Lowering LDL cholesterol with drugs like Vytorin could prevent cardiac events in some people, but the real benefit is blood thinning—not cholesterol reduction.
As many of you know, I’ve long said that inflammation—not cholesterol—is the real culprit in heart disease. Plus, I’ve warned that driving LDL cholesterol too low with cholesterol lowering statin medications can cause bigger health issues because your body requires LDL cholesterol for immunity, mental functioning, and more.
But, now a new study funded by the drug company Merck is suggesting that drastically lowering LDL cholesterol could prevent cardiac events. Specifically, Merck studied 18,000 participants who had either had a heart attack or chest pain so severe that it required hospitalization. Half of the participants received a statin. The other half received the Merck drug Vytorin, which is a combination of a statin and Zetia, which prevents the absorption of cholesterol.
At the end of the study, both groups had very low LDL cholesterol levels. The statin group had an average LDL cholesterol of 69, and the Vytorin group averaged 54. But the biggest news for Merck was that the group taking Vytorin had a 6.4% lower risk of a cardiac event—which they immediately concluded was due to the lower LDL cholesterol level.
Yet, There Are a Lot of Flaws in the Vytorin Trial on LDL Cholesterol
First off, this is almost a repeat performance of the ENHANCE study, which looked at plaque regression in people on a straight statin versus Vytorin. What they found is that Vytorin actually increased heart plaque, more than a statin taken alone! In fact, results on that study were withheld from the medical community for two years and caused significant angst among physicians.
Second, this current study was done on very sick people who had acute coronary syndrome—which is a life-threatening disease. Vytorin did happen to lower LDL cholesterol, but in the situation of acute coronary syndrome there are many variables in play—including blood thinning, which statins do very impressively. In fact, if you withdraw statins from this high risk population, deaths are three times higher. But there’s no evidence that the combination drug Vytorin was any more protective than a statin taken alone.
Finally, the researchers were talking about relative risk, which doesn’t really mean anything. In absolute risk terms, Vytorin prevented a heart attack for one in 50 people who may have had a heart attack—but with no change in the death rate. What we have to weigh is whether or not this treatment is worth prescribing for the one in 50 people who may benefit when these drugs taken over the long haul may have side effects?
What’s the Bottom Line for You?
When it comes to treating heart disease, the most important aspect is the clinician, and their clinical experience trumps double blind trials. I continue to recommend statins for people with acute coronary syndrome; in fact it’s the best indication for a statin. It has nothing to do with cholesterol, though. Statins thin the blood, and someone with acute coronary syndrome needs blood thinning, as well as the antioxidant and anti-inflammatory support which statins also provide.
My bigger fear is that drug companies will use the data from this trial to say that we need to treat LDL cholesterol, driving it as low as possible. The real benefit for the individuals in this study wasn’t in the very low LDL cholesterol, but rather the fact that statins thin the blood.
Unless you have advanced coronary disease, or another risk factor that warrants a statin, I wouldn’t jump on the bandwagon to lower LDL cholesterol. Remember, oxidized LDL cholesterol is a source of inflammation and modifications of inflammatory LDL need to be considered in order to reduce overall risk. But there are safer, more natural ways to prevent the oxidation of LDL, including vitamin E, CoQ10, omega-3s, niacin, and maybe citrus Bergamot.
I strongly believe it's the blood thinning, or blood rheology effect, that is the major sizzle in outcome and must be considered in the analysis.
Now it’s your turn: What’s your opinion on LDL cholesterol and statin drugs?