August 9, 2001 marks the very first serious tremor in the statin house
of cards with the withdrawal of Baycol (cerivastatin) from the
market. Clearly the massive wealth and power of the combined statin
industry is the vanguard and driving force behind the anti cholesterol
crusade. Before the release of the first statin, Mevacor, in 1987, one
could argue that the anti cholesterol crusade was faltering with dietary
advice that was at best ignored and at worst used as a sort of sadistic
bludgeon, eg: The East Texas farmer who awakens after his first
myocardial infarction (MI) lying in a hospital bed surrounded by
dieticians and physicians who
a. convince him that his evil consumption of eggs and bacon every day
for breakfast caused his MI
b. convince his wife of the same
c. ensure years of misery and guilt with a serious disruption in one
of life's greatest joys - eating truly good food with all of its
family, cultural and religious implications.
Further, prior to statins, cholesterol lowering drugs were fraught
with early side effects - thus thankfully eliciting that most wonderful
of human defense mechanism - "non-compliance". These pre-statin drugs
were not even useful in treating cases of cholesterol-neurosis. A pure
iatrogenic neurosis, caused by decades of very successful propaganda.
Then came the miracle drugs, the HMG-CoA redustase inhibitors with
two striking characteristics:
- very few early side effects
- a brisk reduction in cholesterol with psychological benefits to
both doctor and patient.
Finally, we are beginning to see the results of this vast human
experiment wherein millions of people (many whose only claim to "illness"
is an elevated cholesterol) have taken a class of drugs for many years
that blocks a vital biosynthetic pathway leading not only to a lowering
of cholesterol but of coenzyme Q10, dolichol and prenyl proteins. There
is very good evidence that CoQ10 depletion is associated with impairment
in myocardial function. We first presented and published data in 1990
that patients with idiopathic dilated cardiomyopathy show a drop in
blood CoQ10 level and a life threatening decline in heart function when
placed on statins. Since the release of statins in 1987 there has been a
roughly three fold increase in CHF in USA.
(See fig. 5, titled "Prevalence of CHF, by Age, 1976-1980 and 1988-1991"
at http://www.nhlbi.nih.gov/health/public/heart/other/CHF.htm).
This "epidemic" of heart failure has been the topic of several large
cardiology conferences and some of the increase in CHF has been
attributed to a lowering of the immediate death rate of acute MI.
Although there is some truth to this I find it hard to believe that such
a large increase in HF can be attributed to our "just doing such a good
job in treating acute MI". Certainly, we must be very sure that we are
not contributing to this epidemic with the overzealous use of statins,
with ever more potency aimed at an ever shrinking "target" LDL cholesterol.
I believe the deaths from rhabdomyolysis are truly the very tip of a very
large side effect iceberg and would agree with Uffe that we are seeing the
beginning of the greatest medical tragedy of all times.
But never fear, as our fearless FDA spokesman has stated in an attempt
to keep people from panicking:
"Baycol has been linked to significantly more fatal cases than
its competitors, said FDA's Dr. John Jenkins. So, he said, there are no
plans to strengthen existing warnings or take other action against the
other statins - Mevacor, Pravachol, Zocor, Lescol and Lipitor."
Equally non-reassuring are the strident, almost panicked-sounding
exaltations on the benefits of statins in the press releases accompanying
the recent Baycol withdrawal.
By Peter H. Langsjoen, MD, FACC, PA, Langsjoen@compuserve.com
For more information about Coenzyme Q10 see http://www.coenzymeQ10.org
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