More Voices Against Statins

pills

It seems I wasn’t the only one concerned about the American Heart Association and the American College of Cardiology’s new guidelines for lowering cholesterol and suggesting the use of statins for more patients.

On November 13, the New York Times published an op-ed piece entitled “Don’t Give More Patients Statins.” The piece was written by John D. Abramson, a lecturer at Harvard Medical School and the author of “Overdosed America: The Broken Promise of American Medicine,” and Rita F. Redberg, a cardiologist at the University of California, San Francisco Medical Center and the editor of JAMA Internal Medicine.

Here are some excerpts:

On Tuesday, the American Heart Association (AHA) and the American College of Cardiology (ACC) issued new cholesterol guidelines that essentially declared, in one fell swoop, that millions of healthy Americans should immediately start taking pills — namely statins — for undefined health “benefits.”

This announcement is not a result of a sudden epidemic of heart disease, nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else.

Statins are effective for people with known heart disease. But for people who have less than a 20 percent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail even to reduce the risk of serious illness…

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease. According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day…

The process by which these latest guidelines were developed gives rise to further skepticism. The group that wrote the recommendations was not sufficiently free of conflicts of interest; several of the experts on the panel have recent or current financial ties to drug makers. In addition, both the American Heart Association and the American College of Cardiology, while nonprofit entities, are heavily supported by drug companies.

Other stories appeared. According to some cardiologists, the new online gauge for determining the risk of heart disease was based on old data and was flawed.

The New York Times Editorial Board weighed in also with an opinion piece entitled “Cholesterol Guidelines Under Attack.”

Patients in good cardiovascular health would be well advised to stay away for now from following the cholesterol guidelines issued last week by the nation’s two leading heart organizations.

The guidelines are accompanied by an online calculator that appears to overestimate greatly the risk of heart attack or stroke that currently healthy individuals might face over the next decade. As a result, tens of millions of people could be prescribed cholesterol-lowering statin drugs that they don’t really need.

Great advice, however, later in the opinion piece, they have this to say:

Statins are among the safest prescription drugs available, but they do have adverse side effects in some patients, including muscle pain and muscle damage; an increased risk of diabetes, especially in women; memory loss and confusion; cataracts; and, rarely, kidney or liver damage.

They don’t sound very safe to me.

Of course, the AHA and ACC reaffirmed their new guidelines and the calculator.

“This risk calculator was subjected to rigorous external validation during the development process,” said David Goff, Jr., MD, Dean of the Colorado School of Public Health, who co-chaired the committee that wrote the risk assessment guidelines.

“The goal is not to get more people on statins,” said American Heart Association President Mariell Jessup, MD, Medical Director of the Penn Medicine Heart and Vascular Center at the University of Pennsylvania. “The goal is to help Americans reduce their risk of cardiovascular diseases and stroke.  The goal is to help people live longer, healthier lives.  This means we have to treat the right people – those at the highest risk who have been shown to benefit.”

Unfortunately, neither side of this debate is talking about lifestyle changes – nutrition, exercise, reducing stress – as a way to reduce the need for any drugs.

The medical establishment is not ready for that – just internal squabbles that will be off the radar in a few months and drug company profits will continue to soar.

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