Generic Lipitor Is Not the Answer to Our Heart Disease Epidemic

Image Credit: davetron5000 / Flickr. This image has been modified.

The cholesterol-lowering drug Lipitor (atorvastatin) is the best-selling drug on the planet. Nearly a million Americans filled their prescriptions the first week after it went generic this month. Over the past 25 years, this one drug raked in $100 billion in sales.

Although as a class, the statin drugs are remarkably safe, there is concerning new evidence I reviewed in my video Statin Muscle Toxicity that even people who don’t experience pain or weakness on cholesterol-lowering statin drugs may be suffering muscle damage, which may increase the risk of falls in older men and women. This is nothing, though, compared to the risk of elevated cholesterol, the primary risk factor for our primary cause of death, heart disease.

Is that our choice, though? Taking drugs for the rest of our lives to reduce the risk of damage to our heart muscle at the risk of damaging our skeletal muscles? No, according to the editor-in-chief of the American Journal of Cardiology, Dr. William Clifford Roberts. In my video-of-the-day on Wednesday, Heart Attacks and Cholesterol: Purely a Question of Diet, I profile his new editorial “It’s the Cholesterol, Stupid!”. “For the build-up of plaque in our arteries to cease,” Dr. Roberts writes, “it appears that the serum total cholesterol needs to be lowered to the 150 area. In other words the serum total cholesterol must be lowered to that of the average pure vegetarian. Because relatively few persons are willing to abide by the vegetarian lifestyle, lipid-lowering drugs are required in most to reach the 150 level.” He concludes: “Whether or not we are willing to alter our diet sufficiently and/or to spend the money necessary to obtain the lipid-lowering drugs, and then take them religiously to achieve this goal is up to us.”

In my Heart Attacks and Cholesterol videos on Monday and Tuesday, Dying Under Normal Circumstances and Agribusiness Sees It Differently, I cover new data from hundreds of hospitals on people admitted for heart attacks, suggesting that the current cholesterol guidelines are too lax. The average LDL (“bad cholesterol”) of those hospitalized was under 130, in the official normal range, but well above the LDL limit recommended by Dr. Roberts (under 60). Having a “normal” cholesterol in a society where it’s normal to die of heart disease is not necessarily a good thing.

In Convergence of Evidence, Dr. Dean Ornish talks about the advantages of choosing diet over drugs to reach cholesterol goals. Unlike statins, a plant-based diet can prevent and treat other chronic conditions such as diabetes and obesity at the same time. His research shows that living and eating healthy can actually change us on a genetic level, up-regulating disease-preventing genes and down-regulating genes that promote breast cancer, prostate cancer, inflammation, and oxidative stress. Drugs can’t do that, but diet can.

Cardiologists are realistic, though. They know not everyone is going to shift to a more plant-based diet, which brings us to yesterday’s video-of-the-day, Fast food: Do You Want Fries With That? Lipitor? “We envisage a future in which fast food restaurants encourage a holistic approach to healthy living,” wrote a group of prominent cardiologists. “On ordering an unhealthy meal, the food will arrive labeled with a warning message similar to those found on cigarette packets (‘This meal increases your risk for heart disease and death’), and on the tray, next to the ketchup, will be a new and protective packet, ‘McStatin,’ which could be sprinkled onto a Quarter Pounder or into a milkshake. This could easily be provided at no extra charge, just as sugar and salt.” That’s modern medicine’s idea of a “holistic” approach, drugs with every Happy Meal.

Others advocate for a more aggressive approach: the “polypill,” 5 drugs wrapped into one, a statin, three blood pressure medications—a thiazide, beta blocker, and an ACE inhibitor—and some aspirin. The balance of benefits versus risks of life-threatening side-effects continues to be hotly debated within the medical community. I’m sympathetic to the drug-pushers’ arguments. Look, we have filters on cigarettes for people who continue to smoke, why not have drugs for people who continue to eat unhealthfully? Though the ideal, of course, is for people to quit their bad habits.

In this morning’s video-of-the-day, Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero, I detail how to prevent heart disease naturally by avoiding the three things that increase bad cholesterol: 1) trans fats, which come mostly from junk food and animal products, 2) saturated fat, mostly from dairy products and chicken, and 3) dietary cholesterol, the leading sources being eggs and poultry. Any intake above zero appears to increase LDL cholesterol, so consumption of meat, eggs, dairy, and junk food should be as low as possible.

The highlight of my holidays is family. Some years it’s the only time I get to see all of them. Sometimes I worry it may be the last time. My great (in more ways than one) aunt Pearl is nearly 100. We need to inspire each other to live as healthy as possible to maximize the quality and quantity of the time we all have left with each other. I hope has helped your family in some small way this year. Blessings from my family to yours this holiday season with hopes for a happy, healthy new year.

-Michael Greger, M.D.

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