Confirmed: Lowering LDL is Effective

There’s a hidden story behind the groundbreaking Zetia/Vytorin Study. Just as important as the confirmation of the effectiveness of the new drug ezetimibe is the more general result that lowering your LDL (bad cholesterol) is good for you.

Huh? Didn’t we already know that?

You may be as surprised as I to learn that the medical guidelines for prevention of heart disease and stroke do not say you should lower your LDL – they say you should take statins. It’s a rather subtle but very important difference. Statins lower your cholesterol but also have anti-inflammatory effects which cannot be readily separated in a typical study. This new study showed the addition of the second LDL-lowering drug (combined as Vytorin) worked better than the statin alone, giving direct evidence for the reduction of heart attack and stroke risk. This drug decreases the uptake of LDL in the gut so other approaches that reduce LDL intake or absorption are likely to be beneficial as well.

I first learned of these narrow guidelines from my doctor in her response to my own approach to lowering LDL. In addition to my low-dose of statin I added a collection of other supplements that are known to reduce LDL (plant sterols/stanols, fiber, garlic). When I conveyed this to her, she said those are fine but if you forget to take any pills (she knows me well) don’t forget to take the statin. “Why is that?”, I asked. “Because I have no medical evidence that lowering LDL alone is going to protect you from a stroke”, she said. Before yesterday, that was true.

So although this study will have a huge impact on Vytorin sales (thankfully off patent in 2016), the far more important result will be new medical guidelines for lowering LDL opening the way for the prescription of other preventative treatments, including drugs, supplements, and diet.

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