Ravnskov of Cholesterol Skeptics responds to Canada's new guidelines for physicians to treat cardiovascular disease, potential cardiovascular disease, and imagined cardiovsascular disease:
Dear Mr Evenson
A friend of mine sent me your article about the new Canadian guidelines. Evidently the Canadian authorities have bought the new
American ones uncritically.
Here is a summary of the way these guidelines were created:
1. A small group of private individuals come together and call themselves the "Expert Panel."
2. These people recieve large sums of money from pharmeceutical companies to give talks, do research, etc.
3. The Expert Panel rewrites the guidelines and issue them with the apparent endorsement of the federal government.
4. Thirty million more Americans now need to be on cholesterol-lowering drugs.
5. Insurance companies, Medicare, etc. pay the pharmeceutical companies billions of dollars a year for those drugs.
Here is the list of commitments for the members of the expert panel:
Financial Disclosure:
Dr Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, and Bristol-Myers Squibb. Dr Hunninghake has current grants from
Merck, Pfizer, Kos Pharmaceuticals, Schering Plough, Wyeth Ayerst,
Sankyo, Bayer, AstraZeneca, Bristol-Myers Squibb, and G. D. Searle; he has also received consulting honoraria from Merck, Pfizer, Kos
Pharmaceuticals, Sankyo, AstraZeneca, and Bayer. Dr McBride has received grants and/or research support from Pfizer, Merck,
Parke-Davis, and AstraZeneca; has served as a consultant for Kos
Pharmaceuticals, Abbott, and Merck; and has received honoraria from
Abbott, Bristol-Myers Squibb, Novartis, Merck, Kos Pharmaceuticals,
Parke-Davis, Pfizer, and DuPont. Dr Pasternak has served as a consultant for and received honoraria from Merck, Pfizer, and Kos
Pharmaceuticals, and has received grants from Merck and Pfizer. Dr
Stone has served as a consultant and/or received honoraria for lectures from Abbott, Bayer, Bristol-Myers Squibb, Kos
Pharmaceuticals, Merck, Novartis, Parke-Davis/Pfizer, and Sankyo. Dr
Schwartz has served as a consultant for and/or conducted research funded by Bristol-Myers Squibb, AstraZeneca, Merck, Johnson &
Johnson-Merck, and Pfizer.
Read also my comments to the American guidelines on
http://www.ravnskov.nu/ncep_guidelines.htm
Best wishes
Uffe Ravnskov, MD, PhD; independent researcher
Spokesman for THINCS, The International Network of Cholesterol
Skeptics (
www.thincs.org )
www.ravnskov.nu/uffe And the National Post story on the new heart disease guidelines which will leave no-one unmedicated. In fact,
Genest one of the stooges on the take here, was quoted as saying last spring "Is there anyone who shouldn't be on statins?"
Heart doctors redefine 'normal'
Lower cholesterol, lower blood pressure now expected
Brad Evenson
National Post
Thursday, October 30, 2003
To all Canadians who plan to get a medical exam soon: Brace yourselves
That beer belly is no longer a source of humour.
Your borderline blood pressure has crossed the border. And those cholesterol levels that last week seemed normal, are now the dark precursors of a heart attack.
Guidelines for what is "normal" cardiovascular health have fallen. The new normal is lower, lower, lower.
As a result, millions of Canadians with no outward signs of heart disease can soon expect to be prescribed a shelf-load of pills, including statins, diuretics and ACE inhibitors, to safeguard their hearts.
"In the past we looked at a lot of patients as kind of being in the grey zone and decided, 'Well, maybe we'll try diet for another year,' " says
Dr. Ruth McPherson, director of the lipid clinic at the University of
Ottawa Heart Institute. "Now we're being a little more categorical that these people definitely will benefit from treatment."
This week, the Canadian Medical Association
Journal published a summary of new guidelines for blood fats. Among the most stringent in the world, they shift focus from so-called bad (LDL) cholesterol toward the lack of good (HDL) cholesterol levels. They also cast a suspicious eye on big waistlines and insulin levels.
The shift follows changes in May to blood pressure guidelines, which replaced the category "high normal" with the worrisome-sounding label
"pre-hypertensive."
"Definitely more people are now candidates for [drug] treatment," says
Dr. McPherson, part of the working group that drafted the new cholesterol guidelines.
"And some people are concerned about that. But the truth is that the safety of these medications is well established."
The upshot is that people who three years ago could be told they were reasonably healthy will now be informed they are ticking cardiac time bombs.
Researchers have been fighting for years over the best ways to predict and ward off heart disease.
In recent years, such studies as the MIRACL trial and the Heart
Protection Study have shown if you have a family history of heart disease, are overweight, diabetic or hypertensive, then treatment with lipid-lowering statins such as Lipitor or Zocor can save your life.
"Even if you have a rock-bottom cholesterol level, if you have heart disease, going on statins definitely decreases your risk of having heart attacks and dying of heart disease," says Dr.
McPherson. "That risk is decreased, in different studies, anywhere from
25% to 50%."
Now that they know it's possible to prevent cardiovascular disease, doctors are now inclined to be stickier about details.
For example, research shows artery damage can start at blood pressure levels as low as 115/75 and doubles for each
20/10 millimetres of mercury. Previously, such levels were considered satisfactory.
At least four million Canadians have hypertension, sometimes known as the silent killer. Up to 30% of victims do not realize they have it.
Controlling blood pressure can reduce the incidence of stroke by 40%, reduce heart attacks by 25% and lower the rate of heart failure by 50%.
So hypertension guidelines have fallen.
Previously, systolic pressure of 130 to 139 and diastolic pressure of 85 to 89 were deemed "high normal." (Systolic is the pressure on blood vessels when the heart muscle is contracting, and diastolic is the pressure when the heart is pausing between beats.) Now this pressure is called pre-hypertensive, a name meant to evoke concern. Patients in this category may be told to lose weight, quit smoking and reduce salt consumption, or in some cases may be prescribed such drugs as diuretics
