Behind America’s biggest fears — cancer, multiple sclerosis, Alzheimer’s — the real killer often gets overlooked.
Statistics from the American Heart Association are startling. More men and women die of heart disease – 38.5 percent of all U.S. deaths in 2001 – each year than any other type of health problem.
Cholesterol is key
A primary cause of heart disease among Americans is high cholesterol. An estimated 20 million Americans took cholesterol-lowering medication in 2001.
High cholesterol, along with other risks, leads to atherosclerosis — a clogging of the arteries that causes heart disease and failure. This clogging is the result of a build-up of fatty substances on the walls of the arteries, a process that, over time, restricts blood flow to the heart.
The body automatically produces cholesterol, the fatty substance in the blood that it needs to form cell membranes, some hormones and other tissues.
Cholesterol exists in two forms: LDL and HDL. The abbreviations are based on the lipoproteins that transport each type through the body.
LDL, or Low Density Lipoprotein, carries cholesterol around the body from the liver, accounting for approximately 60 to 70 percent of the body’s cholesterol.
HDL, or High Density Lipoprotein, transports cholesterol back to the liver, where it can be disposed. HDL is considered “good” cholesterol, while LDL is “bad” cholesterol.
According to the American Heart Association, LDL levels can be intensified by family history, cigarette smoking, diabetes millitus and diets rich in fish and dairy products.
Cholesterol problems can be overcome
But the condition is fixable. The process of lowering “bad” cholesterol while raising “good” cholesterol typically calls for lifestyle adjustments and prescription drugs.
“Changes in diet and exercise alone can lower your cholesterol 10 to 15 percent,” said Washington Muro, a doctor of internal medicine.
But it’s cholesterol-lowering drugs that has physicians, researchers and patients constantly evaluating new information.
The results of PROVE-IT, a recent Harvard Medical School study comparing treatment of high cholesterol by two different drugs, suggest that high LDL levels should be treated even more aggressively than current guidelines dictate.
Gerald Mancuso, a cardiologist in Kansas City, is familiar with PROVE-IT and other similar studies.
Mancuso said he and other cardiologists have always been more aggressive with medical treatment and that “there is a push toward more aggressive therapy and earlier therapy.” The recent findings suggest a lowering of regulations for acceptable LDL levels might occur in the future.
Mancuso believes drugs known as statins are most capable for the job.
Statins, America’s top-selling drugs, prevent the production of cholesterol in the liver, lowering levels in the blood. The most common statins include Lipitor, Zocor, Pravachol, Lescol and Mevacor. Drug companies made $12.4 billion in profits from these drugs in 2002.
Lipitor, the most prescribed drug in the U.S., was shown in one study to reverse the hardening of the arteries due to build-up of cholesterol and other plaque-building substances.
“There is impressive literature showing the reducing of cardiac events in people without elevated lipid (blood fat) levels,” Muro said. A recent study suggests that men and women with average or below average LDL levels can benefit from lowering their LDLs, he said.
Muro said that because lower LDL levels decrease the risk of heart disease, he sees no reason not to stop the problem before it starts.
But he added that some patients don’t see it so simply and are frightened by the possibility that statins damage the liver.
When Muro encounters patients who have reservations about taking statins, he said he explains that the risk of heart disease far outweighs the potential for liver function abnormalities.
Muro said chances of experiencing the potential side effects of statins, which include intense muscle aches and elevated liver function tests, are lower than five percent in his experience.
However, statins also put a dent in a patient’s pocket book.
For those without medical coverage, the cost of one month of Lipitor ranges from $60 to $90. Another problem is the lack of a less expensive, generic equivalent for Lipitor.
But given research that shows fatty build-up in arteries in the college-aged population, Mancuso said people might want to accept the idea of a lifetime spent taking what he calls “wonderful drugs.”
Even younger adults should check cholesterol
The American Heart Association recommends people start checking cholesterol at age 18, regardless of other heart disease risk factors present.
Lauri Hamilton works for the Health Connection, which offers different cholesterol and lipid tests. Hamilton said that while her clients range from 20 to 80 years old, the majority of them are over 50. Muro said cholesterol monitoring needs to start much earlier so prevention is possible.
Checking cholesterol requires a blood test and takes less than ten minutes when completed at Health Connection.
In the past when a person had high HDL levels, patients often assumed they counteracted high LDL levels.
But Muro said this is only one piece of a larger picture.
Mancuso said an individual’s whole lipid profile must be evaluated to accurately assess risk.
Muro, 42, has been so convinced by the drugs’ preventative possibilities that he’s considering placing himself on Lipitor, although he does not have high cholesterol.
“Why not? It’s a cholesterol-lowering drug,” he said, “and the data shows lowering your cholesterol lowers your chance for heart disease.”