The business of cholesterol reduction

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Cholesterol reduction is big business.  Should it be?

Well, before answering that question, you must look at whether the results of cholesterol reduction are positive.  There are those who say that the side effects outweigh the benefits, but more who say the benefits are such that everyone should be on Statins, the cholesterol reducing pharmaceutical.

But first a little history.  I was never one to be the first to prescribe new ‘wonder’ drugs, but with the cardiologists sending patients back on this drug regimen, I too began to prescribe it.  Simvastatin became one of the drugs I enjoyed prescribing most – it actually did work!  Not that other prescribed medications did not work, but Simvastatin produced an amazing lowering of the body’s burden of cholesterol very quickly.  And every time.

However, the long term results of any drug use are sometimes difficult to demonstrate at first.  After many years, does your blood pressure go through the roof?  Or do your dangly bits fall off?  In some instances it could be a case of ‘wait and see’.  However, as far as is possible, the results of longer term usage are looked at through many ways, including animal testing.  The poor old laboratory mouse is flat out keeping numbers up to scratch!

There is just so much information to collect – there are epidemiological results found from over hundreds of thousands of cases and critically reviewing the results at the end.  This is one of the ways that differentiates between the pharmaceutical industry and the “alternative” industry.

Now, a startling fact has emerged from one of the longer term examinations of statin usage.  It appears that statins safely reduce the risk of cardiovascular illness even years after treatment is stopped, according to a probe into the popular cholesterol-lowering group of drugs published a couple of years ago.

A look at the background is justified here.  Statins work by blocking a liver enzyme that makes fatty molecules, which line arterial walls and increase the danger of heart disease and strokes.  With worldwide annual sales of more than 20 billion dollars, the lingering questions persisted about their long-term safety for the heart, liver and cancer risk.

In one examination, researchers at the Heart Protection Study Collaborative Group in Oxford in the UK looked at 20,536 patients at risk of cardiovascular disease who were randomly allocated 40 mg daily of Simvastatin or a dummy look-alike (known as placebos) over more than five years.

In this study, those who took the statins saw a reduction in “bad” cholesterol (LDL) and a 23 percent reduction in episodes of vascular ill-health, compared to the placebo group.  The exhaustive study did not end there.  The monitoring of the volunteers continued for a further six years after the trial ended.  The investigators found that the benefits persisted throughout this monitoring period even among those volunteers who had stopped taking the statins.  Now that is somewhat amazing.  In addition, there was no emergence of any new health hazard among those who had taken, or were continuing to take, the drugs.

“The persistence of benefit we observed among participants originally allocated simvastatin during the subsequent six year post-trial period is remarkable,” said one of the investigators, Richard Bulbulia.

As far as cancer incidence was concerned, a number of cancers (nearly 3500) developed amongst the 20,536 volunteers during this follow-up period (roughly one in six), but there was no difference in cancer incidence between the statin and placebo groups.

Richard Bulbulia continued, saying “In addition, the reliable evidence of safety, with no excess risk of cancer or other major illnesses during over 11 years follow-up, is very reassuring for doctors who prescribe statins and the increasingly large numbers of patients who take them to reduce their risk of vascular disease.  In November 2010 another trial found that long-term use of statins was less risky than thought for people with non-alcoholic fatty liver disease (NAFLD), a common liver ailment.

So what does all this mean as far as cardiovascular disease is concerned?  I believe it is beyond doubt, that LDL cholesterol is a major factor in coronary artery disease.  It has been shown that statins do reduce LDL, do reduce your risk, and appear safe.