Have you heard your doctor speaking of statins, cholesterol reducing drugs, as if they were a universal panacea and a harmless substance? For several years now statins have been prescribed pervasively by doctors, to anyone having high cholesterol, without any careful attention to important individual physiological differences. Your doctor may have even been surprised, uncomfortable, caught off guard or indignant towards a question that may challenge the established orthodoxy of statin prescription. Statins such as Lipitor (Pfizer), Crestor (Astra Zeneca), and Pravachol (Bristol Myers Squibb) may even lower the risks of heart attack and further cardiovascular disease in some people but not all. Vytorin, a statin combination drug, was recently found to be no more effective than a simple statin in reducing cholesterol. The “one size fits all” approach in the indiscriminate use of statins has long been under fire and scrutiny from a segment of the medical community. Many patients taking statins have high cholesterol levels but they don't have established heart disease and do not have any of the additional risk factors (high inflammation markers in the blood, history of smoking, obesity, etc.) that can potentially predispose them to cardiovascular complications. Such patients will obtain no benefit from taking these drugs and may very well be exposed to adverse effects for no good reason. Dr Beatrice Golumb, an associate professor of medicine at the University of California, San Diego School of Medicine has been studying cholesterol and statins for more than a decade under research grants given by the Robert Wood Johnson Foundation and the Harry Frank Guggenheim Foundation. Golomb, a whiz kid, with an imposing personality, graduated from the University of Southern California with highest honors at age 19, is an M.D. with a PhD in Biology. In a recent conversation, I asked her about the correlation between cholesterol and heart disease. “There is a correlation but the question again is if in the group in question whether the evidence suggests that reducing cholesterol has benefits that exceed risks,” she said. Golumb mentions that such correlation exists for middle-aged men who have heart disease or have selected risk factors that put them at elevated risk but it is not true by the available randomized trial data for any other population. She mentioned that these excluded groups include: the elderly even if they have heart disease; women even if they have heart disease; and middle-aged individuals unless they have heart disease or selected risk factors for heart disease. In her opinion the potential benefits of statins may not outweigh their risks except among middle aged man who have heart disease or who are at high risk for it. A recent meta-analysis published by Dr Kansik K. Ray in the June issue of Archives of Internal Medicine, one of the JAMA (Journal of the American Medical Association) Archives journals, found no evidence that statins were associated with a reduced risk of death among individuals at risk for but with no history of cardiovascular disease. The result of this study indicates the need for caution when applying statin therapy in lower risk primary prevention populations. One major concern is that the side effects of statins haven't been well studied, have been downplayed in general, and are grossly underreported by the mainstream media. Dr Golumb has a special website devoted to tracking patients side effects and the internet is inundated with reports from statin use that include muscle pain, fatigue, rhabdomyolysis, a serious degenerative muscle tissue condition, impotence, and scarring of the liver. There have been reports highlighting the symptoms of anxiety and depression seen concomitantly with statin administration in several patients. In a study published this month in the Journal of Biochemistry by Dr Amitabha Chattopadhyay, receptors for serotonin, a neurotransmitter in the brain that controls mood, were observed to be impaired by lowered cholesterol levels from the use of statins. Other alarming reports of cognitive related problems and memory loss have also been noted. Yeon-Kyun Shin, a biophysics professor at Iowa State University in the department of biochemistry, biophysics and molecular biology, wrote a recent opinion suggesting that lower levels of cholesterol from statin use in certain people may impair brain functions such as cognition, emotion, decision making and memory. Shin's opinion was published last year in the Interdisciplinary Bio Journal. Dr Uffe Ravnskov, a well renowned Swedish scientist, a vocal critic of statins, who has published extensively in scientific journals, believes that the side effects are much more frequent and serious than have been reported. It is surprising to note how so many doctors continue to naively fall prey to propaganda and claims of over inflated benefits from the drug companies trying to expand the use of statins. Many doctors have become so stubbornly brainwashed by the pervasive marketing behind these drugs that they seem to have lost the ability to look at research critically. In many instances they have recklessly subjected their patients unnecessarily to the side effects of these drugs. Are doctors so busy with so many patients that they don't have time to critically analyze the data? Is there a more subtle mechanism in place that is influencing their judgment? Dr Golumb mentioned that a few years ago six of the nine experts that were in the powerful influential panel of the National Cholesterol Education Program (NCEP), responsible for setting the cholesterol guidelines in the US, failed to initially disclose their ties to pharmaceutical companies. After they were exposed by an investigative reporter they currently do list such conflict of interests. Statins are among the most prescribed and profitable group of drugs in the world. Most debates and critical roundtables that doctors participate in have been stifled and are strategically geared towards the financial interests of the drug companies. In order for doctors to maintain their licenses in the United States they must fulfill continued medical education (CMEs) hours every year. Dr Gerald Reaven, an American endocrinologist, professor emeritus at Stanford University medical school, who is world renowned for his research in diabetes and for having coined the term Syndrome X, believes that the drug companies undeniably have a major role in the continued education of doctors in the US. Dr. Raven told me that, “a substantial number of physicians giving a talk at educational efforts (that count for CMEs) at a hospital which they do not work at receive their honorariums directly from a drug company or from a grant the hospital has received from one of those companies. Moreover the slides the speakers use to present at most of these meetings are also produced by the drug companies.” There certainly appears to be a conflict of interest when the drug companies so pervasively influence the continued medical education of doctors. The last major revision of the US guidelines, in 2001, issued by the panel of the NCEP, increased the number of Americans for whom statins are recommended from 13 million to 36 million, most of whom do not yet have but are estimated to be at moderately elevated risk of developing coronary heart disease. One is left to wonder how many are taking these drugs unnecessarily. Ricardo Guerra is an Exercise Physiologist. He has a Masters of Science in Sports Physiology from the Liverpool John Moores University. He has worked with several clubs and teams in the Middle East and Europe, including the Egyptian and Qatari national teams. [email protected]
