Svenska Dagbladet: “Debate on blood lipids reignited”

12Jun11

The newspaper Svenska Dagbladet writes: “Debate on blood lipids reignited”
May 9, 2011

Läkemedelsverket (the Swedish Medical Products Agency) review advice on cholesterol-loweing medications. The are now going to re-exam the current recommendations for treatment of healty people with high cholesterol. Meanwhile, an acclaimed campaign for statins is being critizised for being excessive and confusing.

It’s no doubt one of medicine’s most protracted and aggressice conflicts: the contradictions between those who believe that blood lipids, cholesterol, affect the risk of heart disease and those who deny it. And those who are for or against treatment using statins.

Today there’s massive support for the lipid theory and for statin treatment among doctors, researchers, government agencies as Läkemedelsverket and Livsmedelsverket, and especially the pharmaceutical companies that have earned billions of these best-selling drugs.

But now Läkemedelsverket is going to develop new recommendations for statin treatments, probably during next year.
– It’s good that Läkemedelsverket takes up this issue again, but that doesn’t have to mean any major changes, said professor Tore Scherstén, member of the critics group.

For over thirty years there has been a loud and extremely stubborn band of critics. From the beginning they called themselves “the cholesterol skeptics”, and were a constant feature of many of the large international cardiovascular medical congresses in the past.

A group in Sweden with various backgrounds, lead by doctor Uffe Ravnskog, have been active. They now pursuit the fight mainly through debate articles. The theme is nowadays less criticism of the cholesterol theory. Instead two parallell tracks dominate: the condemnation of statin treatment, directed primarily against Läkemedelsverket, and criticism against the lipid theories regarding diet, with Livsmedelsverkets diet recommendations as main target. It is this group that successfully pushed the so-called LCHF diet (low carbohydrate and high fat).

Obvious opponents are also scientists and physicians within the medical establishment which has a different view. The polemical tone is usually turned up loud.

Now, the controversy have flared up again. The starting point is a report about statin treatment published in January, from the renowned Cochrane Institute – a network of researchers with very high reputation that analyze research reports.

According to the cholesterol critics’ debate article, the report shows that half a million people are treated unnecessarily, that statings have little effect and a long list of scary side effects like impotence and depression.

The response from many professors say the opposite, that the report shows beneficial effects with statin therapy, among other things on mortality and heart attacks. That no increase in severe side effects were detected in the study.
– It’s really totally confusing, says Inger Rose from the Swedish Heart and Lung Association. What are the patients supposted to think?

Lennart Forslund at Läkemedelsverket agrees that the different messages have caused concern:
– Both prescription-dispensing doctors and patients have contacted us and are perplexed, he says.

Läkemedelsverkets recommendations for lipid treatment from 2005/2006 remains the same. The reason that they now will investigate the statins has nothing to do with the infected debate.
– The reason is that so many years have passed with the current guidelines. Much have happened since then, and we need to evaluate the new research, among them the current Cochrane report.

Preventive treatment with statins was also discussed at the Swedish heart doctors’ annual spring meeting in Örebro in the last week.
– Cochrane urges for caution in giving statins to healthy people at low cardiovascular risk, said Professor Peter M. Nilsson from Malmö. There is every reason to think about it and discuss it with patients. That was our most important advice to the Swedish doctors.

Fact box in the article: What is the debate about?
Statins are drugs that reduce blood lipid levels and are likely to have other effects such as inhibiting inflammations. Several studies have shown that they can reduce cholesterol and protect against heart attacks and strokes among patients who have heart disease and/or have survived a heart attack. It is generally accepted to use statin treatment of established cardiovascular disease. The controversy is about healthy people who have high levels of blood lipids. Should they also take statins for the rest of their lives to reduce the risk of heart problems?

The recommendations in Sweden is to not only look at the blood lipids but also weigh in the cardiovascular risks such as smoking, high blood pressure, diabetes and obesity, before medication is initiated. The goal is to find high-risk individuals and focus on treating them.

The present Cochrane report is a compilation of 14 studies with a total of 34 000 patients. It was concluded to advise caution in giving statins to healthy patients with low risk.

Side effects. Statins are considered to be safe drugs with relatively few side effects. The greatest risk is muscle problems like pain and weakness. Hepatic and renal effects occur but are rare. Other symptoms may be nausea, constipation, abdominal pain, nausea, vomiting, usually mild and transient. Other frightening side effects that critics raise is extremely rare or not designated as possible. Increased risk of cancer has been debated for over twenty years but the risk is now considered to be dismissed.

Blood lipids. High cholesterol (hypercholesterolemia) is considered to exist when the total cholesterol in the blood greater than 5 millimoles per liter of blood. Occurs in about 70 percent of all between 30 and 50 years and in 90-95 percent of those between 50 and 70 years.
• The limit for the bad LDL cholesterol is 3.0 millimoles per liter.
• The so-called triglycerides should be below 1.7 millimoles per liter.
• The good HDL cholesterol should be more than 1.0 millimoles per liter for men and 1.3 millimoles per liter for women.

Link to the article in Swedish, written by Inger Atterstam.

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