British journal warns that new American cholesterol recommendations are too low
A commentary published in the June 3, 2006 issue of the British Medical Journal (BMJ) expresses the concern that the recommendation for more aggressive cholesterol treatment for individuals at high risk of cardiovascular disease published last year by the American National Cholesterol Education Program will increase the risk of side effects with no overall decrease in mortality if implemented.
The American recommendation in question is that low density lipoprotein (LDL) cholesterol be lowered to less than 1.81 millimoles per liter of blood (equivalent to 70 milligrams per deciliter). Achieving this goal would be almost impossible for most adults without taking statin drugs, and the doses needed would be over eight times higher than those used by most people to treat high cholesterol. This would incur a number of risks and side effects without necessarily lowering mortality, as suggested by the results of clinical trials.
The authors point out that statin drugs are associated with major adverse effects that are seldom reported by physicians. Statin drugs inhibit the synthesis of hydroxymethylglutaryl coenzyme A reductase, an enzyme involved in the synthesis of the precursor of cholesterol and of coenzyme Q10 (coQ10), which is used by the cells’ mitochondria to produce energy. Impairment of coQ10 synthesis can decrease heart function in heart failure patients, but the heart failure observed in patients taking statins is likely to be erroneously attributed to the primary disease rather than to the drug. Additionally, heart failure patients have been excluded from statin drug trials, so the effect of these drugs among this group has not been clinically documented.
Statin drugs have also been shown to cause muscle pain and weakness, mental and neurological symptoms, and may even have a carcinogenic effect, although low doses of the drugs can often provide a benefit with a reduced risk of side effects.
According to an article published in a previous issue of the BMJ, in Norway, one of the world’s healthiest countries, 85 percent of the men and over 20 percent of the women over the age of 40 would need to be treated for high cholesterol under the American recommendations. Indeed, the authors of the current article state that these recommendations would have most of the world’s adult population on statin drugs. They write, “As the risk to benefit ratio for a more drastic lowering of low density lipoprotein cholesterol is unknown, we question the wisdom of this advice.”
The latest introduction to the powerful group of lipid-lowering drugs known as statins, or HMG reductase inhibitors, is atorvastatin (Lipitor). It is the only statin approved for the reduction of triglycerides as well as total and LDL cholesterol. It reduces LDL by 40 to 60%, triglycerides by 20 to 40%, and raises HDL cholesterol by 5 to 10%, changes which may be bigger than those produced by other statins. It can be taken once a day, at any time of day, and the recommended dose range is from 10 to 80 mg a day. Atorvastatin provides the lowest cost per percentage of LDL cholesterol reduction of available statins. Other available statins, which primarily reduce LDL cholesterols are cerivastatin (Baychol), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor).
Diseases associated with high cholesterol (and fats) are the number one killer. Fats also play a key role in the incidence of cancers and many other degenerative diseases. Cholesterol exists only in animal tissues, therefore, one's diet is an important first step in its control. For some people, however, limiting fat and cholesterol intake alone is not enough to reduce serum cholesterol to safe levels because of their own liver's production of excess cholesterol. The use of supplements to augment dietary modification can help reduce cholesterol without the side effects of many drugs.
It was as early as the 1930s that scientists first discovered that artichoke extract had a favorable effect on atherosclerotic plaques in the arteries (Tixier, 1939). Later animal studies, in which rats were fed a high-fat diet, also showed that artichoke extract prevented a rise in serum cholesterol levels and the manifestation of atherosclerotic plaque (Samochowiec, 1959 and 1962).
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