| Letters to the Editor |
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VALUE OF "CHOLESTEROL MEDICINES"
Eddie Vos, Editor, www.health-heart.org The year 2002
was a terrible year for cholesterol lowering drug studies despite some glowing
accounts by their authors, such as the one recently reported in DiabetesInControl.com
regarding the PROSPER study in "Elderly at Risk". Yes, in a
group of almost 2900 over 70 year olds given Pravachol [a
"statin" drug of the family of Lipitor, Zocor, Lescol, Mevacor
and other] there were 28 fewer deaths from heart attacks--but there were 24
more deaths from cancer than in the similarly sized group given placebo
[dummy] pills. After 3.2 years, the death rate was the same within 0.1%.
Just prior to
the PROSPER trial, we had the world's largest cholesterol lowering statin
study, HPS,
and immediately following there was ALLHAT,
the second largest statin trial ever. In HPS three quarters of
heart attacks continued to take place and about 300 had to take the drug for 1
year to save one life--while in ALLHAT, no effect was found of any type, not
in heart attacks, stroke, vascular disease or mortality, the death rate being
the same within 0.07%. The scientific
reactions regarding PROSPER were just published in the journal The Lancet
on Feb. 1st 2003 and they included statements such as: "...the treatment
changed the way patients died by increasing cancer death and decreasing death
from coronary heart disease." Or, "Surely one relevant
statistic is that by treating 5804 high-risk patients with pravastatin or a
placebo, the overall death rate was reduced from 306 to 298 over 3 years.
This was achieved at what cost to the perception of good health, comfort or
anxiety among the participants." There is good
reason for suspecting that these drugs promote cancer, as per The Lancet
letters, because they stimulate the growth of new blood vessels. This
may be good for heart disease and diabetes but it is likely to feed and
stimulate a slow-growing cancer. Significantly more new cancer
was found in the statin group during each year of the PROSPER study
even though it started with 52 fewer smokers. Furthermore, statins
lower CoQ10, an antioxidant and energy producer of every cell, and this by the
same percentage by which they lower LDL-cholesterol. Statins similarly
lower squalene, a likely anti-cancer agent found, for example, in our skin and
in olive oil. So, what is a
diabetic person to do with this confusion? My perspective is as follows:
while diabetes often leads to heart disease, heart disease does not cause
diabetes. Therefore, diabetes prevention should come first, and heart
disease "treatment" second. About
cholesterol, it is not clear that "cholesterol lowering" with statins
reduces mortality, as reports the ALLHAT website: ".. trials
demonstrating a reduction in CHD [heart disease] have not demonstrated a net
reduction in [all-cause] mortality." The British Medical
Journal headlined on March
6th 2003: "Evidence for lowering LDL cholesterol in diabetes
is lacking." These are serious calls for concern about the use of
cholesterol lowering drugs in anybody. Doctors are
put in a difficult position between drug company advertising, treatment panel
recommendations and a clear lack of evidence that cholesterol lowering with statins
will benefit their patients. To clear-up this issue should be a
government task, in the U.S. that would be the NIH, without the input of
interest groups. We need clear long-term data that include all-cause
mortality, and that include well defined diabetic groups. No such data
exist. My personal
take on the science is that statin drugs don't work for most people,
including diabetics. Statins reduce energy and promote muscle
weakness and maybe cancer, and there are better options available. In
nutrition, the good news is that there is increasing evidence of benefits from
the healthy fats, such as omega-3 oils [flax, canola, walnuts, fatty fish],
and from low glycemic index / high-fiber / low processed carbohydrate foods
that retain some of their original plant structure. The
LDL-cholesterol ["bad"] particle is our transport vehicle for fats,
cholesterol and any fat-soluble vitamin and nutrient, from vitamins A, D, E
and K to carotene, lycopene, lutein, CoQ10 and more. The problem is not
so much the amount of these particles as having them transport healthy
substances and not toxic ones, like burnt or hydrogenated trans fats
[deep fried foods, most margarines], oxidized cholesterol from dried egg or
milk powder and, last but not least, homocysteine. It is the quality of
the cholesterol-bearing particles that is important--so that arteries consider
them friend, not foe. For example,
there is fascinating and solid evidence published since the year 2000 in the
large medical journals like JAMA, NEJM and Stroke that lowering
homocysteine, a "natural blood toxin" we all have, leads to less
artery blockage before as well as after balloon angioplasties.
High-homocysteine is caused by foods low in low B-vitamins and it is
effectively lowered to healthy levels by the use of a good multi-vitamin
supplement, as these studies show. These are economical prevention and
health strategies whereas a statin drug will costs you, or the society,
somewhere near $1000 per year, with little hope for a comparable benefit. For diabetics,
pre-diabetics and probably for most of us, diabetes prevention strategies
should logically come before heart disease prevention. Statins
change nothing in the glucose and insulin departments. Proper nutrition,
weight control, exercise and smoking avoidance are proven routes that help
both conditions. More of these
strategies are described in my website www.health-heart.org
and its diabetes
page which also gives some information about other diseases, and with
scientific references for you and your doctor. This non-profit website
clarifies some nutritional approaches to health: the age-old concept "let
foods be your medicine" is a prevention strategy and where
cholesterol-lowering statins have shown little if any benefit,
especially in diabetics. With over one
quarter million patients in trials having been on statins for one year,
little benefit has emerged from this massive 15 year old pile of data.
If benefits from statins or from lowering cholesterol were to be found,
the data would have been clear, consistent and convincing; they are not. Eddie Vos is forensic material sciences
engineer following the biochemical/nutritional field. He edits and runs
the not-for-profit site http://www.health-heart.org and has been published
regarding these fields in the American Journal of Clinical Nutrition, most
recently in Feb. 2003, and in the Archives of Internal Medicine. He
resides in Glen Sutton (Qc),
Canada
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