CHOLESTEROL QUESTIONS

Millions of Americans watch their cholesterol levels, confident that they measure the chance of heart troubles ahead. Thirty-six million are being advised to take pills called statins once a day, at around $3 apiece, to help reduce the level. That comes to more than $1,000 a year.

These figures will increase, because the National Heart Association and the federal government have just revised the treatment guidelines and are advising high-risk patients to keep their LDL or “bad cholesterol” levels below 70, down from the current target of 100. That means that another 7 million will be advised to take the pills.

Consumer groups promptly blasted the new guidelines, charging sinister influence by the major pharmaceutical companies that make Lipitor, Provachol and other statins, for a total worldwide take of $26 billion. All but one of the nine cholesterol experts who drafted the new guidelines got money from those same big drug firms, in pay for making speeches, consulting fees and research grants.

Merrill Goozner of the Center for Science in the Public Interest called it “outrageous that they didn’t provide disclosure of the conflicts of interest.” Heart association officials said they thought the disclosure matter had been handled sufficiently when the same experts told of their industry connections in the last guideline update three years ago.

Mr. Goozner said doctors and the public need to know that the people giving advice have their research funded by corporations that have a financial interest in the outcome of the research. He conceded, however, that “it doesn’t mean their research is wrong.”

It is not clear that it is right either. A group of doctors headed by Uffe Ravnskov, a Swedish specialist, has cast serious doubt on the findings. The group took issue with Scott Grundy, who heads the panel from the National Cholesterol Education Program and had written an editorial urging aggressive statin treatment for the elderly, arguing that statins reduce the risk of major coronary events by at least one-third. They objected that the five studies cited by Mr. Grundy skewed the results by including nonfatal heart ailments that may heal with little discomfort or residual damage.

Recalculating the data from the five studies, they compared the chances of survival with and without statin treatment and found only trivial differences. Two of the three trials that included only healthy people showed that their chance of survival was even better without treatment.

So, as you are buffeted by a new campaign to persuade you to worry about your cholesterol rate and start taking statins, check carefully with your doctor. And be sure he or she is not one of the MDs whom the statin drug firms hire as consultants and pay to speak at conventions.