Wednesday, February 13, 2008

Is Cholesterol The Real Cause Of Heart Disease?

My friend and colleague, Vreni Gurd, a kinesiologist and CHEK Practitioner Level 3, just recently sent this out to me and I thought you'd be more than interested to know how the whole cholesterol-heart disease debate is backwards. I hope at some point we can put an end to the whole "cholesterol is bad and leads to heart disease thing". Its really blown way out of proportion. Do watch the short videos she mentioned if you can.

Cholesterol, heart-disease mortality, and cholesterol-lowering drugs

More BIG news on the diabetes front this week, but I'll comment on it in a couple of weeks, as today's post is at least a month overdue. The idea that the saturated fat / cholesterol = heart-disease hypothesis is false has been in the popular press a lot (in the NY Times here, here and here, in Business Week for example) and coupled with the failed Vytorin cholesterol-lowering drug trial that was finally disclosed mid January, more and more people are beginning to question how in the world this idea was perpetuated for so long. The medical and pharmaceutical blogosphere is filled with doctors and scientists writing about the failed drug trial and what it means. All I can say, is it's about time!

Please indulge me, and take a minute and 17 seconds to watch this video on cholesterol levels and heart-disease deaths, based on data from the MONICA study that has been going on for 40 years, involving tens of thousands of people. Notice that there is no relationship at all between cholesterol levels and deaths from heart disease. On top of that, the effectiveness of cholesterol-lowering drugs (statins like Lipitor, Crestor, Zocor etc.) at preventing heart attacks is now being questioned. These paragraphs from an article on the topic in Business Week Magazine explains the issue better than I could.

"The second crucial point is hiding in plain sight in Pfizer's own Lipitor newspaper ad. The dramatic 36% figure has an asterisk. Read the smaller type. It says: "That means in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor."

Now do some simple math. The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit. Or to put it in terms of a little-known but useful statistic, the number needed to treat (or NNT) for one person to benefit is 100.

Compare that with, say, today's standard antibiotic therapy to eradicate ulcer-causing H. pylori stomach bacteria. The NNT is 1.1. Give the drugs to 11 people, and 10 will be cured."

According to Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina at Chapel Hill, "Anything over an NNT of 50 is worse than a lottery," According to the Business Week article, several recent scientific papers peg the NNT for statins at 250 and up for lower-risk patients, even if they take it for five years or more.

Posted on a pharmaceutical industry blog is this telling quote:

"What if you put 250 people in a room and told them they would each pay $1,000 a year for a drug they would have to take every day, that many would get diarrhea and muscle pain, and that 249 would have no benefit? And that they could do just as well by exercising? How many would take that?" asks drug industry critic Dr. Jerome R. Hoffman, professor of clinical medicine at the University of California at Los Angeles.

So ask yourself, if you have high cholesterol and you have been put on cholesterol-lowering medication even though you have NOT been diagnosed with heart disease, whether the side-effects of taking the drug, like muscle pain, reduced memory, diarrhea etc. are worth it, since clearly lowering cholesterol is not going to lengthen your life. In fact, many other studies are indicating that those with cholesterol levels that are too low die more frequently than those whose cholesterol levels are too high.

If you DO have heart disease, statin drugs do seem to have a protective effect, but due to the failed Vytorin (ENHANCE) trial, as well as the failed cholesterol drug torcetrapib trial that ended in Dec. '06, it is becoming clear that the reason they are protective has nothing to do with lowering cholesterol levels. One of the other many effects of statin drugs, is to lower arterial inflammation, and this may be how the drug helps. I can think of a whole host of other ways to lower arterial inflammation that won't give you terrible side effects, like cutting out sugar, flour, refined omega 6 vegetable oils, processed food, upping one's intake of omega 3 fatty acids (particularly from fish), cooking with tumeric, etc.

So, if high cholesterol levels do not cause heart disease, what does? Dr. Malcolm Kendrick hypothesizes that stress is the biggest cause, and he has noticed that those that have a flattened circadian cortisol rhythm are at higher risk. As I've tried to indicate previously, problems with cortisol are likely the root cause of many of our chronic conditions today. He also went back and looked at the historical epidemiological data with respect to peoples that had high rates of death from heart disease, and noticed that frequently those populations were displaced, or their lifestyle had been altered, like the Finnish being moved by the Russians in 1948, or the American Natives being put on reservations etc. These sorts of events are HIGHLY stressful. For more on this idea, see this video. These days, stress and cortisol rhythm disruption is very common, and the sooner physicians start testing the cortisol circadian rhythms of their patients, the sooner we will get a handle on heart disease.

I look forward to your comments on my blog.

Related tips
Saturated fat - the misunderstood nutrient
High cholesterol does NOT cause heart disease
Stress and Cardiovascular disease
Inflammation and inflammatory conditions
Cortisol, our stress hormone

Taubes, Gary What if It's All Been a Big Fat Lie? New York Times Magazine, July 2002.

John Tierney Diet and Fat: A Severe Case of Mistaken Consensus October 9, 2007

Nina Teicholz What if bad fat isn't so bad? No one's ever proved that saturated fat clogs arteries, causes heart disease MSNBC Health, Dec. 13, 2007.

John Tierney How the Low-Fat, Low-Fact Cascade Just Keeps Rolling Along New York Times, October 9, 2007

Alex Berenson Cholesterol As a Danger Has Skeptics New York Times, February 9, 2008.

Dr. Malcolm Kendrick A Raised Cholesterol level does not cause heart disease You Tube Video from BMA Meeting, Leeds, Nov. 2007.

Dr. Malcolm Kendrick Familial Hypercholesterolemia You Tube Video from BMA Meeting Leeds, Nov. 2007.

Dr. Malcolm Kendrick About Statins You Tube Video from BMA Meeting Leeds, Nov. 2007.

Dr. Malcolm Kendrick What causes heart disease? You Tube Video from BMA Meeting Leeds, Nov. 2007.

Dr. Malcolm Kendrick CVD Populations You Tube Video from BMA Meeting Leeds, Nov. 2007.

John Carey Do Cholesterol Drugs Do Any Good? Business Week, January 17, 2008

Tara Parker-Pope WELL; Great Drug, but Does It Prolong Life? New York Times, Jan. 29, 2008.

John Carey In the Real World, a Slew of Side Effects from Statins Business Week, January 17, 2008

New York Times EDITORIAL; Cholesterol Drug Bombs Jan. 16, 2008.

Merck Merck/Schering-Plough Pharmaceuticals Provides Update on ENHANCE Trial Nov. 19, 2007.

Herper, Matthew, The Vytorin Question Forbes.com, Nov. 19, 2007

Dr Aubrey Blumsohn Ezetimibe (Zetia, Vytorin): the smell of bad science Scientific Misconduct Blog, Nov. 24, 2007

Hughes, Sue Concerns Raised on Delay of Ezetimibe Data Medscape News, Nov. 23, '07.

Dr. John Mack Vytorin Study Stallin' - Notes from the Field Hands Pharma Marketing Blog, Nov. 26, 2007.

Insider Vytorin - There's none so blind.... Pharmagossip, Jan. 31, 2008.

Copyright 2008 Vreni Gurd

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Tyron
www.MakersBody.com

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