Tuesday, November 12, 2013

Cholesterol Lowering Drugs

   To my knowledge, there is little evidence to support broad use of statins - or medicines that lower cholesterol.  The goal for treating high cholesterol is to decrease risk of heart attack and early death.  The research I have reviewed only showed this benefit for statin users who have been diagnosed with heart disease or who have had a heart attack.  It is that group that benefits from use. The new recommendations are to give statin medications based on factors (like having diabetes) other than a persons blood cholesterol level.  In a way, this removes the argument of how high the LDL level has to be before medicine is prescribed and at what dose should the statin be started, based on that LDL number.  The cut off number was always arbitrary.  How could there be more risk at 120 and not 119, for example.  But I don't know that this is any better, because it still places an emphasis on pills over lifestyle.
   I share the concerns of CNNs Dr. Sanjay Gupta who equates this shift to medication over changes in diet (and exercise) as a sign of defeat against the prevention of diseases associated with obesity.  Medication is not the solution here and we shouldn't give up on prevention.
    I understand that efforts to nudge people into better lifestyles has not been successful.  I don't think encouraging people to rely on medicine to fix problems is better than changing the environment to provide people better options (i.e.,  options to be physically active and to eat in moderation).  It does seem that nutrition information and nutrition guidelines are consistently and broadly misunderstood by a majority of persons.  This is in large part due to the complicated and ever changing information out there.  It is confusing and most people don't know what to look for when assessing a food's nutritional content and 'healthiness.'
    Just recently, I walked by a man and woman at the grocery store as the man was reading the back of package nutrition label.  (YAY!)  I heard him say, "Oh no, this is loaded with carbohydrates."  I wanted to stop, go back and ask him,"And what exactly does that mean to you?  Why is that a good or bad thing?"   Because if all someone told me was "its loaded in carbohydrates," I could not make an informed decision.  Sugar is a carbohydrate, so are vegetables and grains!  
   Our education and health promotion efforts must be constant, but simplified. Americans consume diets that are high in calories and items that might lead to high cholesterol, diabetes, obesity, heart disease, etc.  The main objective to improve health should be changing the diet (and increasing activity) not medicating the entire country.  Using medication in this way is as foolish as providing more rescue workers to collect the drowning from the river instead of putting a rail on the bridge to keep people from falling in the river.

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