Cholesterol, statins and (inflated?) sensationalism
We'll have to apologize: the conclusions of scientists who have become a bomb in the medical world
Tatiana Bateneva, "News of Science"
I have two pieces of news for you: bad and good. I'll start with the bad one. The favorite refrain of doctors – watch your cholesterol level, because its norm guarantees against heart attacks and strokes – turned out to be a mistake. Does not guarantee. But the trouble can be corrected with the help of drugs-statins. And this is good news, although not cheap.
The norm should be reviewed
More recently, we talked in detail about cholesterol and its role in the body. For many years, doctors have assured us that the normal level of this important substance is below 5 mmol per liter. Then there were nuances – what should be the combination of "good" and "bad" cholesterol, due to which it can be lowered, etc.
And now the results of a two-year international JUPITER study have been published, in which our Russian doctors also took part. I will tell you about the study a little later, and now the most important thing is its conclusions. They have become a bomb in the medical world. It turned out that in order to keep the heart and blood vessels healthy after 40 years, it is necessary to lower the level of total cholesterol not to the norm of 5 mmol / l, but to 3, and even better to 2 mmol / l. Here's to you, Grandma, and cholesterol day!
Where does it come from
People who monitor their health know that cholesterol is taken from animal products – meat, butter, eggs, etc. If it were so, what would be easier: sit on a vegetarian diet – and now there is no cholesterol in the body! But–alas! – it's not like that. The harshest vegetarianism reduces cholesterol by no more than 20%. After all, it is also produced inside our body – not only in the liver, but also in almost all cells. Because the body cannot live without it. Cholesterol is needed to create the shells of all cells, for the brain to work, for the synthesis of sex hormones and much more. The problem is that it is different.
There is a good one – high–density cholesterol (HDL), and there is a bad one - low and very low density cholesterol (HDL and HCL). These loose guys are deposited inside the blood vessels, gradually narrowing their lumen. Atherosclerosis occurs – the main cause of premature death in industrial countries. And if a blood clot also clings to such a plaque, the lumen can completely close – a heart attack will happen if the vessel is in the heart, or a stroke if the vessel is in the head.
Throughout the civilized world, doctors have been prescribing special medications - statins - to people with high cholesterol for 20 years. Their regular intake reduces the level of total and bad cholesterol, prolonging life and protecting against heart attacks-strokes. In Western countries, 60-65% of patients with coronary heart disease and hypertension take statins. We have no more than 6%.
And now it turns out that statins are also needed by people whom doctors consider to be "practically healthy" – without hypertension, without coronary artery disease and even as if without atherosclerosis.
What do statins stop?
Before the discovery of statins, science tried to lower cholesterol levels in patients with atherosclerosis with the help of nicotinic acid, fibroic acid compounds and other substances. But statins have proven to be the most effective class of such drugs.
They stop the synthesis of "bad" cholesterol in the body.
They were discovered in 1973 in microorganisms that fought with other microorganisms, suppressing the synthesis of vital cholesterol in those. Scientists were interested in this ability, and the result was the creation of medicines.
In many European countries, statins are sold in pharmacies without a prescription. And at the recent international congress on atherosclerosis, they even suggested adding them to drinking water. This, according to experts, could reduce morbidity and mortality from major diseases and become habitual, like salt iodization or fortification of children's products. No decision has been made yet, but it is very possible that we will come to this.
All major statins are registered in our country.
They are also included in the list of medicines for beneficiaries – those who have suffered a heart attack can be prescribed by the decision of the medical commission of the polyclinic. But maybe you shouldn't bring yourself to a heart attack?
JUPITER came out of the fog
They like to give resonant, easy-to-remember names to international medical research. The English abbreviation JUPITER stands for something like this: "Testing the effectiveness of statin use for the prevention of cardiovascular diseases in people with low low-density cholesterol."
17,802 people were selected according to strict criteria. Everyone has a normal cholesterol level, there is no coronary heart disease and only one of the risk factors is either smoking, or slightly elevated blood pressure, or weight slightly more than normal. Equally men over 50 and women over 60. By lot, they were divided into two equal groups. And for two years, each of them took either one of the latest highly effective statins, or a placebo, that is, a dummy pill. Neither did the doctors controlling the experiment know who was taking what exactly.
The Russian part of the international study involved 40 cardiology departments in Moscow, St. Petersburg, Saratov, Samara, Tomsk, Novosibirsk and other cities.
And so the researchers summed up. In the placebo group, heart attacks, strokes and other cardiovascular troubles occurred 2 times more often! The overall mortality rate was 20% higher than in the group taking statin. These data stunned the doctors themselves. So, the "normal" cholesterol level may well be a factor in premature death!
This means that it should be lowered to the levels that were achieved by those who took the drug – almost twice the norm accepted in medicine. And this, in turn, means that we have to admit that modern ideas about the role of cholesterol and the risks of premature death need to be revised. It's not a quick thing in such a conservative business as medicine.
A task for patients
Coming to terms with this idea is not easy for us, potential and real patients. On the one hand, taking pills every day is a small joy. On the other hand, for those who are too lazy to lead a healthy lifestyle, that is, to monitor nutrition, exercise regularly, not get fat and quit smoking, the opportunity to replace all this with a single pill can do a disservice. Cholesterol is not the only risk factor for premature inglorious death.
Besides, modern statins are expensive. The one that was tested in a sensational study, at a minimum dose of 10 mg per day, will cost almost a thousand rubles in a month. In a more effective – 20 mg – already almost two thousand.
And to take these drugs, if you want to get a real effect, you need almost always, although doctors avoid the word "for life".
In general, as they say, decide for yourself.
From the editors – a hint to the problem
(from the article by the famous biochemist, gerontologist Zhores Medvedev "Is Cholesterol our friend or enemy?"):
"Statins were introduced into widespread practice and prescribed to millions of patients after 5-7 years of clinical trials in the period 1985-1995 on very large groups, mainly 50-60 years of age, since this age accounts for the main risk of cardiovascular diseases. However, now, 10-12 years after these trials, when former patients who continue to take statins become pensioners of 70-80 years of age, it is found that such long-term statin therapy weakens memory, increases the risk of Parkinson's disease and increases the incidence of Alzheimer's disease… By reducing the risk of diseases of the elderly, the hasty introduction of mass chemical therapy, fueled by commercial advertising, increased the risk of chronic and so far incurable diseases of later age...
In December 2006, quite recently, there was a new “cholesterol” sensation that threatens the multibillion-dollar statin business. Created earlier “The Longevity Genes Project decided to study the “cholesterol profile” of centenarians — people who have lived for more than 100 years… As it turned out, all these centenarians had an increased content of “bad” cholesterol, localized in very large cholesterol particles, chylomicrons. Additional studies... have found a clear correlation between the content of large lipoprotein particles in the blood and the preservation of intellectual abilities in old age. The results of the research, published in the journal “Neurology” of the American Federation of Neuropathologists on December 26, 2006, caused a sensation in many newspapers and television reports. Some medications designed specifically to selectively reduce this previously considered “bad" fraction of cholesterol are in development. Pfizer company, which intended to release a new drug, is delaying its production for the time being. A company representative explained this decision as follows: “People want to preserve their intelligence in old age and prevent Alzheimer's disease, even if it is associated with a slight increase in risk to the heart”…
In this case, the large pharmaceutical business faced common sense. In the USA in 2003, the cost of drug consumption exceeded the cost of food consumption. Mass medical psychosis, which began with cholesterol phobia, can only be cured by time."
Portal "Eternal youth" http://www.vechnayamolodost.ru/22.12.2008