Less than a month ago, international drug giant AstraZeneca (AZ) launched a new cholesterol-lowering statin drug called Crestor. AZ reps claim their Crestor is less expensive and more effective than Lipitor (made by Pfizer), the drug that dominates the statin market, grossing about $8 billion per year.

But in light of a recent study that reveals conclusions about LDL levels and arterial plaque that would shock the mainstream, these are hard times for any statin drug manufacturer.

I'm just kidding, of course. Not about the study. That's real. But the study received almost no mainstream media coverage whatsoever. By all appearances, the astronomical profits of Lipitor and its new competitor, Crestor, are quite safe.

Voice in the crowd

In what should have been terrible news for any statin drug manufacturer, a recent study reported in the American Journal of Cardiology casts serious doubts on the commonly held mainstream belief that lowering your LDL cholesterol is the most effective way to reduce arterial plaque.

Researchers at Beth Israel Medical Center (BIMC) in New York City examined the coronary plaque buildup in 182 subjects who took statin drugs to lower cholesterol levels. One group of subjects used the drug aggressively (more than 80 mg per day), while the balance of the subjects took less than 80 mg per day. Using electron beam tomography, the researchers measured plaque in all of the subjects before and after a study period of more than one year.

The subjects were generally successful in lowering their cholesterol, but in the end there was no statistical difference in the two groups in the progression of arterial calcified plaque. On average, subjects in both groups showed a 9.2 percent INCREASE in plaque buildup. The BIMC concluded that the LDL cholesterol mantra that "lower is better" could not be supported by their findings.

Now, did you hear this news shouted from the rooftops? Of course not. Did you hear it at all before today? Reuters Health covered it, but not one major news outlet picked it up. And while further research is called for to corroborate the results, this was a significant trial that flies in the face of the cholesterol message we're bombarded with daily in commercials and mainstream commentary.

It's as if the little boy who cried out, "The emperor has no clothes!" made his observation during rush hour in Times Square. What's that, kid? Cholesterol what? Sorry, can't hear you. Gotta run.

Not one, but two…

The BIMC study is far from the last word on the cholesterol issue. But it's not the first time research has concluded that LDL cholesterol is not quite the terrible killer that drug ads and cereal commercials tell us to fear.

Last year the Journal of the American Medical Association published a study that used data from more than 10,000 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; better known as ALLHAT. Following the subjects over a period of four years, researchers compared the use of a statin drug to "usual care" (maintaining proper body weight, no smoking, regular exercise, etc.) in treating subjects with moderately high levels of LDL cholesterol.

Of the 5170 subjects in the group that received statin drugs, 28% lowered their LDL cholesterol significantly. And of the 5185 usual-care subjects, about 11% had a similar drop in LDL. More importantly, however, both groups showed the same rates of death, heart attack and heart disease.

So the statin group lowered its LDL more than twice as effectively as the usual-care group, but didn't experience any fewer heart attacks than the usual-care group; not exactly a ringing endorsement for risking the side effects of statin drugs.

The right track

One report I read estimates that AstraZeneca is planning to spend as much as $1 billion to promote Crestor in the U.S this year. With drug companies willing to devote that kind of money to convince us that cholesterol should be our number one health fear, I'm afraid it's going to be a long time before the general public gets the message that lowering LDL cholesterol is not the urgent end-all and be-all of heart health.

Next week I'll take a closer look at the fascinating marketing battle that's already underway between AstraZeneca's Crestor and Pfizer's Lipitor. In the meantime, we'll continue to focus on this reality: Reducing homocysteine, triglyceride, and C-reactive protein levels is much more important to heart health than worrying about your cholesterol. And the best way to reduce all of those levels is to exercise, maintain a proper body weight, don't smoke, limit alcohol consumption, increase your intake of omega-3 fatty acids, cut out the junk foods in favor of the soluble fiber in fruits and vegetables, and take supplements that are known to protect the heart.

Easy as popping a pill? No. Effective? Yes. And worlds safer than prescription drugs.

To Your Good Health,

Jenny Thompson

Health Sciences Institute

Sources:

"Relation of Aggressiveness of Lipid-Lowering Treatment to Changes in Calcified Plaque Burden by Electron Beam Tomography" American Journal of Cardiology, 2003 Aug 1;92 (3):334-6, ncbi.nlm.nih.gov

"Aggressive Lipid Lowering does not Slow Atherosclerosis" Reuters Health, 8/4/03, reuters.com

"Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin vs Usual Care" Journal of the American Medical Association, Vol. 288, No. 23, 2998-3007, 12/18/02, jama.ama-assn.org

"The New Statin" Nicholas Regush, Red Flags Weekly, 10/6/03, redflagsweekly.com

"AstraZeneca's Crestor" Jeff Hwang, The Motley Fool, 10/2/03, fool.com