Whatever happened to “If it ain’t broke, don’t fix it”?– Cholesterol-reducing agents for everyone!

Cholesterol–it’s bad, right? Wrong! That is, there is a reason that 80% of the cholesterol in our bodies is made by our very own liver. And it is not so that AstraZeneca can increase their profit margin. But, it is a fact that this pharmaceutical company market Crestor, a cholesterol-reducing drug (statin), to be prescribed  for use by people who do not have elevated cholesterol levels.

Cholesterol is a fatty substance with a number of essential functions. First, every one of the approximately one hundred trillion cells in our body has cholesterol molecules inserted into its membrane. It is essential that cells communicate with each other–and cholesterol helps this process. It is also important that cell membranes are not too fluid (so we turn into mush) or too rigid (so our membranes tear when we move). The amount of cholesterol in our cell membranes is carefully regulated to keep the balance exactly where it should be.

Second, cholesterol is a precursor for (that is, it is made into) 1) our sex hormones (estrogen, testosterone, etc.), 2) cortisol, which regulates blood sugar levels and dampens down over-active immune reactions, and even 3) vitamin D. Without cholesterol, women would have menopausal symptoms, men would be less “butch,” our allergies would go nuts, and we would develop osteoporosis.

Third, it bears thinking about that 25% of our cholesterol is found in our brains–perhaps it has an important neurological function? Maybe this is why one commonly-reported, but debated, side-effect of statins is memory loss. For a list of other possible side effects, one only needs to Google “statin side effects.” A quick perusal shows that some of these appear to be the result of yet another mechanism–statins work by inhibiting the function of an enzyme that is important in making cholesterol. Unfortunately, this same enzyme also helps with synthesis of other body chemicals. Loss of those chemicals results in a whole group of side effects of their own.

Of course, the listed side effects of cholesterol-reducing agents vary depending on the source. The pharmaceutical manufacturers, the Mayo Clinic, and even the FDA seem to think that the side effects are mild and rare. Others feel they are rather more serious; one site even suggested that over 90% of people taking statins develop serious muscle pain. It appears obvious that the motive for advocating prescription of statin drugs for those who do not have high cholesterol might be financial.

These days much health care is preventative. People take medications to prevent osteoporosis, have a mastectomy to prevent breast cancer (if they are positive for the gene), and are vaccinated to prevent viral infections, even by agents that they are unlikely to encounter. But, one should always weigh the health risks of any therapy against the possible health (not financial) benefits. In the case of prescribing statins to those who do not have elevated cholesterol levels, we are not convinced that this has been adequately accomplished.