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Pills to avoid heart attacks? Hard to swallow

October 21, 2005|John Abramson and Merrill Goozner | JOHN ABRAMSON is the author of "Overdosed America" (Harper Collins, 2004) and a clinical instructor at Harvard Medical School. MERRILL GOOZNER is the author of "The $800 Million Pill" (University of California Press, 2004) and the director of the Integrity in Science program at the Center for Science in the Public Interest.

IS POPPING A PILL the best way to reduce your risk of a heart attack?

That's the message Americans and their doctors hear almost every day. The Journal of the American Medical Assn., for instance, reports in its Oct. 12 issue that the growing use of statin drugs in the United States is largely responsible for falling cholesterol levels over the last decade. Coupled with new data showing that the number of heart disease deaths is falling in the U.S., it sounds like great news.

Unfortunately, putting those two facts together gives Americans the wrong prescription for the most effective way to minimize their risk of heart disease.

First of all, cholesterol levels in the U.S. actually fell faster before statins entered widespread use in the early 1990s, as some Americans decreased their consumption of saturated fats. But, despite the falling cholesterol levels, National Institutes of Health data show that the U.S. is still lagging badly behind most of the other industrialized countries in eliminating heart disease as a major cause of premature death.

Not only that, but during the period when statin use exploded in the U.S., the death rate from heart disease was actually falling faster in most of the other countries -- which use half as many cholesterol-lowering drugs and a third as many cardiac procedures to open clogged arteries. How can we be taking more than twice as many statins and receiving three times as many cardiac procedures and still have higher death rates from heart disease?

The problem is that while U.S. doctors and public health authorities focus on drug therapy (often working hand in hand with researchers funded by the drug industry), the nation ignores what the scientific evidence really shows to be the most effective way to prevent heart disease: adopting a healthy lifestyle.

For instance, the Nurses Health Study, which began in 1976, shows that women who follow five healthy lifestyle habits -- routine exercise, a Mediterranean-style diet (high in fruits, vegetables, unprocessed grains and olive oil; low in dairy fat, red meat and trans fat or partially hydrogenated fat), not smoking, moderate drinking and maintaining a reasonable body weight -- develop only 17% as much heart disease as those who don't. Sadly, only 3% of U.S. women do those things.

On the other hand, not a single randomized, controlled study shows that cholesterol-lowering statin drugs benefit women without preexisting heart disease. Yet ubiquitous television and print advertising encourages women to talk to their doctors about cholesterol, and a recent survey showed that two-thirds of Americans have.

How about people over 65, those most likely to be taking a statin? A recent study of European seniors showed that 60% of their deaths from all causes could be attributed to not following simple health habits.

On the other hand, a study published in the British journal the Lancet showed that not treating high-risk seniors with a cholesterol-lowering drug increased their risk of death by an insignificant 3%.

Obviously, healthy lifestyle is far more important for seniors. But they are much more likely to emerge from their doctor visits with a prescription for a statin than a realistic plan to adopt a healthier lifestyle.

There's no doubt that statins can help some people, especially those who already have heart disease and men at very high risk of developing it. But the scientific evidence is clear: Most heart disease results from the way we live our lives, and there's no magic pill to help us change that.

So why all the brouhaha about getting so many people on statins? It's an exquisite example of bank robber Willy Sutton's law: That's where the money is.

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