DNC News

Lipitor Worries

Subject: Cholesterol lowering medications such as Lipitor may lower Co Q 10 levels, increase cancer and increase rates of violent death and suicide.

There is a huge promotional push to get more people to take Lipitor and closely related drugs to reduce cholesterol going on in our country. It isn't just the advertisements on TV and in magazines. Medical doctors have been convinced of the need to prescribe for people with relatively low cholesterols. A few years ago you wouldn't see Lipitor prescribed unless cholesterol levels were 250 or above. Now a cholesterol of 220 is adequate excuse for drug therapy.

In this sudden wave of prescriptive enthusiasm a number of longstanding worries about using these medications seem to have been forgotten. Lowering heart disease risk is a great sales incentive used by drug companies. We saw this for years with Premarin which was supposed to reduce heart disease by 50% or more. Research has since proven these claims false. What is good for sales is not necessarily good for health.

There is no question that Lipitor lowers cholesterol, the question is at what price.

One of the simplest concerns about using Lipitor is that it apparently lowers Co Enzyme Q 10 levels in the body. This enzyme plays a key role in many biological functions, one of the most well known is helping the heart work. As a nutritional supplement, it is used as a treatment for heart arrhythmias, cardiac insufficiency, high blood pressure and congestive heart disease. It is also commonly used to protect the heart during chemotherapy. According to a Danish study published in 1997[1] which looked at the effect of using either Pravastatin of Lovastatin for 18 weeks, these types of drugs (HMG-CoA reductase inhibitors) significantly reduce levels of Co Q 10. A recent study, in fact the reason I started thinking about all this, published last Summer in the American Heart Journal did not duplicate these findings. The difference in the studies is striking. The Heart Journal used half doses of the medications for shorter time periods (4 weeks instead of 18 weeks). This we! aker study does not disproves the earlier work that shows long term use depletes Co Q 10. How do you rationalize depleting the body of a heart protecting enzyme in the pursuit of lowering cholesterol? A compromise at least in our practice, is to encourage the use of Co Q 10 for anyone taking any of the HMG-CoA reductase inhibitors. This recent study does not change our policy.

This isn't the only worry. These medications are well documented to cause cancer when given to rodents (think rats and mice) at doses comparable to what people take.[2] Now of course not everything that causes cancer in a rat does so in people.
At least it is difficult to prove that it does in people who are "free living" and susceptible to environmental variables compared to rats living in "controlled environments." A Danish study looked at people who had used these drugs for a 3 year period in the early 1990's and then followed them for 4 years afterwards.[3] They were unable to see a detectable increase in cancer rates among the drug users but as they admit they were, "limited by small numbers and short follow-up period...." I haven't found any large long lasting studies looking at this question. In other words the question of whether these drugs will cause cancer in humans with long term use is unanswered.

There is one other worry about cholesterol, probably the biggest one, that I rarely see mentioned. When the early studies were being done on cholesterol lowering medication, researchers would see a decrease in death from cardiovascular disease but no overall change in death rate.
The decrease in heart disease was balanced out by an increase in other deaths. It was not another disease which was behind this increase but a host of accidents and suicides. In the intervening years a number of studies (though not all) have shown a clear correlation between low cholesterol levels and suicidal ideation and impulsivity, suicide attempts and violent death.[4]

Let me quote from one of these studies:
"Recent reappraisals of data from cardiovascular primary prevention trials aimed at reducing serum cholesterol concentrations showed that despite the reduction in deaths from cardiovascular causes the total mortality had not significantly decreased, owing to a higher mortality from violent deaths and suicide. Meta-analysis confirmed an increased mortality from accidents and violence (suicide and homicide), and low concentrations of cholesterol were prospectively associated with an increase in the risk of violent death or suicide. Moreover, a negative correlation between cholesterol concentration and mortality from injuries, especially for suicide, was reported. ...............An association between low serum cholesterol concentrations and depressive symptoms has been found in elderly men, while low serum cholesterol concentrations have been reported in people with violent or aggressive behaviour..................................

Though seemingly disparate entities, suicide and accidental or violent death have been linked epidemiologically, and it has been postulated that people dying from causes not related to illness may share common dispositional, behavioural, or neurochemical characteristics. Moreover, several studies have reported low cholesterol concentrations in subjects with aggressive or autoaggressive conduct disorders, thus suggesting a possible association between serum cholesterol concentration, neuronal function, and behavioural predisposition. Several studies suggest that low cholesterol concentration could precede depression and consequently enhance the risk of parasuicide. It has been suggested that low serum cholesterol concentration may lead to a rise in suicide risk because serotonin in the brain is decreased."[5]

The media has us thinking that cholesterol is evil. The body makes cholesterol and does its best to maintain a steady supply. Why? because we use cholesterol to manufacture a huge array of other chemicals including the sex hormones. Small drops in cholesterol may disrupt our chemistry to the point of suicide. Are we being too hasty in taking drugs which block our body from making cholesterol?

People are encouraged to use these drugs by promotional campaigns before trying safer, cheaper, less risky propositions, things which are called "alternative medicine." This isn't the correct term. Better to call them, "nonprofitable methods" referring to potential benefits to corporate stockholders rather than therapeutic benefits. There are nutritional supplements which will usually gradually lower cholesterol levels if they are elevated that are rarely tried.

At the same time people are losing sleep worrying what their cholesterol levels are, it is rare to see a medical doctor bother to check a homocysteine level. Levels of this chemical are directly linked to cardiovascular risk. The more homocysteine in your blood the more likely you'll die of heart disease. In most cases elevated homocysteine can be lowered using vitamins; simple combinations of B-vitamins, which have low profit margins compared to prescription drugs.

With this sort of introduction it looks like our next newsletter will be a review natural methods for lowering cholesterol. The list gets longer every day. Along with that how can one lower cardiovascular risk. Stay tuned.....

References:
1. Mortensen SA, Leth A, Agner E, Rohde M.Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors.Mol Aspects Med 1997;18 Suppl:S137-44
2. Newman TB, Hulley SB.Carcinogenicity of lipid-lowering drugs.JAMA 1996 Jan 3;275(1):55-60
3. Olsen JH, Johansen C, Sorensen HT, McLaughlin JK, Mellemkjaer L, Steffensen FH, Fraumeni JF Jr.Lipid-lowering medication and risk of cancer. J Clin Epidemiol 1999 Feb;52(2):167-9
4. Garland M, Hickey D, Corvin A, Golden J, Fitzpatrick P, Cunningham S, Walsh N.Total serum cholesterol in relation to psychological correlates in parasuicide. Br J Psychiatry 2000 Jul;177:77-83
5. Gallerani M, Manfredini R, Caracciolo S, Scapoli C, Molinari S, Fersini CSerum cholesterol concentrations in parasuicide..BMJ 1995 Jun 24;310(6995-6


Ask the Doctor:
What's the difference between naturopathy and homeopathy?

[click here for the answer]

Submit your question here.


Newsletter:
Enter your email to recieve the latest Health and Wellness newsletters from the clinic.