Wed Feb 27th, 2013 at 02:07:08 PM EST
[Hoisted from today's Newsroom.]
Once again, medical conventional wisdom is being overturned:
Doubts Emerge on the Value of Very Low Cholesterol Levels: Scientific American
Soon after Joseph Francis learned that his levels of ‘bad’ LDL cholesterol sat at twice the norm, he discovered the shortcomings of cholesterol-lowering drugs — and of the clinical advice guiding their use. Francis, the director of clinical analysis and reporting at the Veterans Health Administration (VA) in Washington DC, started taking Lipitor (atorvastatin), a cholesterol-lowering statin and the best-selling drug in pharmaceutical history. His LDL plummeted, but still hovered just above a target mandated by clinical guidelines. Adding other medications had no effect, and upping the dose of Lipitor made his muscles hurt — a rare side effect of statins, which can cause muscle breakdown.
So Francis pulled back to moderate Lipitor doses and decided that he could live with his high cholesterol. Later, he learned that other patients were being aggressively treated by doctors chasing stringent LDL targets. But Francis found the science behind the target guidelines to be surprisingly ambiguous. “You couldn’t necessarily say lowering LDL further was going to benefit the patient,” he says.
The standard advice may soon change. For the first time in more than a decade, the US National Heart, Lung and Blood Institute is revising the clinical guidelines that shaped Francis’s treatment (see ‘How low can you go?’). Expected to be released later this year, the fourth set of guidelines, called ATP IV, has been drawn up by an expert panel of 15 cardiologists appointed by the institute. The guidelines will set the tone for clinical practice in the United States and beyond, and will profoundly influence pharmaceutical markets. They will also reflect the growing debate over cholesterol targets, which have never been directly tested in clinical trials.
What other pharmaceutical panaceas do we need to revisit?