This headline in USA Today caught
my eye recently: "Statins Gain Wonder Status."
Oh brother! – I thought – Here
we go again.
But unlike the headline, the
article that followed turned out to be surprisingly balanced. Rather
than just falling in line with the
mainstream concept that
virtually everyone could use a cholesterol-lowering statin drug (even
if your LDL level is already
low), the article examined the
validity of statin's emerging wonder drug status.
And then there was the
clincher. The article quoted Christie Ballantyne, M.D., a cardiologist
with Baylor College of Medicine,
who said that most of her
heart disease patients have a total cholesterol level of less than 240.
And she added: "The majority of
people who end up having heart
attacks or stroke don't have high cholesterol."
It's a stunning remark, isn't
it? And I'm afraid that Dr. Ballantyne will never get appointed to the
National Cholesterol Education
Program (NCEP) if she
continues to make comments like that. Because the cholesterol cowboys
over at NCEP really have only
three basic points to make
concerning cholesterol: 1) Lower. 2) Lower. 3) Lower.
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Round 'em up!
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Last week I sent you an
e-Alert ("Day-Old Fish" 7/29/04) about the new NCEP guidelines for
cholesterol levels that call for a
target LDL of 70 for heart
patients who are considered to be at very high risk of a heart attack.
High risk or not, 70 is an extremely
low LDL. And it will be almost
impossible for anyone to hit that level without using statin drugs,
which the NCEP recommends as a
course of action.
All of this would be business
as usual, except for a little controversy that erupted when a New York
newspaper called on
the NCEP expert panel to
reveal their financial ties to drug companies that make statin drugs.
As it turns out, those ties run
deep and wide, with eight out
of nine panelists reporting consulting work, honoraria for speaking
engagements, and other perks from
drug companies.
Dr. James Cleeman –
coordinator of the NCEP – told WebMD that, in spite of the controversy,
"Nobody is quarreling with the
substance of the message."
Let's check in once more with
that quote from Dr. Ballantyne:
"The majority of people who
end up having heart attacks or stroke don't have high cholesterol."
That may not be a quarrel, but
it couldn't be more contradictory. And Dr. Ballantyne is not alone. Not
in the least.
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Photo op
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If you wanted to give someone
an idea of what the Grand Canyon looks like, you could stand on the rim
and take a wide-angle photo,
or you could take a close-up
shot of the Colorado River rushing past a boulder on the riverbank. And
while both photos could be
called photos of the Grand
Canyon, only the wide-angle shot would convey just how vast the canyon
is.
Trying to assess heart attack
risk by looking at LDL alone (without also taking into account
triglycerides, homocysteine, c-reactive
protein and a few other
important heart health markers) is like representing the Grand Canyon
with the photo of the river boulder.
There's no way you can get the
big picture. And yet, the medical mainstream – while acknowledging
other heart risk markers –
continues to insist that
lowering cholesterol should be the paramount goal.
I asked HSI Panelist Allan
Spreen, M.D., to comment on this concept that LDL cholesterol should be
lowered as much as
possible, and he immediately
cited the Framingham Heart Study: "The largest, longest, and most
prestigious heart disease study
showed that total cholesterol
levels ('total,' now, mind you, they didn't talk a whole lot about LDL)
that went below 160 caused
heart disease problems to go
back up! So it's a curve that bottoms out at 160 instead of a line that
gets better and better as you get
lower and lower."
Dr. Spreen's comments are
echoed in an article in Red Flags Daily by Malcolm Kendrick, M.D.,
which offers this quote about the
Framingham results as
published in the Journal of the American Medical Association: "There is
a direct association between falling
cholesterol levels over the
first 14 years and mortality over the following 18 years."
And from the National Heart,
Lung and Blood Institute's Honolulu Heart Program (an ongoing study
that began in 1965 with more
than 8,000 men), Dr. Kendrick
presents this quote as it appeared in the Lancet medical journal: "Our
data accord with previous
findings of increased
mortality in elderly people with low serum cholesterol, and show that
long-term persistence of low cholesterol
concentration actually
increases the risk of death."
So while the medical
mainstream chants, "Lower! Lower! Lower!" – the better mantra would be,
simply, "Moderation. Balance." But
of course, a call for
cholesterol moderation doesn't make a good sales pitch for statin
drugs.
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Education crisis
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When the new NCEP guidelines
were released last month, Dr. Cleeman told the Associated Press that,
in addition to taking drugs,
heart patients should exercise
and keep their weight under control. I don't believe anyone will
quarrel with the substance of that message.
But to this, Dr. Cleeman
added that patients should eat a diet low in cholesterol.
I'm sorry – coming from
someone who's the spokesman for the National Cholesterol EDUCATION
program – that's just a
flabbergasting comment.
Because study after study has shown that dietary cholesterol does not
raise blood serum cholesterol in the
overwhelming majority of
people. By some estimates, that majority is well over 80 percent. So
most of us can eat a three-egg
omelet every morning without
any change in our cholesterol levels at all.
In tomorrow's e-Alert I'll
turn again to Dr. Spreen for some natural ways to effectively address
elevated cholesterol and other heart
disease markers without the
use of drugs.