Saturday, January 26, 2008

Pulling Back the Curtain on Statins

Business Week does a fine job.
Liao has charted some of these biochemical pathways. His recent work shows that one of the trucks, as it were—a molecule called Rho-kinase—is key. By reducing the amount of this enzyme, statins dial back damaging inflammation in arteries. When Liao knocks down the level of Rho-kinase in rats, they don't get heart disease. "Cholesterol lowering is not the reason for the benefit of statins," he concludes.

The work also offers a possible explanation of why that benefit is mainly seen in people with existing heart disease and not in those who only have elevated cholesterol. Being relatively healthy, their Rho-kinase levels are normal, so there is little inflammation. But when people smoke or get high blood pressure, their Rho-kinase levels rise. Statins would return those levels closer to normal, counteracting the bad stuff.

Add it all together, and "current evidence supports ignoring LDL cholesterol altogether," says the University of Michigan's Hayward. In a country where cholesterol lowering is usually seen as a matter of life and death, these are fighting words. A prominent heart disease physician and statin booster fumed at a recent meeting that "Hayward should be held accountable in a court of law for doing things to kill people," Hayward recounts. NECP's Cleeman adds that, in his view, the evidence against Hayward is overwhelming.
The field of preventitive cardiology and industry-sponsored drug trials is about to change - for the better.



Vreni said...

Hi Dr. Wes,

There are many ways to lower inflammation in the body without resorting to drugs. Increasing the omega 3 to omega 6 ratio will increase the use of the cox one anti-inflammatory pathway, so taking 4000mg of omega 3s per day while avoiding refined vegetable oils (omega 6 oils) will help. Omega 6 oils promote the inflammatory cox 2 pathway - to me it makes more sense to change food habits than to inflame the body and then take cox 2 inhibitors.

Decreasing or eliminating sugar and flour products will decrease body inflammation, as will removing all processed food.

I think it is interesting that we've been eating saturated fats in the form of pasture-fed meats, full-fat dairy, and eggs for millennia and were heart-disease free up until the early 1900s. The first heart attack on record was in 1921. And just as we began to reduce our consumption of these foods in favour of refined vegetable oils and sugar that were beginning to fill the market, heart disease rates began to climb. By 1950 heart disease was the leading killer of North Americans. The latest Canadian data that I've looked at is 2006, and the trends seem to be continuing. Meat, egg and high-fat dairy consumption is still declining, while vegetable oil consumption is still rising. Seems pretty obvious to me that blaming saturated fats and cholesterol is misplaced.

Our food production practices (feeding cattle grain alters negatively the omega 3 to 6 ratio), that are only about getting food to market cheaply as opposed to providing quality food is what has done us in and inflamed our bodies. Our modern diet is filled with trans fats, rancid vegetable oils (polyunsaturate vegetable oils are delicate and can't handle being heated), all forms of sugar, refined salt where the healthy minerals have been removed, flour which may as well be sugar for the effect it has on the body, and all kinds of chemicals to preserve and add flavour to the food.

Eat only food you can pick, pull out of the ground or chase after, and avoid all food that came from a factory, and I really don't think you would get heart disease, as those foods would not cause inflammation.

SeaSpray said...

Hi Dr Wes - interesting post and article as are Vreni's comments too.

I get confused with studies that promote certain drugs only to refute them at a later time.

My husband has been on Lipitor for about 4 years maybe. His mother and all her sisters are on it but they didn't start it until they were older. My husband is a smoker. He has a hobby where he digs up and finds old bottles.

Maybe I overreacted, but I was concerned about such laborious activity (reminded me of shoveling snow)in conjunction with the fact that he smoked, although his weight was good. He didn't have a private doc and so I wanted him to go right to the specialist, a cardiologist I adore (got to know him at the hospital) and have the utmost respect for both professionally and personally. So he had the ekg, the stress test and was cleared to dig based on those but was put on lipitor because his labs (1st since Vietnam - if they even did them then) indicated he had an elevated cholesterol level. He also has HTN. Of course the doc encourages him to quit smoking but he didn't know until recently that my husband was all this time eating chips and sausage, etc.

Anyway, his cholesterol levels have come down and did when he started the Lipitor. He does have Chantix in his dresser and will be starting that in a couple of weeks.

But if I am understanding the article correctly...then most people with elevated cholesterol don't need these statins unless they have the other risk factors? (In husband's case - smoking/htn cause inflammation?)

Also, I have heard that once on ALWAYS have to stay on them (Dr didn't say this and I never thought to ask) or you could have a heart attack if you stop. Something about the body gets used to the drug. Is that true?

Vreni...I wholeheartedly agree with you! I have heard that if you shop the perimeters of the store that you will pretty much have the healthiest food choices there. Unfortunately, I find I have to go into enemy territory for tuna fish, frozen vegetables, oatmeal, etc.

I know heredity is a factor, but I have always eaten eggs, beef, dairy, etc. and my cholesterol is always good although my hdl only recently was perfect but I think that has to do with exercise.?

My uncle used margarine his whole life and ended up with 3 balloon angioplasties. We only use real butter in this house and more recently husband prefers Smart Balance.

Now if only Hellman's Mayonaise could be the 7th addition to the food group pyramid in amounts beyond what they recommend in the daily diet. It does have Omega 3 in it.? ;)

Thank you for the blogroll. :)

I left a comment on your post about why you blog. Good post!

Anonymous said...

Dr. Liao meant LDL-lowering is not the *only* reason for the benefits of statins.

Dr. Hayward does not believe in ignoring LDL for all purposes. He believes in taking LDL (and other lipid levels) into account in assessing overall cardiovascular risk. What he questions is titrating statin dose to achieve specific LDL targets.

I thought the discussion of NNT was useful. I'm not sure that the article makes clear that the NNT varies depending on baseline risk.

Not everyone would agree that there is no reduction in total mortality in primary prevention even in high-risk middle-aged men. Does it really make sense to say that someone with a 20% 10-year risk of heart attack could not benefit from taking a statin?

My personal opinion is that people should look at their absolute risk of an event and how much it can be reduced by taking a statin and then make their own decision.

The overall thrust of the article, that statins are overprescribed for primary prevention, is correct.