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Drug Daze: Why medicate healthy patients to prevent heart disease?

BY BRYCE WILLIAMS – High cholesterol is a key risk factor for heart disease, so reducing cholesterol should lower the rate of cardiovascular disease, right? In theory, that’s correct, but in practice it’s not that simple.

A recent New York Times story reported on the disappointing results of a much-hyped cholesterol medication. The drug, evacetrapib, produced by Eli Lilly, was designed to reduce LDL (bad) cholesterol and increase HDL (good) cholesterol levels without many of the adverse side effects associated with current “statin” medications. The study evaluated approximately 12,000 patients at risk for developing cardiovascular disease. Researchers were shocked to discover that while evacetrapib did indeed deliver marked improvement in cholesterol profiles, it failed to demonstrate any reduction in heart attacks, strokes or deaths from cardiovascular disease.

For patients with documented cardiovascular disease, research has largely demonstrated that cholesterol-lowering drugs can reduce subsequent cardiac events and help patients live longer.

However, the results when prescribing these same medications to otherwise healthy patients are debatable. Clinicians and researchers evaluating several large scale studies on preventive cholesterol therapy have significantly different opinions on the risks and benefits. Two comprehensive, well-argued pro/con debates were published in 2012 and again early this year. In short, the science is not settled.

Meanwhile, the research consistently shows that diet and lifestyle changes are cardio-protective, without many of the risks or side effects of traditional medical therapies.

What accounts for the difference? Recall that cardiovascular disease arises from a confluence of multiple risk factors and that cholesterol-lowering medications only address a single, albeit seemingly important, risk factor. Diet and lifestyle, on the other hand, can address virtually all modifiable risk factors (elevated cholesterol, blood pressure, blood sugar, weight, etc.).

That said, cholesterol-lowering medications may be the right choice for certain at risk individuals. However, people respond differently to diet and lifestyle, just like medication, and it may not always be effective for everyone. Members should discuss with their physician the pros and cons of taking cholesterol medication before making a decision.

When the latest miracle pill once again falls short of expectations, don’t forget that lifestyle medicine is almost always the first, best option that delivers safe, effective heart healthy benefits.

Bryce Williams is vice president of Wellbeing at Blue Shield of California