Regular readers of this blog know that I am no fan of the cholesterol theory of heart disease. Despite the mountain of evidence against this so-called causation, (cholesterol-lowering) statins are the best-selling class of drugs in the world.
Late last year, Pfizer started running a print campaign on Lipitor® with the unintentionally paradoxical headline "Are You Kidding Yourself?"
Let's examine the copy...
"Did you know, more than 80% of people who have had heart attacks have high cholesterol?"
Try as I might, I cannot find a source for this assertion, which is also made on the product's website.
Interestingly, this flies in the face of conclusions from the famed Framingham study, which found that as many as one third of all coronary heart disease (CHD) events occurred in individuals with total cholesterol less than 200 mg/dL.
Considering that the average U.S. cholesterol level is approximately 210 to 220 mg/dL, almost half of all heart attack events and all stroke events that will occur in the United States in 1997 will in fact occur among individuals with below-average lipid levels.1
I did find an "80 percent" quote, but it doesn't exactly support Pfizer's assertions, either:
Framingham researchers reported that “80 percent of heart attack patients had similar lipid levels [i.e., fat levels in the blood] to those who did not have heart attacks.”2
"For 2 out of 3 people with high cholesterol, diet and exercise may not be enough."
I'm not sure where they got that one, but it's pretty vague, isn't it? For one thing, they are not defining "high cholesterol," and "may not" be enough is hardly a scientific fact.
After all, it "may" or "may not" be enough, according to that logic. Besides, what's "enough" supposed to signify?
Along with diet, Lipitor has been shown to lower bad cholesterol 39-60% (average effect depending on dose).
Well, no one is disputing that the drug lowers bad cholesterol, and, indeed, that's what the FDA approved. However, Lipitor is not very effective in preventing heart attacks, and that's surely why people are taking it!
Pifzer once claimed that the drug reduces heart attacks by 36 percent, but when you read the fine print you discover what that really means.
In a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor.
Or, put another way: For every 100 people who took the drug over 3.3 years, three people on placebos, and two people on Lipitor, had heart attacks. That means that taking Lipitor resulted in just one fewer heart attack per 100 people.
What dietary changes did these subjects undergo? What about other lifestyle factors? Were they all normalized?
The display ad is accompanied by "Important Facts," which address some of the side effects of the drug. Any drug that messes with how your liver processes cholesterol is going to have plenty of side effects, and some of them are quite nasty.
The tag line of the ad is "Don't kid yourself." That's one thing that Pfizer and I can agree on.
1 Castelli WP. "Lipids, risk factors and ischaemic heart disease." Atherosclerosis 1996;124(Suppl):S1-9.
2 Gordon, T., Castelli, W.P., Hjortland, M.C., et al, “High density lipoprotein as a positive factor against coronary heart disease,” The Framingham Study, American Journal of Medicine May 1977;707-714