Day and Night Pharmacy – Statins and Cholesterol

I was disappointed after reading rather misleading articles and letters to the editor on statins in The Times and the Daily Mail of 2nd August. These pieces were particularly disappointing because they were written by fellow health professionals mourning about NICE guidelines which now recommend the use of cholesterol lowering drugs- statins- in patients with lower cholesterol levels than previously advised. Their main argument being that the guidelines were emphasising pill-popping over reduction in consumption of cholesterol-rich foods. The one in the Daily Mail even suggested that the guidelines were partly driven by pharmaceutical manufacturers’ pursuit of profit. Unfortunately those arguments are flawed because they ignore how statins work to reduce cholesterol and that most patents for statins have now expired and prices have plummeted. 

It is not my intention to induce sickness by delivering a lecture on physiology (how the human body works) and pharmacology (what the drug does to the body and what the body does to the drug) but a bit of that might clarify the voodoo mist. 

Cholesterol is good for many body functions yet an excess of it builds up and hardens to fur up our blood vessels and to predispose us to blood clots- strokes, heart attacks, deep vein thrombosis etc. We get cholesterol from the food we eat but it is important to note that most of the cholesterol in us is made within by the liver- about two thirds to three quarters. 

‘Heard about the good and the bad cholesterol? Forget that for now; if the total level is high it’s most likely that the bad is high. In simple terms, under normal function, cholesterol levels are monitored by a clever negative feedback mechanism- when there’s lots floating about less is manufactured. However, many people have an inherited ‘insensitive’ liver which fails to stop production when cholesterol levels are high thus increasing an early return of dust to dust. The statins, in short, work by stopping that internal production and fooling the liver into mopping up excess cholesterol from the circulating blood stream.  Please read this again and again; this is what my educated colleagues miss in their columns- high cholesterol is not just about individuals stuffing themselves with bad rubbish, this is why some vegans also have high total cholesterol and high bad cholesterol. Stains are proven to reduce cholesterol levels: There’s solid proof, there’s no doubt. A letter from a professor of Clinical Pharmacology makes the same declaration in the same issue of The Times.

A plethora of side effects? Yes, oh yes! Everyone knows these and more are being discovered. My graduate pre-registration pharmacist trainees, like most health professionals, will sing them out. But when it comes to how statins actually reduce cholesterol many stumble and unfortunately that explains the misleading information that some professionals are disseminating. 

Ezetimibe is the drug that works to reduce absorption of cholesterol from the gut into the blood stream. (So to fulfill the pill-popping argument, an unscrupulous patient can be tempted to eat rubbish in the belief that the drug would take care of the cholesterol). This works well with less side effects but  in most cases it still is nowhere as good as statins at overall cholesterol reduction because ( as you now know) most of this bugger is made from within. In fact only a quarter of cholesterol reaching the small intestines is from the food, the rest is from the liver!

Common statins now cost pennies for a month’s supply. Of course the sum of  reasonable lifestyle behaviours- good diet, regular exercise, not smoking, good control of blood pressure and cholesterol markedly reduce the chances of hospital admissions, early deaths and the NHS bill. 

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