Healthy Living
Skin Cancer & Vitamins
By David Perlmutter, MD, FACN
Perhaps nowhere is the quick-fix magic-bullet mentality of modern western medicine more obvious than in the use of drugs to lower cholesterol. During the past decade, the number of prescriptions written for this type of drug has increased tenfold. In 1992 alone, more than 26 million prescriptions for cholesterol-lowering drugs were written. No doubt this trend will continue as cholesterol lowering drugs are among the most heavily promoted pharmaceutical agents.
A recent study published in the Journal of the American Medical Association (January 3, 1996) entitled "Carcinogenicity of Lipid-Lowering Drugs" called to question the safety of long-term usage of various medications designed to lower cholesterol. This study evaluated the carcinogenicity (ability to cause cancer) of various popular cholesterol drugs like Colestid, Mevacor, Pra-vachol, Zocor, Lescol and others. The authors looked at the ability of these drugs to cause cancer in rodents (rats and mice) and related these findings to the use of these drugs in humans.
The results demonstrated that these drugs almost uniformly produced cancer in the animals tested. The type of cancers produced in cluded liver cancer, thyroid cancer, lung cancer, stomach tumors, as well as various "benign" tumors. Of great concern to the authors was the fact that the studies demonstrated cancer production in the animals after a relatively short exposure when it is known that patients may be taking these drugs for 20 years or longer. As the author stated, "In this article, we call attention to evidence of experimental carcinogenicity of lipid-lowering medications. This class of drugs has come into widespread use in people who are currently healthy, but who have laboratory findings - high cholesterol levels - that place them at above-average risk for their age for the development of coronary heart disease in the future. Because the latent period between exposure to a carcinogen and the incidence of clinical cancer in humans may be 20 years or more, the absence of any controlled trials of this duration means that we do not know whether current drug treatment of hypercho-lesterolemia (high cholesterol) will lead to an increased rate of cancer in coming decades." Obviously, the authors are expressing their grave concern that while millions of Americans are taking these medicines for decades, there have been no studies to demonstrate the safety of these medications for that length of time.
Indeed, the data indicating carcinogenicity of these medicines has been published for many years and, submitted to the FDA. The authors ask, "How did it happen that cholesterol-lowering agents were approved by the FDA for long-term use in spite of their animal carcinogenicity? To address this question we obtained minutes of the Endocrinologic and Metabolic Drugs Advisory Committee meetings (under the Freedom of Information Act) at which lovastatin (Mevacor) and gemfibrozil (Lopid) were discussed... the only reported discussion of animal carcinogenicity studies at the FDA Advisory Committee meeting on lovastatin (February 19th and 20th, 1987) was by a representative of Merck, Sharpe and Dohme (makers of the Mevacor brand of lovastatin) who downplayed the importance of the studies."
At the end of this meeting, a vote was taken of the Advisory Committee concerning the safety of Lopid (gemfibrozil) and the minutes state that only "three of the nine members believed that the potential benefit of using gemfibrozil for prevention of coronary heart disease outweighed the potential risk associated with such use." Unfortunately, such votes are only "advisory" to the FDA which then decides whether to approve or deny approval of a drug based upon "other information," much of which is produced by the manufacturers of the drug in question. The FDA, despite the vote of the Advisory Committee, went ahead and approved Lopid for the prevention of coronary heart disease.
The authors conclude that, "Most cholesterol-lowering drugs cause or promote cancer in rodents. Patients to whom these drugs are prescribed, either singly or in combination, are exposed throughout many years to doses approaching those shown to be carcinogenic in animals." Does this mean that physicians should stop prescribing these cholesterol-lowering drugs? In my opinion, drugs like Pravachol still have a role in the management of patients who are at high risk for coronary heart disease. This would include patients who have already experienced an event like a myocardial infarction or severe angina from documented coronary heart disease, patients at very high risk for coronary heart disease as a consequence of a strong family history, or patients who have inherited a disease which causes an extremely high cholesterol.
Unfortunately, what we are now seeing is a gross over utilization of this group of medicines. The typical patient on a cholesterol- lowering drug has had no history of coronary artery related disease, but simply has a mild elevation of the cholesterol on laboratory testing. The unfortunate reflex response that is all to common is for the physician to simply write a prescription for a cholesterol lowering medicine and feel satisfied that he or she has "taken care of the problem". But, the first and foremost consideration in the management of a patient with an elevated cholesterol must be attention to diet. Reducing consumption of animal products is the simplest and most effective dietary technique for reducing cholesterol and reducing risk of heart attack.
Vegetarians typically have much lower cholesterol readings when compared to omnivores. Their cholesterol readings are 9% to 32% lower than meat eaters. Going on a vegetarian diet for just six weeks can reduce your cholesterol from 3 to 11 percent and lower the artery damaging bad cholesterol (LDL) by some 4 to 17 percent. These are very meaningful numbers when you consider that with every one percent drop in your total cholesterol you reduce your risk of suffering a heart attack by two percent. Other sensible steps you can take to safely lower cholesterol include discontinuation of caffeine and tobacco use, appropriate weight loss and the use of a good multivitamin containing 200 mcg of chromium and 100 mg of niacin.