In the September issue of HealthFacts, we reported major studies and meta-analyses with results that raise serious questions about cholesterol reduction by any means (see '"More Research Exposes the Great Cholesterol Myth ").
Cholesterol-lowering drugs were specifically indicted by the results of a meta-analysis published early this year by epidemiologists George Davey Smith, MD, of the London School of Hygiene & Tropical Medicine, and Juha Pekkanen, MD, of the National Public Health Institute, Helsinki, Finland (British Medical Journal, 15 February 1992).
Their results, combined from numerous studies, led them to call for a moratorium on the use of cholesterol-lowering drugs other than for people with severe familial hyperlipidemia. This is a genetic abnormality which affects the way the body handles cholesterol.
Familial hyperlipidemia occurs in only an estimated 0.5% of the population and results in extremely high blood levels of cholesterol (over 300-400 mg/dl). The benefits of cholesterol-lowering drugs dearly outweigh the risks for people with this condition which is associated with a high rate of death and disability due to heart disease.
Despite the evidence that cholesterol-lowering drugs themselves cause a higher incidence of death from both heart disease and other causes, they continue to be prescribed for a broad segment of the American population. About two million or more people are prescribed a long-term regimen of cholesterol-lowering drugs. They are exposed to additional risks from drug side-effects and adverse reactions. Here are some examples:
Niacin: This B vitamin gained popularity in the 1970' s as an effective and inexpensive way to lower cholesterol. However, for many people niacin causes severe flushing, itching and gastrointestinal distress. According to a controlled study (Journal of Family Practice, February 1992) taking 325 mg of aspirin before each niacin dose is effective in reducing the discomfort of flushing. Although initially thought to be an improvement because it reduced side effects, sustained-release niacin has been shown to be more likely to cause serious liver problems. One group of researchers found the incidence of hepatitis related to sustained-release macin alarming enough to recommend it not be available over-the counter (American Journal of Medicine, September 1991).
Gemfibrozil: (brand name: Lopid). There is some evidence that long-term use may cause gallstones and gallbladder disease. There are reports of myopathy (abnormal condition or disease of skeletal muscle), including a potentially fatal form known as rhabdomyolysis (Archives of Internal Medicine, September 1991). Both have been have linked to gemfibrozil use alone, but they can occur with greater frequency when gemfibrozil is used in combination with either niacin, lovastatin or clofibrate.
Clofibrate: (brand name: Atromid-S). This drug has been shown in studies conducted decades ago to increase death rates due to cancer and gastrointestinal disease. Studies also show that the risk of galistones and gallbladder disease requiring surgery is greatly increased in people taking clofibrate.
It can cause severe myopathy. In animals given doses five to eight times the human dose, the drug causes liver cancer. A World Health Organization study of clofibrate found it increased overall death rates by almost 50% leading one expert to question whether it "may be significantly more toxic than other cholesterol-lowering drugs" (British Medical Journal, 15 August 1992).
Cholestyramine: (brand names: Questran, Questran Light & Cholybar) and colestipol (brand name: Colestid). These drugs cause constipation, abdominal pain, heartburn, nausea and other gut-related problems. They can interfere with the body's ability to absorb fat-soluble vitamins and many other drugs.
Lovastatin: (brand name: Mevacor). Approved in 1987, this drug was the first of a new class of cholesterol-lowering drugs known as HMG-CoA Reductase Inhibitors. Lovastatin has rapidly become the most prescribed of all cholesterol-lowering drugs. Because it works by interfering in the body's synthesis of cholesterol, some experts have voiced concern about its long-term effects. In the short term the drug can cause myopathy which can lead to severe myositis (inflammation muscle tissues), rhabdomyolysis and acute kidney failure. Although these occur more commonly when lovastatin is combined with cyclosporine, macin, and particularly gemfibrozil, there are reports of these problems when only Lovastatin is used.
Pravastatin: (brand Name:Pra vachol) and Simvastatin (brand name: Zocor). These are newer members of the HMG-CoA drug family which can be expected to have a similar side-effect profile as the older lovastatin.
COPYRIGHT 1992 Center for Medical Consumers, Inc.
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