Cholesterol-lowering drugs: friend or foe?

IN THE past, fat was used regularly in our cooking and diet and the incidence of coronary artery disease and strokes was much lower than today.

We have changed our eating habits based on the opinions of so-called “experts”, to reduce cholesterol in our diet, and yet the incidence of heart disease has more than doubled in the past 20 years.

Today, millions are being treated on cholesterol-lowering drugs known as “statins”.

Cholesterol is a naturally occurring lipid found in everyone’s blood. It is important to the body as it is used in cell membranes and to manufacture many hormones.

There are three types of lipids in the blood: cholesterol (important in the production of steroid hormones, bile acid and to maintain the integrity of cell membranes), triglycerides (important source of energy that can be stored throughout the body) and phospholipids (major component of small cell membrane, and serve as emulsifiers).

Only a quarter of the cholesterol we acquire comes from food we consume. The rest is produced by the liver and is transported in the bloodstream encased in LDL to supply cholesterol and triglycerides to the cells, after which more than half of the circulating cholesterol is taken up by the liver to produce bile, which dissolves fat in the small intestine.

Excess cholesterol from the peripheral cells is carried back to the liver by HDL, which is produced in the liver and small intestine.

A problem arises when abnormally high levels of cholesterol cling to the inner layer of the artery walls and lead to atherosclerotic lesions. This is why LDL is referred to as “bad cholesterol”.

HDL or “good cholesterol”, however, removes excess cholesterol from the arteries, preventing plaque formation in the artery wall.

“Statins” are medicine groups used to lower high cholesterol. These include any medication with the word “statin” in them, as well as common names such as Crestor and Lipitor.

Debate persists over the recommendations about the use of statins, as this group of medicine is arguably one of the most over-prescribed worldwide.

Since the introduction of this drug from the 1980s, heart failure has doubled.

The incidence of side-effects from the drugs is increasing, which prompted the US Food & Drug Administration to approve warning signs on the labels of statins to notify consumers about side-effects and possible drug interactions.

A growing concern on the use of statins is the increased risk of diabetes mellitus, announced by the FDA in 2012.

A study in 2015 of nearly 26000 beneficiaries of statins concluded those taking statins were 87% more likely to develop diabetes.

In 2012, the FDA warned that one in four patients treated with statins experienced muscle weakness, pain and muscle injury, which could continue even after treatment had stopped.

In 2005, a statin label reflected the risk of serious muscle toxicity and damage (myopathy/ rhabdomyolysis), especially in Asian people.

Rhabdomyolysis is a serious condition in which the muscle fibres are broken down and their contents, called myoglobin, are released into the bloodstream, causing kidney damage.

The FDA also noted various forms of kidney failure were reported in patients taking Crestor.

Some statins have been linked to an increased risk of cardiomyopathy (the heart’s inability to pump blood adequately), resulting from a serious weakening of the heart muscle and depletion of co-enzyme Q10, leading to sudden cardiac death.

Evans and Golomb showed in their study of patients with memory loss or other cognitive problems associated with statin therapy that 90% of them improved after statin discontinuation.

The FDA also noted there were reports of rare but serious liver problems in those who used statins. Symptoms included tiredness or weakness, loss of appetite, upper belly pain, and dark-coloured urine.

Statistical deception created the appearance of statins as ‘miracle drugs’ and magnified the impressive effects of statin treatment in the medical literature and media.

Systematic bias in exaggerating the benefits of statins and minimising adverse effects in studies conducted or funded by pharmaceutical companies convinced many doctors to use statins aggressively in patients, and dismiss complaints regarding the adverse effects as psychological.

This is based on information doctors get from medical reps, as well as incentives to promote the drug. Hence today even healthy people are on statins, although extensive research has demonstrated congestive heart disease occurs irrespective of cholesterol levels.

Even the definition of high cholesterol keeps changing. In 2004 a US panel of so-called “experts” decided to lower the threshold of cholesterol from 6.5mmol/l to 5mmol/l without any scientific data basis, making millions more healthy people around the world become eligible for statins.

For every 1000 treated with statins, at the risk of the sideeffects, only 10 may benefit.

Our experience during consultation for the 3-Dimensional Vasculography (non-invasive cardiac diagnostic test), found that most of the patients experienced one or more of these side-effects, which had a serious negative impact on their physical, mental and social life.

Statins have a place in medicine for patients diagnosed with coronary artery disease and/or vascular occlusive disease, and should be used in low doses in combination with natural products, together with lifestyle modification, to reduce the side-effects.

Statins were not made to prevent heart disease, nor can they break down and remove plaque as some believe. So it has benefits for the correctly selected 1-2% of the population. It is advisable to rather use natural products for prevention.

Friend or foe? Identify whether the benefits outweigh the risks.

Mohanlall is a doctor of clinical technology.