The Cholesterol Controversy

This is a very measured and balanced opinion from my College, the RACGP. I am still on my Crestor, following the strong recommendation from my cardiologist, whom I trust (having chosen him very carefully).

College Crest
RACGP response to ABC
Catalyst programme

7 November 2013

The RACGP is a supporter of informed and unbiased public scrutiny of medical issues, with high level critical analysis and balanced debate cultivating community confidence in medicine and the RACGP itself.

The two part ABC Catalyst edition ‘Heart of the Matter’ (aired on 24 and 31 October 2013) expressed unsubstantiated theories on the causation of heart disease, and was selective in the presentation of evidence on the effectiveness of cholesterol therapy.

The Catalyst programme contained a number of misleading statements regarding nutritional claims on co-enzyme Q and heart health, and the claim that statins do not cause reduction in mortality in primary prevention, the latter of which is refuted by Cochrane reviews.

Patient concern has been high since the airing of the programme. In order to address patient safety and concern, the RACGP has distributed a media release requesting patients continue to take any cholesterol-lowering medications as prescribed and to discuss any concerns with their regular GP.

The RACGP supports a multiple risk factor approach to cardiovascular disease prevention, with cholesterol being only one of a number of risk factors that lead to heart disease. It is known that patients with a history of cardiovascular disease (CVD) are at high risk of further episodes, and will generally have a net benefit from statin and other preventive treatments; patients with no prior history of cardiovascular disease should have a cardiovascular disease risk assessment that will guide preventive therapy decisions.

The RACGP supports the National Vascular Disease Prevention Alliance Guidelines which base treatment decisions on a patients’ absolute cardiovascular risk, with the exception of familial hypercholesterolemia where practitioners should not base treatment decisions on cholesterol levels alone.

The RACGP does however recognise that certain issues raised in the programme are of genuine concern. These include:

  • inappropriate usage of statins in low and moderate risk groups
  • the need for promotion of non drug interventions (non smoking, exercise, Mediterranean diet) in the management of cardiovascular disease
  • the concern of drug company influence on clinical trials, and these companies withholding data from such trials
  • doctors with ties to the pharmaceutical industry that have substantial influence in guideline groups, and the need for open disclosure standards
  • the role of drug companies influencing prescribing of practitioners
  • the dangers of changing ‘disease definitions’, specifically what level of cholesterol is considered ‘abnormal’, that results in more drug use
  • over diagnosis becoming a significant issue in health.

It is these issues that are of serious concern and the RACGP believe that these should be considered and debated in the community at large.

Since its formation, the RACGP has been and remains a strong advocate for preventive health and evidence-based medicine. The RACGP urges all GPs to follow guidelines outlined in its Guidelines for preventive activities in general practice (8th edition) (red book) and for patients to see their GP regularly and adopt a healthy lifestyle.

Other useful resources include:

National Vascular Disease Prevention Alliance Guidelines

Absolute cardiovascular risk calculator

Cochrane review – Statins for the primary prevention of cardiovascular disease

The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials

About Dr Colin Holloway

Gp interested in natural hormone treatment for men and women of all ages

Posted on November 7, 2013, in Uncategorized. Bookmark the permalink. Leave a comment.

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