Does Cholesterol Matter? Apparently Only If You're On a Cholesterol-Lowering Drug

The makers of Zetia and Vytorin (which combines Zetia and Zocor) recently announced that their aggressively advertised cholesterol-lowering drugs failed to slow the development of fatty plaque in arteries. In fact, the drugs actually promote the formation of plaque in arteries, which fuels heart disease and increases the risk of a heart attack. The announcement – in a news release, not a medical journal – came after long delays in reporting the findings of their study.

Why the delays? Follow the money. Sales of the two drugs added up to $5 billion in revenues in 2007.

The news release was the first of several fascinating and bizarre reports on Zetia and Vytorin. Even though the drugs don’t prevent heart disease, the American Heart Association quickly issued an official news release in defense of the drugs.

If you’re confused by that, just follow the money trail again. According to an article in the New York Times, the American Heart Association gets $2 million a year from Merck/Schering-Plough Pharmaceuticals, the pharmaceutical group that markets Vytorin.

The failure of this and other recent cholesterol-lowering drug trials has renewed a long-simmering debate about the role of cholesterol in heart disease. Cholesterol is a symptom -- get that, a symptom -- not a cause of heart disease, and Vytorin and other drugs merely alter a symptom. In fact, cholesterol has long been known as only a weak indicator of heart disease risk (American Journal of Epidemiology, 1977;105:281-9). Half of the people who have heart attacks have normal cholesterol levels.

What then causes heart disease? The answer is a variety of factors, most of which are no-brainers, such as prediabetes and overweight, which result from excess intake of refined sugars, processed sugar-like carbohyrates, and trans fats. This dietary pattern elevates blood sugar, insulin – and, yes, cholesterol. Even the oft-recommended high-carb diet for preventing heart disease raises cholesterol and triglyceride levels. That's because, in most people, elevated cholesterol and triglyceride levels reflect sugar and carb intake, not fats.

If all this isn’t strange enough, consider one more recent report. The average cholesterol level of Americans is now lower than it was back in 1960 because of all the cholesterol-lowering drugs that have been prescribed. At the same time, two-thirds of Americans are now overweight –- the number one risk factor for diabetes and heart disease. In effect, Rome is burning while medicine fiddles with cholesterol.