“This is rich. The headline says ‘Statin Drugs Underprescribed.'”
Arthur Johnson, one of my favorite writers, sent me that comment in an e-mail that included a news item claiming that doctors are not writing enough prescriptions for cholesterol-lowering statin drugs.
Statin drugs? UNDERprescribed? Could this article be joking? After all, statins have been the MOST prescribed class of drugs in the U.S. for more than 15 years. And the leader in this class is Lipitor, with yearly sales of about $10 billion. (For perspective consider this: Last year, more than 30 U.S. states had tax revenues less than $10 billion.)
But even though it seemed like there should be a punch line, it was no joke. According to research from Stanford University, U.S. citizens are suffering from an inadequate intake of statin drugs.
Guy with high cholesterol walks into a bar
Should we dwell on the finer points of this study? Surewhy not? Even though the Stanford team isn’t joking, it’ll still be good for a laugh or two.
The researchers analyzed data from two large national databases compiled from medical care surveys. Changes in statin treatment and current clinical practice were compared for ten years: 1993 to 2002.
Results showed that patients at high risk of coronary heart disease (CHD) who used statin drugs jumped from 14 percent to 50 percent over the decade. No surprise there; during that ten year stretch, many millions of advertising dollars were devoted to scaring the lipids out of nearly everyone by demonizing cholesterol. The number of statin users with only moderate CHD risk rose from nine to 44 percent during the same period.
Writing in the May 2005 issue of the Public Library of Science Medicine, the researchers state that, “education should be aimed” at doctors so they’ll “adhere to evidence-based medicine and published guidelines for cardiovascular risk reduction.”
Translation: It’s not enough that nearly half of all patients who are at moderate or high risk of CHD are taking statins. Doctors need to be “educated.” They need to “adhere.” For goodness sakes, HALF the market for statin drugs is going unprescribed!
Of course, the “published guidelines for cardiovascular risk reduction” cited by the researchers refers to recommendations from the medical mainstream. In recent years the recommended ideal LDL cholesterol level has dropped steadily, creating an expanding pool of “at risk” patients.
If this study sounds a little bit like a sales pitch, that could have something to do with the fact that it was funded by Merck & Co., the drug giant that manufactures not one but two brands of statins: Zocor and Mevacor.
Education reveals all
The Stanford research provides a perfect tunnel vision view of statin usage. It doesn’t take into account the valid reasons why a doctor might avoid prescribing a statin or a patient might refuse to accept a prescription.
Maybe the doctor wisely disagrees with the concept that LDL should be pushed to absurdly low levels. Or maybe the patient has liver or kidney problems – two very good reasons to avoid statin use. Or maybe the patient has a friend who has experienced muscle pain associated with statin use – why risk that side effect when there are safe alternatives to the drug?
Or maybe the patient is an HSI member who has come to recognize the medical mainstream’s unsupportable fixation on lowering cholesterol at any cost.
It doesn’t seem to have occurred to the Stanford team that there are doctors and patients out there who avoid statin prescriptions precisely because they HAVE been educated about the drug.
One more note on cholesterol
A new study has associated high cholesterol in elderly subjects with a lowered risk of dementia.
Yes, you read that correctly: lowered risk.
A team of U.S. and Swedish researchers analyzed medical data collected on more than 380 elderly residents of Goteborg, Sweden. Over a period of nearly two decades, subjects underwent physicals, blood tests, chest x-rays, EKGs, CT scans and neuropsychiatric examinations.
Researchers found that elevated levels of total cholesterol recorded while subjects were in their early 70s were linked with reduced dementia risk in their later 70s. Furthermore, elevated total cholesterol throughout their 70s was associated with reduced dementia risk throughout their 80s.
In an interview with HealthDay News, one member of the U.S. team – Johns Hopkins researcher Michelle M. Mielke – noted that the results of the study “raise more questions than they give answers,” and I agree. Previous studies have shown that high cholesterol may increase Alzheimer’s risk (see the e-Alert “Clear as a Bell” 6/26/02). But other research in this area has been conflicting.
Ms. Mielke added that we can no longer rely on over simplified answers, “for example, that high cholesterol is always bad and low cholesterol is always good.”
And that brings to mind another simple concept that should not be relied on: That statin drugs are as universally protective as drug company sponsored trials might lead us to believe.
Sources:
“Patterns of Statin Prescribing” Public Library of Science Medicine, Vol. 2, No. 5, May 2005, medicine.plosjournals.org
“Statin Drugs Underprescribed, U.S. Study Finds” Reuters Health, 5/31/05, reutershealth.com “Could High Cholesterol Ward Off Dementia?” HealthDay News, 5/24/05, rednova.com
