Should healthy people with no heart symptoms take a cholesterol-lowering drug (CLD) to prevent heart disease?
Federal regulators in the U.S. have recently given the green light to allow Crestor, one of the CLDs, to be sold for this purpose. So is this decision a scientific breakthrough or medical madness?
Why should millions of healthy people be added to the millions already prescribed CLDs? The reason is a study of 17,800 people who had no heart disease, but did have high amounts of c-reactive protein (CRP) in the blood, which is linked to an inflammatory process in arteries.
Those who took Crestor showed a decrease in the level of bad cholesterol and CRP, and fewer deaths from heart attack and stroke.
Today half of coronary deaths occur in people who are apparently healthy. So why not use CLDs to decrease bad cholesterol and CRP as much as possible? This is what some doctors advise in both the U.S. and Canada. But there are a few "ifs" to consider.
A Harvard professor once made a remark that all doctors should consider. He counselled that, "It's impossible to make a patient feel any better who doesn't have any complaints"! So far, no study has shown that CLDs help people live longer or better if they have no heart disease.
The next question is how safe is it to use Crestor, or other CLDs, to decrease the cholesterol level?
Some cardiologists believe the lower the better. But cholesterol is a major component of cell membranes, needed in several metabolic processes, and there's a high concentration of cholesterol in the brain. When CLDs lower the production of cholesterol in the liver they also lower the amount in the brain. Some researchers believe this adversely affects brain function.
For example, Duane Graveline, a physician astronaut, developed transient global amnesia after being on Lipitor 10 milligrams (mg). Graveline did not recognize his wife or children and couldn't believe he had been an astronaut and doctor. His NASA physicians refused to believe that Lipitor could have this effect. Six months after his recovery doctors again prescribed just five mg of Lipitor. This resulted in another episode of amnesia.
Since then Dr. Graveline has documented hundreds of cases showing that CLDs pose an increased risk of neurological and muscular complications. Other studies show an increase in violent crime and car accidents by those prescribed CLDs which may be related to a change in brain function.
How many people with normal hearts were saved from cardiovascular deaths by taking Crestor? A report from the University of California estimates that 29 people had to be treated for five years to prevent one heart attack, stroke or death. But, in addition, those taking Crestor showed a slightly increased risk of developing diabetes and muscle pain. It's yet another example that we rarely, if ever, get something for nothing.
What about the CRP test? In 1931 Oswald Avery, a Rockefeller researcher, discovered that patients had increased CRP levels after being infected with the Streptococcus A bacteria. In effect, CRP revealed the presence of infection. But increased CRP does not tell doctors the site of the infection. Moreover, how high does CRP have to be to cause trouble? No one knows at the moment.
Some researchers believe, and I share this view, that prescribing CLDs to those with normal hearts is a risky business. But there is little doubt this will continue.
Today millions of dollars are being spent by pharmaceutical companies to determine further benefits of CLDs. But there are no millions available to study negative aspects of the treatment.
What makes more sense? It's true that if cholesterol and CRP blood levels are high, this is a warning that all may not be well. It's time to lose weight, stop smoking, eat a well-balanced diet and take the advice of former U.S. President Abraham Lincoln who remarked, "We have the two best doctors in our body, our left and right legs.
Dr. Graveline has written several books on this cholesterol problem. His book Lipitor, Thief In The Night is an interesting read for those who want more information on this subject. See the web site www.spacedoc.net
