Heart Health: When Should Medicine Be Prescribed To Lower Cholesterol?
The FDA's proposed ban on trans fats and new heart disease prevention guidelines jointly released by the American Heart Association and the American College of Cardiology have stirred up debate over best practices to improve heart health.
Michael Lim, SLUCare cardiologist and professor and director of cardiology at Saint Louis University, returned to St. Louis on the Air to explain the issues. Lim was also a guest in August, when he discussed the AMA's classification of obesity as a disease.
One of the four new guidelines recommends the use of the medication statin to lower cholesterol levels in people who are at risk for developing heart disease but don't yet have it. Originally, statin was recommended primarily to people who had already had a heart attack or had been diagnosed with coronary artery disease. The new guidelines also recommend the medication for people who have a higher ten year risk for developing the disease.
"These are new things and new guidelines and that stirs on controversy," said Lim. "Can we adequately really assess somebody's ten year risk of a heart attack? Is that appropriate? Should everybody get a statin? What about other alternative medications? And there's a lot of different ways to skin that fish, but I think trying to open up the door and looking at it and trying to reduce this heart attack number is probably a good thing."
While a recommendation for increased prescription of a medication can lead to concerns about influence from the pharmacy industry, Lim doesn't think that is the case in this instance.
"I think you have to look at everything with a little bit of skepticism, but prevention of heart attacks and helping people live longer, I think that's been reproducible no matter who pays for it or what kind of medication it is with respect to cholesterol lowering in the statin category. So when things line up like that, I think there is some sense to it," said Lim.
But the possible influence of the pharmacy industry on what physicians prescribe remains an issue to be aware of. Earlier this year, a report by ProPublica and NPR revealed that some top Medicare prescribers rake in speaking fees from drug companies.
For example, nine of the top 10 prescribers of the Alzheimer's drug Exelon received money from the company that makes it. Eight of the top 10 for a Johnson & Johnson painkiller were paid speakers, as were six of the top 10 prescribers of an antidepressant made by Pfizer.
And, a survey published in the Archives of Internal Medicine in 2010 found that physicians with industry relationships said they were more likely to prescribe a brand-name drug when a generic was available.
Plus, companies have paid billions of dollars to settle whistle blower cases which allege that such fees are thinly veiled kickbacks.
"There is a lot of smoke," said Lim of the data linking higher prescription levels to paid speakers. "There are opportunities to make money outside of taking care of patients when you're a physician. That does not necessarily have to translate into how you interact with your patients and what you recommend. But this has a lot to do with your own personal integrity."
Also discussed on the show were trans fats, the concept of "healthy obesity," the increased risk people with diabetes have of developing heart disease, and the role of oral health in preventing heart attacks.
According to Lim, good oral health leads to less inflamed gums, and less inflammation in the body reduces the risk of a heart attack.