a moderately hypocaloric diet designed to bring weight to the lower ranges (low in total energy)
2) eat a diet which contains extremely little to no food dense in absorbable/digestible saccharides...this excludes almost all forms & quantities of bread, rolls, pastas, all forms of rice, many legumes, and any grain based-food - whole or refined. (low in total carbohydrate)
3) eat a diet moderate in total fat, with most of the fat coming from monosaturated fatty acids, followed by saturated fatty acids, with PUFAs forming the minority of fat intake. (moderate to slightly high in total fat)
4) eat a diet moderate in food products which contain high amounts of nutritious indigestible saccharides (spinach kale broccoli romaine lettuce and other deeply colored cruciferous veggies, tomatoes melons and other low-sugar fruits, strawberries and other berries) (high in low-energy, low-sugar, high nutrition fibrous food sources)
5) eat overly processed, nutrient-void food products very infrequently (low in junkfood)
6) eat good protein sources shown to improve cardiac risk factors, such as soy protein (which is shown to improve cardiac profile for some reason), and fish (which is high in omega 3s which likewise improve cardiac risk).
7) do moderate physical activity several times a week.

Do all of the above and the overwhelming majority of people wouldn't need statins.

The problem is, no one wants to do the above. It means you have to make a really big lifestyle change and commit yourself to healthy living at the expense of pleasure. You know, sometimes I read other health-related boards and I am AMAZED by how stubborn people are and how much they refuse to give up their pleasures even when faced with dire consequences. There was this one diabetic fellow with poor control who said he sometimes drinks full sugar soda because "he doesn't like the taste of diet". That just FLOORED me. How could a diabetic put that junk in his body? As someone who's insulin resistance isn't yet life threatening, I couldn't even *imagine* finding such a minor compromise (switching from full sugar to no sugar) a problem. Of all the changes I've had to make to my diet, switching to no-sugar soft drinks doesn't even register on the "PITA radar" for me. However, there are people out there apparently with much more life-threatening diseases (T2 diabetes) who refuse to make even such a minor change (or will only do so after much fussing & whining). I just don't understand that at all. Don't they realize they are killing themselves? To be diabetic is, in essence, to be violently allergic to a high sugar diet. This diabetic is literally *poisoning* himself every time he drinks that stuff.

I sometimes forget that people like us are in the minority. Many people are like children who want their cake and they want to eat it too. They want good health, but they don't want to make an effort... they want a doctor to give them a pill and they want to drink a bottle of soda & eat a pint of takeout rice. Reality just doesn't work like that.

Sadly, I think most people *would* sooner welcome a statin before making even moderate lifestyle changes. Yes it's true that a lot of the demand for statins is artifical (big pharma telling us that we need it or our insides will rot), however a lot of it is also genuine public demand. People have insulin resistance, they have high cholesterol, they have heart disease, but they don't want to commit to healthier living. They want pills instead.

"at the expense of pleasure." Not! It's sad that so many people can't see that it's so much more pleasurable to eat well and get active than to be dependent on drugs merely to exist as long as they can keep eating their junk. I love the foods I eat, I love being active. I wouldn't have it any other way.

I do have to admit, that I don't follow your plan exactly, primarily in the protein sources component since I avoid soy and eat beef, pork and fowl as well as fish. ;-)

Oh I wasn't trying to say that other protein sources are bad (quite the contrary in fact, beef and pork and fowl are very good for you), I was just trying to say that if heart disease is a concern there is evidence that you would be well served by increasing fish & soy consumption slightly.

I don't do all of what I wrote, either, especially the exercise part . But even if people just *tried* to live sensibly it would make a world of difference. If people made an effort to eat low or adequate cal, and to eat healthier food choices, we wouldn't have the epidemic diseases we do.
But people don't want to put in the effort. They want to smoke, they want to binge eat, they want to eat take out, they don't want to have to plan or think about their meals, and they tend to resist change. I notice some people find the concept of change very disturbing... these are the types who won't eat anything if it's "healthy" or advertised as such, not because it actually does taste inferior, but because they perceive that change is bad, especially changes that they perceive as being "forced" on them due to circumstance.

Let me relate to you a story about my mother. My mother is about 60 pounds overweight. Sick of being overweight, she attempted to try Atkins (it was an ill fated venture for numerous reasons, but that's for another story).
When she was preparing her meal one day, I noticed she slathered on a huge amount of processed cheese sauce over her veggies. Now processed cheese sauce is junkfood in the purest sense - loaded with salt, virtually no vitamins and minerals (other than sodium), loaded with calories (and those calories come from pretty inferior sources of fatty acids too btw).

I proceed to then advise my mother (as best as I could without sounding like a food-nazi nag) that she would probably lose weight faster if she used less empty calories & refined food dressings on her food. I also told her that in my own weight loss journey I've discovered that only a surprisingly small amount of dressings and fats are needed to make veggies yummy (if I were to eat the recommended portion size of cheese sauce my broccoli would taste sickeningly salty).
Her response? As well as becoming offended (despite the fact I tried not to offend her), she said she was absolutely certain that reducing the amount of dressing she was eating would "make her food taste bad" and it was a compromise she was unwilling to make.

It then struck me quite poignantly that people have a violent negative reaction to a perception of forced change. People find it incredibly unpleasant even if, in reality, there is nothing objectively unpleasant about the changes. Does eggplant really taste worse than lasagna noodles? Of course not, but if you ask a lot of people they would most certainly say "YES". People hate change, and they hate change being forced on them.

I think resistance/intolerance for change is a prime reason people fail to lose weight or keep it off. It's this simple: your old lifestyle made you sick and fat. If you want to be thin and healthy, you need to be open and tolerant of lifestyle change. People just won't hear it. They want to believe that eating a product which says "zero carb" or "magic fat burner" or "magic heart disease pill" will solve all their problems. These things are tools, and like any tool their success or failure depends on the user. If people were more open to new experiences I don't think people would find the prospect of changing your lifestyle unpleasant.

My own mom refused to make a lot of lifestyle compromises during her weight loss journey (for example, she kept eating the "net carb" bars and candy despite my urgings for her to avoid them early on, she refused to limit portion size in any shape or form as well despite the fact I told her she probably wouldn't be hungry with slightly less, among other things). Of course when she didn't see results, she wound up quitting and blaming the diet for not working for her. Sigh.

Too true! I blame this on a lack of imagination. They can't imagine "a life without bread" and so they don't even entertain the possibility.

Likewise, no one changes their lifestyle unless forced into it by increasing disease. If people in their fifties and sixties would have a little chat with their elders, they would realize what these folks in their eighties and nineties are saying:

Good health is so precious.
If they could walk upstairs now, watch TV, work in the garden, or get a good night's sleep, they would give up every Twinkie, soda, and plate of pasta they ever ate. There is no comparison.

But, probably due to a lack of imagination and our natural tendency towards denial, people who do not yet see the link between their behavior and their health will continue to do "whatever they want" and not see the consequences until it is too late.

Nice summary, Woo! I'm so with you. I am sometimes floored by people who have so little self-control. I never thought myself all that disciplined but in comparison I'm thinking I ain't so bad!