In the 1992 presidential
campaign, Bill Clinton was a heavy underdog to popular incumbent George H. W.
Bush. Bush was considered unbeatable due to foreign policy successes including
the end of the Cold War and routing Saddam Hussein in the first Gulf War. But
Bushs approval ratings, which had been in the 90 percent range, began to dip as
his campaign ignored the economic recession. Clintons campaign manager James
Carvilles now famous campaign slogan, "Its the economy stupid," helped turn
the tide and Bill Clinton became the forty-second American president.
Just like George Bushs 1992
presidential campaign, todays medical community continues to promote the
medical myths associated with cholesterol while ignoring the real cause of
cardiovascular disease, inflammation.
Conventional opinion and
current medical dogma holds that low cholesterol, especially low LDL
cholesterol, reduces the risk and incidence of heart disease and stroke. This
belief is so entrenched in the medical community that the FDA now approves drugs
to prevent heart disease, as it did with Zetia and Vytorin, solely on the
evidence that they lower LDL cholesterol levels. Zetia has never been proven to
reduce heart attacks, strokes or death. Statin drugs help reduce the risk of
heart attack and stroke for those whove already had a cardiac event (one
percent over placebo) but fail to reduce death in women, the elderly, men over
the age of 47, and in men without cardiovascular risk factors.
A 2006 study in The
Archives of Internal Medicine looked at seven trials of statin use in
nearly 43,000 patients, mostly middle-aged men without heart disease. In that
review, statins didnt lower mortality.
Nor did they in a study known
as Prosper, published in The Lancet in 2002, which studied statin use
in people seventy and older. Nor did they in a 2004 review in The Journal of
the American Medical Association, which looked at thirteen studies of
nearly 20,000 women, both healthy and with established heart disease.
Despite a growing voice of
reason, which became even louder after the recently released Enhance study, the
cholesterol zealots continue to view cardiovascular disease with tunnel vision.
This myopic vision fuels the cholesterol drug war which rages on as each
pharmaceutical company seeks to gain economic gain in the 40 billion dollar a
year lipid lowering drug market.
In an attempt to take on the
cholesterol Goliath, Pfizers Lipitor (10 billion dollars in sales annually),
Merck and Schering-Plough combined their cholesterol lowering drugs, Zocor and
Zetia, to form the "super drug" known as Vytorin. Vytorins goal was to lower
LDL cholesterol more than either drug could alone. Zetia lowers blood
cholesterol by blocking the absorption of dietary cholesterol from the
intestines. Zetia used alone is modestly effective in lowering LDL cholesterol
by approximately 17 percent. Zocor alone lowers LDL levels by 36 percentsimilar
The hope was that by lowering
LDL to dramatically low levels, Vytorin would do a better job of slowing the
accumulation of fatty plaques in the arteries. Vytorin did, in fact, reduce
LDLby a whopping 51 percent (similar to AstraZenecas Crestor).
However, the two-year
"Enhance" trial failed to prove that Vytorin is better than Zocor alone for
slowing plaque accumulation; instead atherosclerosis worsened in those taking
Merck and Schering-Plough
suppressed this finding for twenty months.
The study results were not
revealed until the two drug companies were pressured into doing so by an article
in The New York Times and a Congressional inquiry. The marketers of
Vytorin said they had nothing to hide. Its hard to believe they werent just a
little reluctant to publish their highly anticipated study. The news that
Vytorin, which retails for $100 a month and did $2 billion in sales in 2007, was
clinically inferior (perhaps even dangerous) to generic simvastatin (statin),
costing less than $20 a month, obviously wasnt what stockholders wanted to
Merck and Schering-Plough are
running full-page ads daily in the Times and Wall Street
Journal, warning people not to be confused by a single study and to
continue taking Vytorin. The advice was backed by the American Heart
Association, which the Times reported receives nearly $2 million a year
from Merck/Schering-Plough Pharmaceuticals.
Other LDL lowering drugs have
bitten the dust in the last coupe of years as well.
Pfizers trial of its
much-anticipated drug torcetrapib, which raised HDL, the good cholesterol, and
lowered LDL, had to be stopped in 2006 because the drug caused heart attacks and
Estrogen replacement therapy,
which is known to lower LDL cholesterol levels, failed to reduce the incidence
of heart attack and stroke in clinical studies.
Ok, if cholesterol lowering
isnt the answer for everyone, why do statins help people with existing heart
disease? Dr. James K. Liao of Brigham & Womens Hospital in Cambridge,
Massachusetts, has been investigating this question for over a decade. He
suspects that statins have other biological effects. His research shows that
statin drugs not only block cholesterol, but also an inflammation-generating
enzyme known as rho-kinase.
When Liao reduced the
rho-kinase levels in rats, they didnt get heart disease. "Cholesterol lowering
is not the reason for the benefit of statins," he concludes. Of course, there
are dozens of inflammatory chemicals that play a role in triggering
cardiovascular disease. Diet, health habits, our environment, even our
personality may initiate inflammatory chemicals that perpetuate cardiovascular
Ralph Waldo Emerson once said,
"People see only what they are prepared to see." As the evidence about
inflammation and cardiovascular disease rises, will conventional medicine and
the public at large be prepared to see that its not about lowering cholesterol
but in reducing inflammation? Hopefully, "Its the inflammation, stupid," will
become a common slogan in the campaign to fight cardiovascular disease.
Rodger Murphree, D.C., has
been in private practice since 1990. He is the founder of, and past clinic
director for a large integrated medical practice, which was located on the
campus of Brookwood Hospital in Birmingham, Alabama. He is the author of
Treating and Beating Fibromyalgia
and Chronic Fatigue Syndrome, Heart Disease What Your Doctor Wont Tell You,
and Treating and Beating Anxiety and Depression with Orthomolecular
Medicine. He can be reached at www.treatingandbeating.com, by email at
firstname.lastname@example.org or 1-205-879-2383.
1. Harriet Rosenberg and
Danielle Allard "Evidence for Ca Women and statin use." Women and Health
Protection June 2007.
2. Business Week magazine
Lipitor cover story: "Do Cholesterol Drugs do any Good?" January 17,
3. TheHeart.org from Web MD
www.theheart.org, see video blog of Eric J. Topol, MD, "Temple of the LDL
4. "REPEAT/New Study Showed
VYTORIN® Superior to Lipitor in Reducing LDL Bad Cholesterol in
Patients with Type II Diabetes at the Recommended Usual Starting Doses."
Business Wire. June 12, 2006.
5. The International Network
of Cholesterol Skeptics, www.thincs.org.
6. Rodger H. Murphree D.C.,
Heart Disease What Your Doctor Wont Tell You. Harrison and Hampton
Publishing Birmingham, AL. 2006.