British, American doctors disagree on cholesterol


August 03, 1993|By Joe Graedon and Dr. Teresa Graedon | Joe Graedon and Dr. Teresa Graedon,King Features Syndicate

Margaret leads a double life. For six months of the year she lives in London teaching design. The other half of the time she works in the United States at a studio in Atlanta.

Her American doctor is alarmed about Margaret's cholesterol level of 234. That's way too high, he says, well over the target range of 200, and he wants her to take Pravachol to get it under control.

Margaret's British doctor is not alarmed about her cholesterol level. He doesn't want to prescribe a drug.

She has never smoked, is in good shape and eats sensibly. Her parents are in their 80s and have never had heart problems. Margaret's blood pressure is normal and her HDL (good cholesterol) level is high, making her lipid profile excellent.

Margaret doesn't know which doctor to believe.

Recent articles in the British Medical Journal point out that most research on cholesterol reduction has been carried out on high-risk middle-age men, and the results may not apply to women. A review of many studies found no significant link between cholesterol level and death from heart attack in women, unless they were at very high risk.

American cardiologists point out that heart disease is the principal cause of death in older women. Just because the studies have, by and large, not included enough women to show a benefit doesn't mean they should be neglected. Margaret's doctor is trying to prevent problems before they get started. Since side effects from drugs like Pravachol are uncommon, he believes this is a prudent approach.

British heart specialists point out that cholesterol-lowering medications haven't been shown to improve longevity. They warn that very low cholesterol is linked to an increase in deaths from other causes, such as digestive disease, accidents, lung disease or cancer.

Margaret plans to try Pravachol (pravastatin) to see if it works. Like its chemical cousins, Mevacor (lovastatin) and Zocor (simvastatin), this drug is more effective when taken at night rather than in the morning. Margaret will also need periodic blood tests for liver function. She'll keep exercising but will be alert for muscle pain or weakness. If these signs of serious trouble surface, she'll contact her physician.

The cholesterol controversy won't disappear any time soon. Since doctors don't always agree, patients will have to use their common sense.

Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert. Their newest book is "The Aspirin Handbook" (Bantam Books).

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