by John M. Curtis
(310) 204-8700

Copyright March 9, 2004
All Rights Reserved.

iving Pfizer and Bristol-Myers Squibb something to cheer about, a new study found that statin drugs—popular cholesterol-blocking medications—reduced dangerous cardiovascular mishaps, including, chest pain, heart attacks, strokes and the need for angioplasty and bypass by 16%. In a study funded by Pfizer, the maker of Lipitor, Dr. Christopher P. Cannon of Brigham and Women's Hospital in Boston showed that doubling doses reduced cholesterol levels, leaving patients less susceptible to lethal events. Cannon's colleague, Dr. Steven Nissen of The Cleveland Clinic, whose earlier research was funded by Briston-Myers Squibb, the maker of Pravochol, also found that doubling doses dramatically reduced life-threatening events. While part of a preventive strategy, the benefits of statin drugs were known to reduce cholesterol but not improve survivability.

      Cannon showed that dramatically lowering cholesterol improves patients' chances for survival following heart attack and stroke. According to the American Heart Attack Assn., 42% of heart attack victims die within the first year. “Our results should be a wake-up call to everyone with heart disease—that treatment of cholesterol is very important,” said Cannon, confirming the preventive value to statin drugs, improving survivability of heart attacks. Other recent studies about statin drugs have also shown their benefits for overall cardiovascular health. Calling the use of statins “a sea change in cardiovascular prevention,” Cleveland Clinic's Eric J. Topel predicts “this will mean a major change in the daily practice of medicine,” urging physicians to aggressively use statins for prevention. Cannon and Nissen's study could more than triple the use of statin drugs.

      Currently, 11-million patients receive statin drugs in the U.S. Under the new cholesterol guidelines, that number could grow to over 36-million, more than tripling drug sales for publicly traded drug companies. With Cannon's new study, drug makers can now influence the American College of Cardiology—a division of the American Medical Association—to change treatment protocols, lowering the cholesterol threshold for prescribing statin drugs and upping the dosage. Cannon found that by doubling the dosage, they could drop cholesterol levels an additional 35%. “There's no such thing as too low a cholesterol level,” Dr. Steven Nissen of the Cleveland Clinic, making a compelling case for lowering the FDA guidelines and upping the dosage. Neither Cannon nor Nissen emphasize lifestyle changes, including diet, exercise and unhealthy behavior like smoking and drinking.

      When the groundbreaking 1948 Framingham study first identified “risk factors” in heart disease, physicians singled out cigarette smoking, cholesterol and high blood pressure. Recommendations to lower heart disease risk included changes in diet and exercise, specifically reduced saturated fat and vigorous aerobic activity. When statins were introduced in 1987, the paradigm swung from lifestyle to drugs. Today's findings emphasize drugs over lifestyle. Recent studies address presumptive drug benefits, downplaying adverse side effects, including liver and kidney toxicity from higher doses and increased frequency. Cannon's study, presented to the American College of Cardiology, indicated that 64-million Americans diagnosed with heart disease would benefit from statin drugs. Reducing heart attacks and strokes is reason enough to use statins—but not at the expense forgetting key “risk factors.”

      Before doctors ignore lifestyle, they should remind patients with heart problems—or those on the way—to think about something other than statin drugs to control heart disease. Popping pills offers the quick-fix but doesn't reverse harmful lifestyles that contribute to conditions. Whatever the benefits of statins, they could be easily offset by harmful lifestyles, including smoking, alcohol, high fat diets and sedentary behavior. “This is a big step downward in the cholesterol [levels], and it made a big step down in the incidence of cardiac events,” said Cannon, ignoring lifestyle as a major factor in cardiovascular disease. Taking statin drugs, or, for that matter, surgically cleaning or bypassing blocked arteries, doesn't address the “risk factors” in heart disease. While statins reduce cardiac events by 16%, they shouldn't be used as nutritional supplements.

      More than ever, publicly traded drug companies are under increased pressure to augment sales of existing products. It's a real bonanza for studies to find that popular, but limited, drugs should be increased in both dosage and frequency. Like all drug companies, Pfizer and Bristol-Meyers Squibb have an ax to grind producing research that augments drug sales. Recent studies at Yale University, published in respected scientific journals and reported in newspapers, indicate that drug companies often skew research to advance agendas. Before jumping the gun, more research is needed to carefully evaluate the alleged benefits against potential dangerous side effects—but, more importantly, the price of emphasizing drugs over lifestyle changes. It's easier to pop pills than make tough choices. Before calling Cannon's study “a sea change in cardiovascular prevention,” it needs a good second look.

About the Author

John M. Curtis writes politically neutral commentary analyzing spin in national and global news. He's editor of OnlineColumnist.com and author of Dodging the Bullet and Operation Charisma.

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