Cholesterol and the media

The media is currently bombarding the internet with a recent study published in the New England Journal of Medicine regarding a class of cholesterol lowering drugs known as Ezetimibe (Vyotrin, Zetia) and that the public is being lied too. An example of this media outrage can be found here in the New York Times or pretty much any other of a host of news outlets.

This study investigated the impact of a class of drugs known as Ezetimibe in patients with familial hypercholesterolemia. These drugs were designed to be used in conjunction with statins as a way to lower Low Density Lipoprotien cholesterol (LDL-C). Opposed to statins which impede a key biochemical pathway in the liver (HMG-CO-A), these drugs inhibit the absorption of cholesterol by binding to Niemann–Pick C1-like 1 (NPC1L1) protein (Niemann-Pick disease is an autosomal recessive disease). The reason an individual takes cholesterol lowering drugs is to reduce plaques that occur in arteries, which is apparently not the case here. Anyone who has watched TV in the last 20 years has realized that we are bombarded with ambiguous prescription drug ads and an earlier article compared the prescription rate between the U.S. and Canada, where ads are strictly regulated. In this case there was a higher prescription rate in the US than in Canada as people were more likely to ask their doctor to prescribe it for them.

A significant problem I have with the media response to this study is that the population investigated had familial hypercholesterolemia, which is a rare genetic disorder and likely with heterozygotes as homzygotes with this disorder are immune to drug treatment (although this was never stated in the article). So making a comparison to the wider population is somewhat misguided as the majority of the population does not have this genetic disorder. This demonstrates a significant disconnect between what is presented by the scientist, how it is interpreted in the media, and it is presented to the public. While I believe statins are over-prescribed (like antibiotics) and we will end up facing consequences of a dire magnitude (similar to anti-biotic resistance) and an increase in cardiovascular diseases in the near future this particular case is far fetched. It would be better to look at a Ezetimbibe study of a general population but this won't be available until 2011.