The singular focus on treating cholesterol as a means to prevent heart attacks is leading to the deaths of millions of people because the real underlying cause of the majority of heart disease is not being diagnosed or treated by most physicians. For example, I recently saw a patient named Jim who had “normal” cholesterol levels yet was taking the most powerful statin on the market, Crestor. Despite this aggressive pharmaceutical treatment, this man was headed for a serious heart attack. Jim’s doctors had missed his real disease risks by focusing on and treating his cholesterol levels. All the while they were ignoring the most important condition that put him at dramatically higher risk of heart attacks, diabetes, cancer and dementia. In a moment I will explain what this condition is and what you can do about it.
This craze for treating cholesterol has led to an onslaught of pharmaceuticals designed to “lower cholesterol.” Statins are now the number one selling class of drugs in the nation and new cholesterol medications are produced every day. The latest in a new class of “super” cholesterol drugs, CETP inhibitors, now in the drug approval pipeline from Merck (anacetrapib) burst into the news recently with exclamations from typically restrained scientists. Data on this new drug was recently published in the New England Journal of Medicine and presented at the American Heart Association conference in Chicago.
The study found a 39.8 percent reduction in LDL (or bad cholesterol) and a 138 percent increase in HDL or good cholesterol.(i) Sure, the medications lowered cholesterol. However, the study was not large enough or long enough to answer the most important question: Did the drug result in fewer heart attacks and deaths? Despite this glaring omission, the scientists reporting on these results used words such as “spectacular,” “giddy,” “enormous,” “most excited in decades” to describe their enthusiasm over the medication. Of course, the researchers (as I described in a recent post “Dangerous Spin Doctors“) were on the payroll of Merck who funded the study.
Why Lowering Cholesterol May Not Lower the Risk of Death
Unfortunately, these scientists seemed to have short-term memory loss. Just three short years ago in 2007, another new “wonder” drug from Pfizer (torcetrapib) which worked on the same mechanism that anacetrapib does, was found to dramatically lower LDL and raise HDL cholesterol, just like this new drug from Merck. There was only one small problem—in those taking the drug, deaths from heart attacks increased 25 percent, deaths from heart disease increased 40 percent and overall deaths increased 200 percent.(ii) After spending $800 million in development Pfizer had to walk away from the drug. Oops. How can a drug that does all the right things (dramatically lowering bad cholesterol and raise good cholesterol) actually cause more heart disease and deaths?
The answer is simple. Drugs don’t treat the underlying causes of chronic illness. It is not our genes which haven’t changed much in 20,000 years, although they may predispose us to environmental and lifestyle triggers of illness. The causes of chronic disease are rooted in what we eat, how much we move, how we face stress, how connected we are to our communities and toxic chemicals and metals in our environment.
A wry editorial in the New England Journal of Medicine many years ago remarked that doctors should use new drugs as soon as they come on the market before side effects develop. Perhaps that’s what the authors of this study are proposing we do with anacetrapib.
At best this new “super cholesterol” drug will lower cholesterol numbers without killing too many people while increasing health care costs by billions of dollars as millions of new prescriptions are written for this new “super cholesterol drug.” Worse it may end up in the same garbage dump Pfizer’s drug from three years ago did. Even worse scenarios exist and the reason is startling simple.
These drugs do not address the fundamental underlying cause of heart disease. Heart disease is not a Lipitor or Crestor or even an “anacetrapib” deficiency. It is a complex end result of multiple factors driven by our diet, fitness level, stress and other lifestyle factors such as smoking, social connections, and, increasingly, environmental toxins. Taking a pill won’t fix these problems that push our biology steadily along the trajectory of disease. The idea of putting statins at the check out counter of McDonald’s is the epitome of reductionist thinking. The problem isn’t cholesterol—it’s all the stuff we are putting in our mouths!
Jim, my patient, is a perfect example of how doctors treat the symptoms, not the cause of disease. As I have written about in a previous blog, most doctors focus on the wrong target for preventing and treating heart disease. Abnormal cholesterol levels are just a downstream problem that is mostly a result of “diabesity” or the continuum of blood sugar and insulin imbalances that range from pre-diabetes to full-blown end stage diabetes. Taking a statin or a CETP inhibitor cannot reverse this change in our biology. We cannot use a drug to correct what happens to our biology because of a high sugar and refined flour, low fiber, processed diet, a sedentary lifestyle, excessive stress, lack of sleep or the harmful effects of pollution.
Let’s take a closer look at Jim. On 10 mg of Crestor, the most powerful statin on the market, his total cholesterol was a beautiful 173, and his LDL was a respectable 101. But the good news ended there. His triglycerides were 176 (normal is less than 100), and his HDL was 37 (normal is greater than 50).
Jim’s numbers belie a deeper truth about cholesterol that most conventional doctors are ignoring today: Given the current state of scientific understanding, the cholesterol numbers doctors measure today are increasingly irrelevant.