Comment: Good Ship Cholesterol is changing its course

A rare ray of hope illuminated the cholesterol world this week when it was revealed that most people who are taking cholesterol-lowering (statin) drugs probably shouldn’t be. Statins include the drugs Crestor, Lipitor and Zocor, and are consumed by nearly 20 per cent of the Canadian adult population.

New guidelines issued by a few major heart organizations in the U.S. now say that people don’t really need to be aiming for certain numerical targets by swallowing statin drugs. The obsession with “lower is better” around cholesterol levels is revealed to be largely a waste of time. Despite the fact that some researchers and physicians have been saying the same thing for years (and I’ve been ranting on this for at least a decade), the Good Ship Cholesterol is starting to alter its course.

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It is at times like these that folks energetically swallowing their daily Crestor need reminding that cholesterol is a valuable substance in our blood and levels of so-called “high” cholesterol has always been an artifact of the pharmaceutical industry. Even with known dangers of statins (muscle-weakening, cognitive problems and so on) the drug industry has successfully made gazillions of dollars by cleverly getting people (including our doctors) to worry about cholesterol levels, driving patients into taking drugs to lower them.

This new announcement is controversial, with some cardiologists calling it a major course alteration in how doctors will treat people considered at high risk of heart disease. Others say it will still lead to a lot of statin overprescribing and overtreatment.

I would give the typical intelligent patient the benefit of the doubt: that when people see that altering their blood cholesterol with drugs has such a minuscule effect, they might seek out other (and healthier) ways to lower their risk of heart disease.

The new guidelines put out by the American Heart Association and the American College of Cardiology are saying that targeting numerical values of what is considered “ideal” cholesterol is the wrong approach. Like any “treat to target” approach that forces people into drug therapy in a frantic attempt to reach these targets, statistically, some people will never reach them. Which means they now have to live with the anxiety and worry, feeling like a ticking time bomb just because some guideline committee has labelled them at “high risk.”

A lot of things determine your risk of future cardiovascular disease and any online Framingham calculator (consult Dr. Google, or your own doctor) can help you understand what your risks might be. When you realize that of all the risk factors for future heart disease, your cholesterol level probably has the smallest effect on whether you will succumb to a heart attack or stroke, you might just relax a bit.

These new guidelines also put the kibosh on so-called cholesterol-boosting drugs, such as ezetimibe (trade names: Ezetrol or Zetia), which most independent analysts (including myself) have been calling a massive waste of money ever since they hit the market.

This drug may lower your LDL cholesterol, but so what? Does it make a difference in your chances of having a heart attack or stroke? Not at all. Despite this lack of any meaningful effect, it still makes its manufacturer, Merck, nearly $3 billion per year.

I gave a lecture to University of B.C. medical students at a conference about eight years ago, and told them that by the time they graduated, they wouldn’t be prescribing cholesterol-lowering drugs. Boy, was I wrong (I have since stopped making predictions), having vastly underestimated the sheer marketing force of the pharmaceutical industry, the hegemony of industry-funded experts and the strength of the fear factor that cholesterol numbers have on the psyche of many people.

It’s hard to say whether this recent guideline revision will put a halt to all the cholesterol-mongering the population has been subjected to for the last two decades. I think at the very least, it may help people relax, and that’s a good thing. At the end of the day, people will ask their physicians what they should do to reduce their risk of heart attack or stroke, and that advice hasn’t changed: a healthy diet, adequate exercise, not smoking, the usual triumvirate of healthy-living advice.

To that, I’ll add one more: don’t worry, be happy and stop obsessing about your cholesterol numbers.

Alan Cassels is the author of Seeking Sickness: Medical Screening and the Misguided Hunt for Disease. He is a speaker at this year’s TEDxVictoria event at the McPherson Playhouse today. His 12-minute talk is entitled “The Champions of Medicine’s Next Revolution.”

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