Lipitor (atorvastain calcium) tablets made by Pfizer and distributed by Parke-Davis are seen November 30, 2011 in Washington, DC. Pfizer’s patent on the best-selling drug of all-time, the cholesterol-lowering medication Lipitor, expired on November 30, 2011, opening the path to generic competitors for America’s most popular medication. Lipitor came on the market in 1997, and has raked in some $100 billion for Pfizer even in a crowded market that includes various other cholesterol-lowering statins, many of which have already gone generic. In the United States, anti-cholesterol drugs account for 255 million prescriptions a year, and about nine million people are taking Lipitor. AFP Photo/Paul J. Richards (Photo credit should read PAUL J. RICHARDS/AFP/Getty Images)
Q: Would you comment on some information I discovered about statin drugs, which I think reveals some nefarious numbers on behalf of the drug companies?
So far I have found two reports that say the actual number of people who have heart attacks after being placed on Lipitor was reduced from 3.1 percent to 2 percent. This was a study of thousands of people over 10 years and was done by the drug company, not an independent lab. The drug company selling the statin drug claims that a reduction from 3 percent to 2 percent is a 33 percent drop.
I beg to differ on that. If my chances of having a heart attack drop from 3 percent to 2 percent, I say that is a 1 percent drop. So I quit taking the drug because of the long-term side effects. I also changed my diet to eliminate sugars and highly refined carbs, and I am eating a lot of dark green veggies. I keep my weight under 140 pounds, which is still a few pounds over my natural weight (about 135 pounds). I am 5 feet, 9 inches and have always been very thin.
I had a heart attack and triple bypass 11 years ago, even though my blood pressure was 125/80. My current cardiologist wants to up my statin drug from 40 mg to 80 mg. I am 78 years old and very healthy.
Anonymous
A: An old expression is that there are three kinds of lies: lies, damned lies and statistics. What you are calling nefarious, the drug company calls marketing, and both ways of looking at it are true, as long as you understand what is being said.
The original study that looked at the effect of a statin drug in people with heart disease showed that after 5.4 years, the risk of dying was 12 percent in the group randomly assigned to statin, and 8 percent in the group randomly assigned to placebo. The paper called that a 45 percent relative risk reduction, but I would call it a 4 percent absolute risk reduction. Other studies (there have been many that have consistently shown benefit) did not show as great an improvement (33 percent relative risk reduction is more common than 45 percent), but you have to look at both the length of time a study goes on and how sick the subjects in the studies are.
You may still think that it’s not worth taking the drug to go from a 12 percent risk of death to an 8 percent risk of death over five years. I know which group I’d rather be in, so I recommend a statin to a person who has that high an absolute risk. I would never recommend a statin to a person with a 3 percent 10-year absolute risk. Most authorities recommend a statin once their 10-year risk is above 7.5 percent.
You mention long-term risks. Muscle aches cause discontinuation of statins in many people (who are then at increased risk for heart attack compared with those who continue statins), but persistent symptoms after discontinuation are rare.
People at high risk of heart attack and stroke benefit from statin therapy, but the amount they benefit depends on how much risk they have. Those with a prior history of heart attack or bypass graft are at high risk and likely to have much more benefit than harm from a statin. People without a history of heart disease have less absolute benefit, and so a careful evaluation, including assessment of lifestyle issues like diet and exercise, is critical. I have had many people who no longer met criteria for a statin once they made some healthy changes to their lives.
Q: I have struggled with IBS and GERD since I was a small child. I have had multiple gastroscopies and have been on countless medications over the years for my issues. I’ve followed every diet and lifestyle change that my doctor has suggested, with, at best, moderate results.
Recently, a friend of mine suggested having my gut flora screened by a private company for analysis. This company takes your results and suggests a prebiotic regimen for you to help improve your gut’s microbiome. However, these tests are expensive, and I’m leery about spending $200 or more on a test kit that might not be as valuable as these companies claim.
The reviews online seem mixed, with some sources raving their efficacy and other sources saying these tests are limited in scope and of dubious value. What is your opinion on at-home private gut flora screening? Is it worth doing?
NE
A: There is great excitement about the microbiome (the term for the “suite” of thousands of bacterial species in your intestine) but still a great deal of uncertainty. Experts estimate 40 percent of the genes identified in the microbiome have unknown function. There is not a consensus about what makes a “healthy” microbiome or an “unhealthy” one. It’s also not clear that an “unhealthy” result from your microbiome testing is the cause of, or the result of, intestinal disease. It is also very unclear that trying to manipulate a specific microbiome result through diet or probiotics leads to better outcomes than general healthy diet advice.
I rely on evidence, and the evidence that your $200 on testing will lead you to better health is not strong enough for me to recommend them at this time.
Q: My recent DEXA scan said I had a 19 percent chance of a major fracture within the next 10 years. Does that mean that I have an 81 percent chance of not having a major fracture?
MEH
A: Yes, that’s exactly what it means, but you should realize that after the 10 years, your risk will continue to go up. If you are one of the lucky 81 percent who does not get a hip fracture, you have a substantially higher chance in the following years to get a major fracture.
Most authorities recommend treatment when the risk of major osteoporotic fracture exceeds 20 percent, but not everyone will choose therapy at that level. The higher the risk, the more benefit a person will get from treatment, which involves diet, exercise, vitamin D and, sometimes, medication. Treatment reduces the risk of fracture. In women with very low bone density, for every 100 women who took the medicine for three years, six did not get fractures who otherwise would have.
All medicines have downsides, and bisphosphonate drugs (the most common class of medicines used; Fosamax is one) increase the risk of several problems, including osteonecrosis of the jaw. These medicines should only be used when there is a clear benefit outweighing the risk, and the 20 percent threshold is one commonly used guideline.
Q: What are some natural ways to reduce blood pressure?
JW
A: Too often, physicians jump to medication treatment to control blood pressure, when there are nondrug ways of reducing blood pressure that are often overlooked.
Not every person with high blood pressure is salt-sensitive, but overall, reducing salt can make a significant improvement in high blood pressure — an average of 5 points systolic and 3 points diastolic from moderate salt restriction. Other dietary changes proven to improve high blood pressure include high potassium foods, such as fruits; a more plant-based diet with more vegetables and legumes and less meat; and higher calcium and magnesium in the diet.
Alcohol can have an extremely large harmful effect on blood pressure in many people, especially the day after drinking three or more drinks. Smoking also raises blood pressure, and quitting has many health benefits beyond the drop in blood pressure. Regular moderate-intensity exercise (40 minutes three or four times weekly) similarly improves blood pressure.
There is evidence for benefit from some supplements. A study on aged garlic supplements was methodologically strong and showed a drop in systolic blood pressure an average of 5 points. Smaller trials showed benefit with the supplements berberine and whey protein. Dark chocolate and decaf coffee/tea have small beneficial effects.
Finally, some types of meditation have been shown to help lower blood pressure. Even slow, deep breathing techniques can lower blood pressure in the short term.
Not everybody with high blood pressure can avoid medications with these natural remedies, but there are many who can, and many of these natural remedies have additional health benefits beyond blood pressure.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.
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