“It’s no accident that we’re drug oriented, really. The drug companies got us that way and they’d like to keep us that way. It’s a simple thing. They start you early with the oral habit. Little orange flavored aspirin for children. (pop, pop) Two in the mouth, son. Something wrong with your head? (pop, pop) Two in the mouth. Remember that: head, mouth. (pop, pop) These are orange; there’ll be other colors later on.”
– George Carlin
I’m wondering what color the drug companies will choose for children’s statins. Maybe they’ll produce cherry-flavored pills shaped like the American Heart Association’s logo. Two in the mouth, son.
I was hoping against hope the anti-cholesterol hysterics would never be foolish enough prescribe statins for kids, but a recent news article suggests that’s where we’re headed:
More children should be screened for high cholesterol before puberty, beyond those with a family history of problems, according to wide-ranging new guidelines expected from government-appointed experts who are trying to prevent heart disease later in life.
Any call for wider screening is likely to raise concern about overdiagnosing a condition that may not cause problems for decades, if ever. Yet studies suggest that half of children with high cholesterol will also have it as adults, and it’s one of the best-known causes of clogged arteries that can lead to heart attacks.
High cholesterol is one of the best-known causes of clogged arteries? Well, in that case, obviously most people who suffer heart attacks must have high cholesterol. We’ll come back to that.
About a third of U.S. children and teens are obese or overweight. And government studies estimate that about 10 to 13 percent of children and teens have high cholesterol — defined as a score above 200.
Yup, that’s how high cholesterol is defined, all right. It was defined that way for an important scientific reason: the average cholesterol level among (non-statinated) adults is around 220. By defining a normal cholesterol level as high, the National Cholesterol Education Program (whose members nearly all had consulting contracts with statin-makers) turned millions of adults into instant patients. Now the statin-makers want to tap the kiddie market too.
A key change will be more aggressive recommendations for cholesterol screening and treatment in children, including a change in “the age at which we feel we can safely use statins,” said Dr. Reginald Washington, a pediatric heart specialist in Denver and member of the panel.
I wasn’t aware that the safety of statins for children was based on feelings. I was thinking perhaps there should be some hard evidence involved.
The pediatrics academy already advises that some children as young as 8 can safely use these cholesterol-lowering medicines, sold as Lipitor, Zocor and in generic form. They are known to prevent heart disease and deaths in adults and are approved for use in children.
Statins are known to prevent heart disease and deaths in adults? Let’s see what the science has to say on that. Here’s the conclusion of a meta-analysis on the usefulness of statins for primary prevention – that is, preventing heart attacks in people who don’t already have heart disease:
A new meta-analysis of statins in the primary prevention of heart disease has not shown a significant reduction in all-cause mortality.
Here’s the conclusion of a similar study:
In patients without CV disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations, but not coronary heart disease or overall mortality.
Statins may slightly reduce your chances of having a heart attack (if you already have several known risk factors), but they don’t reduce heart disease or overall mortality. So when a journalist tells you statins are known to prevent heart disease and deaths in adults, the journalist is making a statement that simply isn’t true.
Statins are worthless for primary prevention. So at best, the kids would be taking a powerful drug they don’t need. At worst (and I expect the worst), the statins would starve their brains of cholesterol and destroy the mitochondria in their muscles – at exactly the time when their brains and muscles are developing rapidly. This is a disaster waiting to happen. With their brain development stunted at an early age, the only career paths open to these kids will be running for Congress or working for the FDA.
But there aren’t big studies showing that using them in children will prevent heart attacks years or decades later.
Well then, by all means, let’s start giving statins to kids based on nothing more than anti-cholesterol hysteria — and our feelings. We needn’t bother waiting for those big studies. To paraphrase George McGovern, we don’t have time to wait for every last shred of evidence to come in.
I said earlier that we’d come back to the statement that high cholesterol being one of the best-known causes of clogged arteries. If that’s true, then we’d expect most heart-attack victims to have high cholesterol. But that simply isn’t the case. Several months ago, I posted about a study showing that nearly three-quarters of heart-attack victims have normal or even low LDL levels – and course, it’s LDL that statins beat into submission.
If you look at heart disease rates and cholesterol levels around the world, you won’t find any correlation whatsoever. The French and the Swiss both have average cholesterol levels over 230. They also have the first and second lowest rates of heart disease among industrialized nations. Russians have an average cholesterol level of 190 – below that magic number of 200. Russians also have the highest rate of heart disease in Europe.
In another recent news story warning that (eek!) up to one-fifth of people with heart disease aren’t being good little patients and taking their statins, the truth about cholesterol and heart disease slips out again — although that wasn’t the intention of the article:
More than one in five people with heart disease aren’t getting life-saving statin drugs despite guidelines saying they should, a new study shows. Researchers looked at nearly 39,000 people who had experienced a heart attack or undergone heart surgery, and found about 8,600 people weren’t prescribed the cholesterol-lowering medications.
Notice the reporter couldn’t resist referring to statins as “life-saving.” Bias? What bias? We don’t see any bias.
Now for the paragraph where the truth slips out:
“Our study shows that half of untreated patients had low LDL levels,” said Dr. Suzanne Arnold of Saint Luke’s Mid America Heart Institute in Kansas City, who worked on the new findings. “This supports the assumption that some doctors may not think patients with low LDL levels need lipid-lowering medication,” she told Reuters Health.
The patients in this study were people who already had a heart attack – and half of them had low LDL levels. If high cholesterol is one of the best-known causes of clogged arteries, then how the @#$% do we explain away the fact that at least half of the people who suffer heart attacks don’t have high cholesterol? And how on earth do we justify giving statins to kids just because they have “high” cholesterol?
But even in people with low LDL cholesterol, statins can provide a benefit, according to Arnold. “Statins do more than just lower cholesterol,” she said. “They also play a role in reducing plaque and inflammation in arteries. That benefits people regardless of their cholesterol levels.”
Here’s a crazy idea, Dr. Arnold: Given what you just said, perhaps high cholesterol isn’t the problem. Perhaps inflammation is the problem, and the only reason statins provide any benefit at all is that they lower inflammation. We don’t need drugs to reduce inflammation. We can do that with a proper diet. Beating down our cholesterol levels isn’t a benefit of statins; it’s a nasty side-effect.
In some people, statins can cause muscle pain and stomach problems such as nausea, gas, diarrhea or constipation. And their long-term effect on muscle tissue is unknown.
Yes, determining the long-term effect of statins on muscle tissue is tricky, especially since so many older people take statins. As my mom discovered, if you’re a senior citizen who takes statins and you complain to your doctor about muscle pain, your doctor will probably attribute the pain to old age.
So here’s what we need to do: Let’s prescribe statins to a whole generation of kids. In just 20 years or so, we’ll finally know the long-term effects of statins on muscle tissue. I’m sure all those 30-year-olds in wheelchairs will be glad to know they contributed to medical science.