Cholesterol Guidelines A Gift For Merck, Pfizer

[Guest guest]

Yes, a gift for Big Pharma from the politicians and

government, but at a terrible price to pay for all the

resultant illness that will happen in public health.

F.

 

 

http://www.forbes.com/2004/07/12/cx_mh_0712mrk.html

 

Pharmaceuticals

Cholesterol Guidelines A Gift For Merck, Pfizer

Matthew Herper, 07.12.04, 4:30 PM ET

 

NEW YORK - New guidelines issued by the United States

government could increase the number of people who

take cholesterol-lowering medicines; already the

top-selling medication in the world with $26 billion

in annual sales.

 

The new guidelines were predicted here months ago.

(See: " Is Lipitor The New Aspirin? " )

 

Under previously existing guidelines, 36 million

people should be taking cholesterol-lowering pills

such as Lipitor, Zocor, or Pravachol to prevent heart

attacks. In reality, only about 11 million do. Changes

issued today by the National Cholesterol Education

Program (NCEP), to be published in tomorrow's issue of

the journal Circulation, advocate lowering cholesterol

in even more patients. Moreover, patients at the

highest risk should receive even more aggressive

treatment--meaning higher, more expensive doses of

these drugs. Now, that figure will increase by

millions of people, as the new guidelines suggest

treating diabetics and people who at one time would

have been considered healthy. Those at high risk, or

who have had recent heart attacks, should be treated

even more aggressively.

 

 

The NCEP did not release an estimate of how many

patients should now take cholesterol-lowering drugs,

called statins. Christopher P. Cannon, a cardiologist

at Brigham & Woman's hospital, says 50 million people

should take the drugs. Another cardiologist, Steven E.

Nissen of the Cleveland Clinic, said that number

looked reasonable, although James I. Cleeman, a

researcher at the National Heart Blood and Lung

Institute and a co-author of the report said it was " a

little high. " The cost of treating that many people

with even the lowest dose of Pfizer's (nyse: PFE -

news - people ) Lipitor could approach $40 billion.

 

But an even more important facet of the guidelines is

that many people would not be on low doses of these

drugs. For patients at the highest risk of heart

attack, the new guidelines suggest that " bad

cholesterol, " or low-density lipoprotein (LDL), be

reduced to 70 mg per deciliter--although the new

guideline is optional. Previous guidelines suggest

that LDL of 100 mg was good enough. Many patients will

not be able to get to those levels at starting doses

of most current drugs. " It may be that reducing

cholesterol to levels that are consistent with what

used to be found in rural china is where we need to

head, " says Sydney Smith, a cardiologist at the

University of North Carolina, Chapel Hill, and a

co-author of the new guidelines.

 

Even for patients at modest risk of heart

attacks--meaning that they have heart disease,

diabetes, or a combination of some risk factors--the

new guidelines suggest lowering cholesterol at least

30-40%. With weaker statins, such as Pravachol from

Bristol-Myers Squibb (nyse: BMY - news - people ) or

lovastatin, available as a cheap generic, that

requires the second-highest dose. That could encourage

doctors to use stronger drugs--a big boost for

Lipitor. Crestor, an even more powerful statin from

AstraZeneca (nyse: AZN - news - people ) could also

benefit, but may be held back because it does not have

the same track record of safety as Lipitor.

 

Another big winner could be Vytorin, a new cholesterol

pill from Merck (nyse: MRK - news - people ) and

Schering-Plough (nyse: SGP - news - people ) that is

expected to hit the market soon. It combines Merck's

Zocor with another drug, Zetia, to lower cholesterol

even more at lower doses.

 

Some say the new guidelines do not go far enough.

" It's very disappointing to me that NCEP couldn't get

it right given the data, " says Eric Topol, a

cardiologist at the Cleveland Clinic. He points out

that two clinical trials have shown that many patients

would benefit from more cholesterol lowering. Says

Topol: " To make an LDL of 70 an optional strategy is

ignoring the trials. "