Why the new ‘cholesterol-busting’ drug is nothing to get excited about

Earlier this week saw the holding of the American College of Cardiology’s annual meeting in Chicago. Quite a lot of media interest in this scientific meeting centred on the drug currently going by the name of REGN727. It’s an injectable drug, and it lowers levels of supposedly unhealthy ‘LDL’ cholesterol. It does this, apparently, by inhibiting a protein called PCSK9, thus allowing more effective clearing of cholesterol from the bloodstream.

In a study presented at the meeting, REGN727 was administered to individuals in one of three doses. At the highest dosage, LDL levels dropped an average of 72 per cent. There’s been quite a bit of excitement in cardiological circles about this. Dr Rich Nishimura, a heart specialist who was head of the committee that chose which studies to highlight at the meeting is quoted as saying “This is a ‘wow’ study. It takes us to a whole new level of cholesterol control and could be a game changer in the future.” I’m unmoved, however.

I couldn’t care less about the impact that REGN727 has on LDL cholesterol levels. What I care about is the impact it has on health. Many doctors, especially cardiologists in my experience, view these as pretty much one and same thing. They are not.

By way of example, let’s look at the drug ezetimibe. This drug inhibits cholesterol absorption from the gut, and is an effective cholesterol lowerer. It’s licensed and prescribed on this basis. Only problem is, not one single study has shown it to improve health outcomes. Not one. In fact, there’s some evidence that it might actually worsen health outcomes.

Even if cholesterol reduction, per se, is beneficial (I doubt that it is), we need to remember that all drugs have the potential for side effects and hazard. Arsenic and cyanide might be fantastic for reducing cholesterol for all we know, but they still wouldn’t make very effective drugs.
Despite the fact that there is no evidence that ezetimibe improves health, there as been surprisingly little dissent about it in the medical community. Many cardiologists continue to write prescriptions for it in an effort to improve their patients’ ‘numbers’. The whole supposed point of this exercise, to improve the health of their patients, is often utterly lost.

This is, I think, how the drug companies like it. Having doctors believe that cholesterol reduction must somehow translate into better health down the line is one of the big deceptions of modern medicine.
Before we get all excited about REGN727 or any other cholesterol-reducing drug, we should really know its impact on health. How effective, if at all, is it at preventing heart attacks, strokes and deaths? What are its side effects and hazards, particularly in the long term.

I’m not one for predictions, but I won’t be at all surprised if it turns out that REGN727’s cholesterol-reducing power does not translate into much in the way of health benefit. And I won’t be too surprised either if it turns out to have some nasty side-effects over time. After all, in the area of cholesterol management, we’ve seen it all before.

10 Responses to Why the new ‘cholesterol-busting’ drug is nothing to get excited about

  1. Franco 28 March 2012 at 7:25 pm #

    Love the website, but any chance of creating as RSS feed for all your blog posts, can’t seem to find one on your site?

  2. Trish Cherry 30 March 2012 at 6:40 pm #

    I was on Ezetemide, had been put on it by a lipid specialist. It made me feel very ill. When I stopped it I wrote to her expressing my concerns and she actually sent a disclaimer letter to my GP and reported the matter to the British heart council saying that she was concerned about people taking “Their Lives in Their Hands” leaving off Cholesterol Lowering Drugs. She contacted Malcom Kendrick who wrote the Great Cholesterol Myth, and Uffe (Cant remember his surname) who wrote Ignore The Awkward saying that they had no right to put peoples lives at risk like this! I kept my composure through all this with the backing and encouragement of Zoe Harcombe. Also my GP wrote to the specailist saying that this patient (me) was very well informed and would not be taking this decision lightly. I have Familial Hypercholesterolemia, which as you know is genetic, but there have never been any early deaths in the family from heart disease. My parents are still in pretty good health at the age of 90. I could have been very frightened if I were not so “Well informed” What of people who do not look into this and are completely in the hands of the GP,s and specialists who hand out these drugs not knowing what they are really doing. Again my GP said to me that I probably know more about Cholesterol that she does as GP,s dont have the time to do all the research.

  3. Moyra Peralta 31 March 2012 at 1:43 am #

    I do so like Dr Briffa’s most careful and soft-pedalled approach over medical outcomes that thoroughly enrage me! Apropos the above article’s comment on Ezetimibe’s actual worsening of health outcomes, do not practically ALL prescription drugs do this?
    My husband fell victim to the effects of this drug – aggressively prescribed in combination with others as “necessary” – when after several years of taking it he suddenly acquired a crop of unpleasant skin growths all over his face and head.
    It seems to me, after a decade of research, that what the medical profession, the Pharma companies and the FDA are prescribing for patients is an ever-lengthening list of perfectly well-known outcomes ranging from cancer, dementia, heart failure, stroke, diabetes, etc. to drug-induced suicides and sudden death. I speak as one who has had two members of my family destroyed by the actions of pharmaceuticals and those dispensing them.
    That said, it is nevertheless most heartening to hear a London doctor speak out against this whole sorry mess that is now deemed to be ‘healthcare’.
    (If any readers have knowledge of London GPs who are truly interested in assisting the health of their patients, do please respond. At this stage in our lives we need to be registered with someone in the NHS who has a transparent and holistic approach and who is not committed to forcing detrimental, agenda-driven government guidelines on us.)
    PS. Appreciate also Trish Cherry’s commentary… if GPs don’t have the time to acquaint themselves with what the rest of the world knows, this makes them somewhat dangerous. FIRST do no harm!!

  4. JustMEinT 31 March 2012 at 4:45 am #

    Professor Uffe Ravnskov and Kilmer McCully have papers out currently looking into the cause of (what might be) arterial inflammation. Uffe said: Inflammation is not the cause of atherosclerosis; it is a useful reaction to infections. All trials using anti inflammatory drugs have ended with an increased CHD mortality. You can read more about that in my books. In my view atherosclerosis is an infectious process.

    This is a whole new ball game, and one which lipid specialists could do well following closely. Chlamydia pneumoniae is one suspect. There are others.

    The human body needs its cholesterol, and drugs be they statins or this new you beaut REGN727 will do nothing to prevent heart disease, because cholesterol is not the cause. These drugs, as Dr. Briffa has so rightly said damage the human body. We already know what damage reduced cholesterol does to the human brain … perhaps they will be happy when we are all walking zombies, that’s if we live that long!

  5. PhilT 31 March 2012 at 3:52 pm #

    Franco – I added the blog link to Google Reader and the URL it generated is
    http://www.drbriffa.com/feed/ – hope it works for you.

  6. Trish Cherry 31 March 2012 at 11:05 pm #

    Like the replies very much. I will add that I agree that big Pharma is making us all sick with their constant assault on our health. Since January 2011 I have left off Asprin, Fibrates and am currently working on leaving off Anti Depressants. I changed to SSRI,s at the beginning of last year after beeing on Dothiepin for seventeen years. I have since done a lot of work with side issues with Zoe Harcombe and because of further reading material such as Barry Groves “Trick and Treat”, Uffe and Malcom on the Cholesterol problem, Gary Taubes, Zoe Harcombes “The Obesity Epidemic”, John Biffras latest book on Getting out of the Diet trap. “The Emperers New Drugs” another good book and many more.

    I will only have one drug left after the AD,s but we shall see about that one when the time comes. I am so grateful that I am in a time when we can do our own research and we are not totally at the mercy of GP,s and Consultants.

  7. Tom 8 April 2012 at 6:19 pm #

    A couple of things worth mentioning to perhaps balance the comments a little? Trish – I’m really glad you have worked positively with your GP who has acknowledged your own research into cholesterol and is empowering you to make choices about your own health. It is by far a healthier attitude to have, rather than the one you espouse at the end of your last post about being “at the mercy of GPs and consultants”.

    People, your doctors are trying to help you. Sometimes they arrogantly think they know everything, sometimes they should have done a bit more reading, but please believe me when I tell you that the majority work pretty hard, beyond what they could “get away with”, and want the best for your health. The fact that the national guidelines they are increasingly pressed to follow are based on studies not as robust as they should be does not mean your doctor is an evil tyrant, with a swimming pool sponsored by a drug company etc. etc.

    Moyra – “the rest of the world” does not “know” what you feel GPs are ignorant about. These issues are still controversial, even among the people who do the studies. And please remember, for every well informed person who has read the research themselves and come to their own conclusions, there are a thousand people who come saying “Doctor, I’m not doing that, I read this article in the Daily Mail…” – if you want to make a difference, you need to differentiate yourself from “tabloid rubbish” crowd and make it clear that you have sought good quality evidence, or at least know a bit about what you’re talking about.

    There are some brilliant blogs out there. RawfoodSOS, hyperlipid, cooling inflammation (and this one of course!) – some very clever people exposing poorly defended health beliefs. But there are also a load of quacks, charlatans and idiots. Just because you read it on a blog, doesn’t mean it is right and your doctor is wrong. Let’s work together, not fight it out. If you want to make a demonstration about something, how about writing to the people who make the guidelines, comittees who are opening their doors to food industry lobbyists etc. rather than giving your GP an earbashing in the 7 minutes the poor chap has to try and help you.

  8. Trish Cherry 12 April 2012 at 4:34 pm #

    The reason why I made the comment about being at the mercy of GP,s and Consultants is because that is how many people feel. If I wasn,t stronger that is how I would have felt last year when I informed my Lipid Consultant that I could no longer carry on taking the Ezetamibe that she had put me on. She wrote a letter back to me saying that she would be reporting my case to the Brithish Heart Ascociation who were meeting the week after she wrote to me. She was concerned that the “likes of Malcom Kendrick and Uffe Ravnscoff, could be putting people lives in danger!” Then she wrote to my gp and told her to make sure that she, ( The Consultant) would not be liable if anything happened to me. I do realise that gp,s do not always have the time to look thoroughly in to these things, and my GP and I discussed that. I even went and bought her a copy of Ravnscoff,s book because she said she would like to read it. Then she put it in the Surgery Library. There are many many good Consultants and GP,s out there. I have friends who will bear witness to that. But many people including myself at one time, feel intimidated by them because there are many who will put you down at the drop of a hat! I know I have experienced it many times.

    So thankyou for you comments, and I have only answered you because it is a subject that I feel so strongly about. We all have experiences in our lives and our opinions many times are made because of those experiences.

    I have been helped by a few good ones, but I have been hurt in more ways than one by a few bad ones. I am 67 yrs old and had a lot of treatment with various medical professionals over the years. Most of them are great and the way I was treated on most occasions was excellent. But I have had some horrible negative experiences too.

  9. Parminter 13 April 2012 at 11:17 pm #

    It is as well to remind ourselves that multinational drug companies are legally constructed as amoral entities. Their concern is first with ‘the bottom line’ and second with the shareholders’ return on investment.
    With ‘blockbuster’ drug patents running out on drugs such as Lipitor, they have to find, and push, new patents. It is arguable that the massive new push for vaccines for anything and everything is an unhappy symptom of this.
    Such massive companies know every trick in the book (many books) about marketing to both professionals and governments, not to mention the poor schmucks such as myself. The tales of manipulation of evidence, suppression of negative factors, and the clever sleight-of-statistics are legion.
    But now for the good news – a researcher at Florida State University has found that two apples per day reduced LDLs by 23% in a target group. Much better than chemicals that clobber your muscles, liver and Lord knows what else – and reduce heart attacks not one jot. Bon appetit!

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