The Cholesterol Myth

Personally, I think the United States is in the grip of a cholesterol mania. Since reading a cover story in The Atlantic Monthly (September 1989, "The Cholesterol Myth") over a dozen years ago, I've known that cholesterol is hardly the best predictor of heart attack. It certainly is a poor predictor of overall mortality. (Serum albumin is probably one of the best predictors of mortality from all causes, but that is a story for another day.) Statistically, high cholesterol is associated with cardiovascular disease. But association is not the same as cause. A large percentage of those who die from heart attacks do not have elevated cholesterol. In one trial of a cholesterol-lowering drug, those with very low cholesterol levels after treatment also seemed to have a higher death rate than patients with extremely high levels.

Cholesterol is not only food for the endocrine glands, but it can act as an antioxidant -- which means that if you have excess free radicals, cholesterol might offer some protection. (In this case, cholesterol can easily become oxidized, and oxidized cholesterol can be a much greater threat to your health. Keeping levels of other antioxidants high can help keep oxidized cholesterol in check. In other words, eat your fruits and vegetables!)

But cholesterol testing and treatment is now a major industry, with well-funded means to promote the theory of cholesterol-as-evil and treatment with cholesterol-lowering drugs as the "lifesaving solution". We must keep the drug profit machine rolling.

There may be a cholesterol drug scandal brewing akin to the Vioxx scandal. You see, it appears that cholesterol drugs may cause cancer. So far it has been conveniently been kept under the radar of the major media. It seems they missed a 1996 study published in the Journal of the American Medical Association showing that all types of cholesterol-lowering drugs cause cancer in mice.

OK, causing cancer in mice may not be a big deal, but it should have raised a warning flag. Usually when testing carcinogenicity in mice, the animals are fed a dose hundreds or thousands of times an equivalent human dose. In the case of cholesterol drugs, mice get cancer from the equivalent of a normal human dose.

This still proves nothing, however, unless we have evidence that humans are also more susceptible to cancer when taking cholesterol lowering drugs for the long haul. Most studies tracking the mortality of those taking anti-cholesterol drugs last no longer than five years. But cancer often takes longer than five years to develop to a detectable stage. It might be unusual for most studies to detect increased cancer in the test group, even if the drugs are carcinogenic.

There are at least two longer term studies that show an increase of certain kinds of cancer in those taking cholesterol lowering drugs -- the drugs known as "statins," which happen to be the most popular anti-cholesterol drugs in the United States. Need I say they are also among the most profitable? (Greed is good. Amen.)

The bottom line question is this: We know that statin drugs are effective in lowering cholesterol levels, but do they actually reduce your risk of death? Overall, the answer seems to be no, except in very high risk patients (those with very high risk of death from coronary heart disease). For doctors to be prescribing these drugs to the average patient with high cholesterol is probably not helpful, and may be harmful, on balance. But don't take my word for it. I'm going to identify the articles in medical journals showing the dubious benefits of cholesterol-lowering drugs.

Obviously there is much more to be said, so stay tuned.