Is America Overmedicated? The Great Cholesterol Debate


BikingKate was a young wife and mother when she got the phone call that she would later recall as “shocking”. “I was really shaken up when I got the news,” the active 29-year-old says now.

 

The call came from Kate's doctor's office. “They told me that some of the results of a recent routine blood test were concerning,” Kate recalls. The nurse asked that Kate come into the office the following week to discuss what to do about her cholesterol test results. It was nothing to worry about, the nurse assured Kate; there were medications to try. Help was out there.

 

Kate was confused—and a little doubtful. She'd been eating healthy foods and working out with hand weights and on her treadmill for the past six months. Her weight was within the normal range for her height. What went wrong? How could a slender, active and otherwise healthy woman have something as serious as high cholesterol?

 

Kate's dilemma is not unusual, and her reaction at the time was typical, too: she agreed to start medication immediately. “My 'bad' cholesterol numbers are lower now,” Kate says, “and I feel better than ever.”

 

But in the wake of a wave of new cholesterol-fighting medications entering the market, consumers are beginning to question whether they're being overprescribed. Many of the drugs themselves are being scrutinized more closely to see whether they're as effective (and as safe) as their manufacturers claim they are. Still others argue that not all high cholesterol is bad cholesterol.

 

Here's help in lipid tests, what your results may mean, and whether you should consider being prescribed medication.

 

Help for Cholesterol Issues: Patients Take Control of Their Care
For years, the at-best incomplete phrase “high cholesterol” was a scare word among the general population. Few diagnosed individuals distinguished between high density lipoprotein (HDL) and low density lipoprotein (LDL) or knew what their tests might mean in the long-term. Because of the push to control heart disease, a number one killer, cholesterol as a whole received a bad reputation that has lasted to the present day and is largely misunderstood.

 

That's not to minimize the risks of certain types of cholesterol. But when it comes to lipid screening and making the choice to take medications (or try alternative methods), the times are changing. Patients have begun to ask questions and to work one-on-one with a physician, taking responsibility for their own care in a way their parents' generation wouldn't have dreamed of doing.

 

You may have recently received test results yourself, or have been taking medication for years without being clear on the ins and outs of the different types of lipoproteins and which are and aren't harmful. If so, you're not alone. It may seem like a maze of information, but cholesterol's different forms can actually be broken down into four main categories.

 

Lipid Profile Testing 101
It's important to know that despite its negative reputation in the public sector, not all cholesterol is bad. In fact, your body needs it in order to perform certain vital processes.

  • High-density lipoprotein (HDL) cholesterol, or the “good cholesterol,” binds with fat in the bloodstream and carries it to the liver for disposal. Some studies suggest that a higher HDL number may lower the risk of certain diseases, such as stroke.
  • Low-density lipoprotein (LDL) works at the other end of fat mobilization: it takes fat and a comparatively small percentage of protein from the liver to other parts of the body. Too much LDL may increase the risk of heart disease and/or stroke.
  • Very low-density lipoprotein (VLDL) is another potentially dangerous substance if there's too much of it, as it can cling to artery walls and cause plaque buildup. This narrows the passages, making it harder for blood (and clots) to pass through.
  • Triglycerides: as part of your lipid panel, your doctor may order a triglycerides test. Triglycerides exist in the body to help store fat. If there are too many circulating freely in the blood and a patient's LDL count is also high, the combination raises the risks mentioned above.

If Your Doctor Suggests Medication
Many times, out-of-normal-range test results will warrant a trial period of diet and exercise rather than cholesterol medication. Your doctor may take this approach if you have no or few risk factors associated with high LDL, VLDL and/or triglycerides.

 

However, particularly if you have a family history of high cholesterol and related diseases, your doctor may want to put you on a drug regimen right away. Or he or she may be aware of recent studies suggesting additional benefits to lowered cholesterol (like this one saying lower numbers could mean a reduced risk of prostate cancer in men).

 

The prescription your doctor recommends may be a statin, which works in the liver to prevent the formation of cholesterol; a resin, which works in the intestines to increase the disposal of cholesterol; a fibrate to lower triglycerides and perhaps raise HDL or a selective cholesterol absorption inhibitor, which is a relative newcomer to the drug cholesterol treatment scene.

 

In making your decision, consider your personal risk factors, your family history, how you're feeling in general, other conditions you may currently have and how out of range your numbers appear. If you have concerns about filling a prescription of a certain drug, bring them to your doctor. (NEVER stop taking a medication or neglect to start a prescribed drug without discussing it with your physician.)

 

Stay Informed
It's imperative that you stay informed on news and information on the drug you're taking (or that your doctor has just prescribed). Though it's always best to rely on your doctor's experience and education for a final decision, some cholesterol-lowering/preventing drugs may have side effects you don't want. And some have recently come under scrutiny in the medical community.

 

For instance, the medication Zetia, marketed heavily since 2002 as a superior “bad” cholesterol-lowering drug, is being questioned due to a recent study from the New England Journal of Medicine. According to a Nov. 15 article in the New York Times, the push to sell both Zetia and Vytorin may have led some consumers to believe there was firm evidence that these medications significantly lowered risks...but that evidence doesn't really exist, some cardiologists claim.

 

Zetia isn't the first cholesterol medication to come under the gun. As patients take more of a hand in their own self-care and approach treatment from all angles, including herbal or holistic options, the question comes up again and again: Are we overmedicating for risky lipoprotein numbers? Most cardiologists err on the side of caution; heart disease is a major killer, particularly in developed countries, and lowering the risks can deliver hope.

 

In the end, the decision is yours, but do your homework before taking any drug and discuss concerns with your physician. In the end, the two of you should be able to arrive at the treatment that's right for you.

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