Wednesday, February 13, 2008

Do YOU Worship at the Alter of LDL Cholesterol?

Many years ago, doctors would simply measure total cholesterol and call it a day. As the snail-slow medical community progressed it identified LDL Cholesterol as the "bad" guy and basically did little else for decades but beat up on LDL and develop LDL lowering drugs like statins and, more recently, ezetimibe. But a funny thing happened on the way to the temple.

Much like the COURAGE trial delivered a much different than expected result on stenting (it's not much better than drug therapy for non-acute heart disease) , the ENHANCE trial found that lowering LDL with ezetimibe provided little improvement in outcomes. Track Your Plaque proponent Dr. William Davis often opines, "The average LDL Cholesterol of a heart attack victim is 134mg/dl, the average LDL Cholesterol for someone who does not have a heart attack is 131mg/dl." It is a statistical dead heat!

The latest theory is that what matters most is not merely how low you drive LDL Cholesterol but how you go about lowering it (statins deliver pleiotropic effects beyond simply lowering LDL). Ezetimibe can dramatically lower LDL when taken in combination with a statin. You have probably seen the commercials for Vytorin (simvastatin plus ezetimibe) that proclaim it treats the "two sources of cholesterol" (genetic and dietary). The ENHANCE studiers naturally expected to prove ezetimibe was a blockbuster drug that whose LDL lowering effects would earn billions. But it didn't happen. Moreover, the researchers were accused of delaying publication of the bad news.

Dr. Eric Topol has an interesting Video Blog on the subject that is worth the 4-1/2 minutes of your time to see and hear. He suggests that the true cuplrit is oxidized LDL. It makes a lot of sense as we begin to "peel back the onion" on LDL Cholesterol. Stay tuned! You know my next move. Find a test for it so I can hang on number on it!




Zute said...

Perhaps it isn't LDL at all!

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