Cholesterol is a waxy substance secreted by our livers and found in food that we eat. Medical studies correlate the amount of cholesterol in our blood with the amount of plaque build-up in our arteries, leading to heart attacks and strokes. It is believed that reducing cholesterol in the blood will reduce the risk of cardiovascular disease.
The common method for reducing cholesterol levels are drugs, both statins, which reduce the amount of cholesterol produced internally, and cholesterol absorption inhibitors, which reduce the amount received from food.
Without drugs, I have higher than recommended levels of cholesterol. By taking a statin, Lipitor (Pfizer), in low doses (10mg), my LDL-C (low density lipoprotein or "bad" cholesterol) is lowered to an acceptable level for most persons (2.6 mmol/l; 100 mg/dcl;). A few years ago, this was considered near "optimum".
Two things then happened. First, my brother had heart surgery under age 60. This increased my risk factors for cardiovascular disease to "high risk", because of family history. Secondly, the guidelines for optimum LDL-C levels for "high risk" patients were lowered from 2.5 mmol/l to 2.0 mmol/l.
My doctor then recommended increasing the Lipitor dosage to 20 mg and added a second drug, Ezetrol (Zetia in the U. S.) (Merck), a cholesterol absorption inhibitor. This successfully lowered my LDL-C to 1.8.mmol/l (70 mg/dcl).
Given the apparent success of these types of drugs and their resultant popularity, sales boomed. Lipitor became the #1 selling prescription drug in the U. S. (peaking at revenues of $12.7 billion annually in 2007); and Ezetrol brought in $ 5.0 billion for Merck.
Then a surprise. Under Congressional probing, it was discovered that Merck had failed to release clinical results which showed that while Ezetrol was effective in reducing cholesterol, it apparently had no effect on reducing the amount of plaque build-up in the arteries, and that eventual outcomes for patients were not improved. In fact, outcomes might actually be reduced. Merck pleaded that more studies were needed.
Of course, I asked my doctor about this. He didn't know. He was following the guidelines and the recommendations. He said he would ask his father-in-law, also a doctor, who knew more about these things than he did. I've yet to get an answer from him.
I stopped taking the Ezetrol for six months, but my LDL cholesterol returned to the old (previously acceptable) level. I've resumed taking the Ezetrol.
Now I have several concerns: (1) My drug treatment is not based on any symptoms that I have (other than higher than normal levels of cholesterol); (2) My doctor doesn't know whether a prescribed drug is effective; (3) Clinical reports cast suspicion on the drug; (4) Reasons for the guidelines to be made more stringent (availability of drugs or improved outcomes?); (5) The role of profits to the pharmaceutical industry.
The question of pharmaceutical profits arises particularly when I see their reps trying to get time with my doctor and wonder how successful they are in promoting their products. Lipitor is now available in generic form in Canada, but not in the U. S., due to "negotiations" between Pfizer and the generic manufacturer. It all makes you wonder.