Are You Kidding Yourself?

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.

 

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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

Comments

[Ernest N. Curtis, MD]

Michael--Here's more fuel for the fire:

"Did you know that more than 80% of the people who have had heart attacks have high cholesterol?"

Of course this is nonsense since heart attacks are evenly distributed throughout the entire range of cholesterol levels. You can run that number up to anything you like by changing the definition of "high cholesterol." The anti-cholesterol crowd has repeatedly ratcheted down the "normal" cholesterol level to suit their own purposes. Set it low enough and we can probably get to 100%.

"For 2 out of 3 people, diet and exercise may not be enough."

Actually it will never be enough for 3 out of 3 because diet and exercise really don't affect cholesterol levels that much. I'm sure Pfizer knows this and this is just their insincere genuflection to non-pharmacolgic therapy. "Try this first (wink, wink), then take our pills when that fails." Of course this begs the entire question of enough to do what. My contention and that of others critical of the cholesterol theory is that cholesterol has nothing to do with the development of atherosclerosis and its subsequent complications (primarily heart attacks and strokes) and therefore, the whole question is irrelevant.

"Along with diet, Lipitor has been shown to reduce bad cholesterol......."

Again, your discussion is on the mark. In my book I point out that in all the large studies of statin drugs the very tiny degree of protection afforded by the statins shows a lack of normal exposure-response.

What this means is that the degree of protection from heart attack was the same whether the initial cholesterol level was high or low and was completely unrelated to the degree of cholesterol lowering. That is, the degree of protection was the same for those whose cholesterol was lowered a lot as those whose level was hardly lowered at all.

Whenever a study shows this sort of exposure-response disconnection it means that the factor under investigation is not the true cause of the disorder. The sentence I most enjoyed writing: "What a delicious irony that the final proof that cholesterol has nothing to do with CHD (coronary heart disease) would come from trials of drugs specifically designed to lower cholesterol."

I go on to point out that the statin drugs have a mild inhibitory effect on blood clotting and that it is no coincidence that trials using aspirin and other blood clot inhibitors show the same degree of protection from heart attack as the statins.

The behavior of the pharmaceutical companies is even more nefarious. A number of them had their own employees intimately involved with the planning and execution of some of these trials. And of course it is now well known that many of the more prominent investigators and proponents of the cholesterol theory are virtual paid whores of the drug companies.

It doesn't take much bias or fudging of the data to bring about the very small differences seen in these studies. But these outfits have evolved an even better way. Run several trials at once which will give small differences in outcome both ways due to chance. Then select and publish the one that suits your purpose and make sure the others never see the light of day.

Interested readers can obtain my book, The Cholesterol Delusion, from amazon.com

http://www.amazon.com/s/ref=nb_sb_ss_i_1_24?url=search-alias%3Dstripbooks&field-keywords=the+cholesterol+delusion&sprefix=the+cholesterol+delusion

[Petrossa.wordpress.com]

I've written about the Fat not being a disease.
"The hypothesis that obesity is detrimental to the health.

It doesn’t take much reading to discover this to be completely false but nevertheless time and time again we are brainwashed that we must be slim, be sportive, eat healthy.

So how is it nevertheless possible that we’re brainwashed to believe so, to go so far as to take cholesterol lowering medication, whose dangerous side effects far outweigh the benefits (if any) whereas there only is a correlation between CVD, but no causal relation has ever been proven.

The complete Fat is unhealthy tale started with the discovery of a remote village where the inhabitants suffered less frequently CVD then average for the rest of the, population. After much research a correlation was found:
The majority of the inhabitants had a genetic condition causing low cholesterol levels."

http://petrossa.wordpress.com/2010/04/16/the-disease-fat-does-not-exist/

Interested readers can read it for free ;)