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Antioxidants, Statins and Lowering Cholesterol

Some research questions the effectiveness of antioxidants as a preventative for heart disease, but are statins better than diet and exercise?

| May/June 2001

The future looks bright for companies that make cholesterol-lowering drugs. According to new guidelines from the National Cholesterol Education Program (NCEP), a subsidiary of the National Institutes of Health, an estimated 36 million Americans—about 18 percent of the adult population—are considered to be at very high risk for having a heart attack or stroke. The guidelines indicate that these individuals are beyond the point where lifestyle and dietary changes alone are sufficient to reduce their risk. In other words, they need to be taking medication to lower their cholesterol.

The antioxidant connection

Not long after these recommendations made national news, a somewhat disturbing headline appeared that read, “Substudy Shows No Heart Benefits from Antioxidants.” These conclusions were based on a five-year British study of 20,539 people, all of whom had a history of heart disease, stroke, or diabetes and were therefore at a high risk for further problems. Half of them were given a daily supplement of antioxidants consisting of vitamin C, vitamin E, and beta-carotene, while the other half were given a placebo pill. At the end of the study, the researchers were unable to find any discernible benefits (or side effects) from the antioxidants. This was in direct contrast to results from another group of these same patients who were given simvastatin, a member of the “statin” family of cholesterol-lowering drugs. After five years, it was found that people who took simvastatin experienced a 33 percent reduction in their risk of having an additional heart attack or stroke.

Another disturbing study from the University of Washington in Seattle that was published in August 2001 found that adding both an antioxidant supplement and niacin to simvastatin could actually counteract the effectiveness of the therapy. In test subjects, simvastatin lowered the “bad” LDL cholesterol while the niacin kept the levels of HDL, the “good” cholesterol, in a healthy range. But when the antioxidants were added to the mix, the HDL levels remained low, thus blunting the favorable response achieved by the drug-niacin mixture.

Some cardiology experts can barely conceal their excitement about all of this. When the results of the British study were presented to the American Heart Association, they were called “spectacular” and “stunning.” At the same time, other pundits were commenting that the last nails had been placed in the coffin of antioxidants as a preventive medicine for heart disease. Some have gone so far as to propose that we stop worrying about cholesterol, diet, and lifestyle and simply proceed to put most everyone older than forty on statins. The only obvious problem—at least as far as the public is concerned—appears to be the cost. Depending on the dose and the brand, a typical course of statins ranges from $60 to $120 per month.

Using caution

Perhaps I’m just a gadfly, but this trend toward embracing statins and downplaying the value of diet and lifestyle makes me nervous. It’s easy to forget that the history of medicine is full of so-called magic bullets against disease that end up backfiring and exploding in the barrel. Consider what happened with antibiotics, which were embraced in a similar fashion not long after they were introduced. It took years of careless overprescribing before the downside of antibiotics became obvious—lethal bacteria that have evolved into drug-resistant superstrains.

Statins clearly have a downside. Cerivastatin, marketed under the brand name Baycol, was permanently taken off pharmacy shelves in 2001, after numerous reports of toxicity and thirty-one fatalities. Side effects of statins include inflammation of the muscles, liver problems, rashes, upset stomach, abdominal pain, constipation, diarrhea, and flatulence. Statins work by blocking the enzyme that makes cholesterol in the liver. This same enzyme also makes Coenzyme Q10, an antioxidant critical to normal functioning of the heart and brain. Studies have shown that long-term use of statins can decrease CoQ10 levels. The long-term consequences of this persistently lowered production of CoQ10 are unknown but could potentially include chronic fatigue and weakness, congestive heart failure, and neurodegenerative disorders.

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