Written by Dr. David Brownstein
A couple of years ago, an article about the new cholesterol-lowering drugs appeared in the New York Times (NYT). The article can be read here. The article focused on the side effects of statin drugs and it questioned if doctors will prescribe the new drugs even though they are very expensive. After reading it in the NYT, my friend and colleague, Dr. Ira Goodman, called me and suggested we write a letter to the editor. Of course, the NYT did not accept our letter, but I thought it would make an interesting blog post.
To Editor at the New York Times
Re: New Drugs Add to A Quandary on Cholesterol
Your article about the new cholesterol-lowering medications focused on the side effects of this class of medications. However, you missed the most important part of these medications—do they really work? In other words, do they significantly reduce the incidence and mortality of strokes and heart attacks? The answer is a resounding “No” in approximately 99% of the patients treated. This important fact is usually withheld from patients when they are given these drugs because both the prescribing physician and the unsuspecting patient are unaware of the true statistics related to the studies of cholesterol-lowering medications.
You mention the JUPITER trial and the increased risk of diabetes. However, before talking about undesired effects of a drug, it is incumbent upon a practitioner to assess efficacy. If the efficacy is not there, then who cares what the side effects are- the drug should not be used. Efficacy trumps safety every time. No efficacy, no drug. Period. This is called informed consent which the American public does not have in most cases when these drugs are used.
Imagine a roulette wheel with 99 black slots and 1 red one. The manufacturers of cholesterol lowering drugs have managed to convince about 29% of the American public and nearly 100% of physicians that you should bet on red!! Yes these drugs will lower your cholesterol very effectively but what you are missing is that lowering cholesterol does not result in lower clinical events like heart attacks or stroke in the vast majority. Check the studies—the data is there.
In JUPITER (which was mentioned in the NYT article), 0.35% of those treated with rosuvastatin (Crestor®) suffered a heart attack compared to 0.76% in the control group. That means the absolute difference in heart attacks in those that took the rosuvastatin was 0.41%. In other words, 244 subjects would need to take rosuvastatin for 1.9 years (the length of the JUPITER study) to prevent one heart attack. In fact, 99 percent (243 out of 244) of those that took rosuvastatin received no benefit in lowering their risk of having a heart attack.
For primary prevention of a first cardiac episode, the best of the cholesterol studies has shown approximately a 1% mortality benefit in taking a cholesterol-lowering medication. That means that these drugs fail nearly 99% who take them. For secondary prevention—trying to prevent a second cardiac event—the numbers are not much better as the best studies show approximately a 3.5 percent reduction in mortality. Therefore, using statins for secondary prevention fail 96.5 percent who take them.
The best metric for measuring the effectiveness of a drug is the NNT or the number of patients needed to be treated with the drug to prevent 1 clinically significant endpoint. In the case of statins and presumably in the case of the new class of drug to lower cholesterol the NNT for primary prevention is between 100-500!! I would not want to take an expensive dangerous drug that is likely to increase my incidence of diabetes (which in and of itself increased heart attacks), heart failure, dementia, muscle aches, fatigue, and oxidative stress as a result of lower vitamin D and coenzyme Q10. For what? To lower my chances of an MI or stroke by less than 1%? I would rather take up jogging and eat better. I would rather bet on black.
The statin drugs have been a disaster as they don’t work in the majority of people who take them. Now, we want to spend over $14,000 per year in a new class of cholesterol-lowering drugs?
We must be out of our minds.
Original blog post by Dr. Brownstein can be found here.
Dr. David Brownstein is a Board-Certified family physician and is one of the foremost practitioners of holistic medicine. He is the Medical Director of the Center for Holistic Medicine in West Bloomfield, MI. Dr. Brownstein has lectured internationally to physicians and others about his success in using natural hormones and nutritional therapies in his practice. He is a graduate of the University of Michigan and Wayne State University School of Medicine. Dr. Brownstein is a member of the American Academy of Family Physicians and the American College for the Advancement in Medicine. He is the father of two beautiful girls, Hailey and Jessica, and is a retired soccer coach.
Dr. Brownstein has received two prestigious awards by his colleagues. The first was given by the American College for the Advancement in Medicine at the 2005 annual meeting. The award was the Norman E. Clarke Sr. Award for Science and Practice. The second award was given by the American Academy of Integrative Medicine at their 2005 annual meeting in Florida. This was titled, 2005 ARC Excellence Award for Distinguished Clinician for his “Advancement in the Diagnosis and Treatment of Chronic Diseases.”