Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten,M.D.
7 July 2004

CHOLESTEROL MEDICATIONS:  WHAT DID NOT HAPPEN

     There are approximately 700,000 people living in South Dakota at this time.  Every year approximately 1% of that population will die from various causes.  There will be about an equal number of births and the population of the state will stay relatively stable.  But note that about 7,000 people a year die in South Dakota.

 But if you look at the newspapers or listen to television, you will never see a headline that says “693,000 South Dakotan’s Live Through the Year”.  Instead, there will be an article on somebody drowning in a lake, somebody being killed in an automobile accident or someone dying in a small plane crash.  As tragic as these events are, they make up a very small part of the statistics of life in South Dakota on a day to day basis.  But you would never know that to read the newspapers or listen to television.

     My disappointment with our national news media dipped to a new low this last week  when I listened to Dan Rather on CBS National Television News talking about Crestor.  Crestor is a new anti-cholesterol medication that appears to be somewhat more potent than previously marketed cholesterol medications. There is a general rule in medicine that the more potent the medication is, the more possible and severe side effects might be.  The rule is not uniform but is one to keep in mind when a “more effective” medication comes on the market.  Dan Rather remarked that several individuals had had muscle problems after taking Crestor and that there had been several deaths in people taking the drug.  He remarked that a citizens group suggested taking the drug off the market.

     The reason that I am so disappointed with his reporting has to do with how biased and incomplete this short item was.  As an example:

     1.  He didn’t say a word about multiple other cholesterol drugs having the exact same problems.  Thus, Mevacor, Pravachol, Lipitor, Zocor, and Lescol have all had muscle problems and any of these can lead to kidney failure.

    2.  He didn’t mention a word about how many lives had been saved by lowering the cholesterol in patients with heart disease.  All medications carry a risk/benefit consideration.  People die from taking Aspirin, Ibuprofen, or Penicillin.  Each of these drugs has benefits for which individuals use them.  It is up to the individual patient and whatever medical advice they seek to decide whether any medication is worth taking.  But to take part of an evening news broadcast to remark that several individuals taking Crestor had died neglects the fact that more people will die from Penicillin consumption this year than will ever die from Crestor.

     3. The effect of his irresponsible reporting results in individuals deciding not to take the medication because it is “too dangerous”.  Somehow people seem to lose track how dangerous high cholesterols and heart disease are.

 To give perspective, one can look back at the history of the “statin” family of medications.  Mevacor (lovastatin) first came on the market many years ago.  Initially, it was recommended that liver tests be followed very carefully for fear that there was going to be liver damage side effects from this medication.  That fear never materialized as a significant problem.  Then came on the market Pravachol, Zocor, Lipitor, Lescol, Baycol, and Crestor.  Each one of these is more or less effective than the others but the side effect profile for these drugs is really more or less the same.  They all seem to have more or less the slight possibility of muscle damage, the slight possibility of liver damage and the potential for kidney failure from same.

     Some of you may remember a drug called Baycol which was a very effect anticholesterol medicine.  When combined with a second medication called Gemfibrozil, it seemed to cause a slightly increased likelihood of having muscle damage.  For that reason, the company removed it from the market.  By itself, Baycol was an excellent drug.  The problem for which it was removed from the market was the potential for side effects when it was mixed with another anti-cholesterol drug.

     The stimulus to write this column came with the 7th call in one day from individuals telling me that they needed to stop their Crestor because it was so dangerous.  The practice of medicine is hard enough without some irresponsible newscaster practicing unlicensed medicine on television.

 The facts are that Crestor is an effective medication for lowering cholesterol.  It seems to be somewhat more effective than several other products on the market and is especially useful for those individuals with very high cholesterols that are difficult to control.  It does indeed have a slight tendency to cause muscle problems in less than 1% of the people that take it.  When the medicine is stopped, the muscle problem goes away but it is no more dangerous than the five other products that are already well established on the market.  Physicians who prescribe any cholesterol medication recommend that various blood tests be done periodically to monitor the person’s well being and freedom from side effects.  But this is true for all of the cholesterol medicines and not limited to Crestor.

 Lastly, comments need to be made on what did not happen.  Because of the entire “statin” family of medications, there has been a dramatic drop in the incidence of heart attack and stroke.  Contrary to previous beliefs, we now know that the lower the total cholesterol, the better.  We used to feel that an LDL-cholesterol (bad cholesterol)  of 100 mg% or less was excellent and safe.  We now know that in high risk individuals who have already had one heart attack, getting the LDL-cholesterol into the 60 mg% or less is much more beneficial than leaving it at a 100 mg% as we thought before.  Very gratifyingly, we know that the statin anti-cholesterol family of medications carries an additional 20% benefit in decreasing the rate of heart independent of the cholesterol lowering effect.  The “statin” family of anti-cholesterol medications also has a significant anti-osteoporotic effect helping maintain bone mineral density.  This “statin” family of anti-cholesterol medication has been one of the highest benefit to risk ratios of any group of drugs on the market in recent times.

     In summary, I am not pushing Crestor but I am pushing the “statin” family of anti-cholesterol medications which have a very high benefit to risk ratio.  It is very frustrating to the medical profession to spend their time and efforts trying to prevent disease related events and then have some irresponsible newscaster panic the public while presenting an incomplete picture.  Used judiciously and monitored appropriately, the “statin” family of anti-cholesterol medications is much safer than the disease events that they prevent.  Remember that the biggest killer in the United States is the 600,000 people who die from heart disease; it is not the 4 people that Dan Rather mentioned who died after taking Crestor.