PasseportSanté.net – How do you react to Dr.^r of Lorgeril?

D^r André Carpentier – Its position is simply impossible to defend scientifically. To claim that high cholesterol does not play a role in coronary artery disease is heresy!

Yes the D^r de Lorgeril had stopped saying that we need to advocate more for better nutrition and physical exercise in our health system, I would have fully agreed with him. I think we have focused a lot on pharmacological approaches and unfortunately neglected non-pharmacological approaches, to the detriment of public health. But that doesn’t mean the drugs don’t do an important job. Some nuances are called for.

PasseportSanté.net – So you have no doubt that high cholesterol is a major contributor to heart problems?

D^r André Carpentier – If there is one area of ​​medicine, and more particularly preventive medicine, where we know we have an interest in intervening, it is cholesterol, just like hypertension for that matter. We have at least twenty clinical studies of excellent quality to be able to affirm that the more we lower the cholesterol level, the more the risk of a first heart attack decreases. The risk of recurrent heart attack, stroke and death also decreases. And the cause and effect relationship is straightforward, because the magnitude of the benefit depends on the magnitude of the drop in cholesterol.

I think there is a consensus that lowering cholesterol has a big impact, except maybe for some people, like D^r de Lorgeril.

Where there is some doubt is whether cholesterol medications have other health benefits that are not caused by lowering cholesterol levels. Personally, I am not convinced of this.

PasseportSanté.net – Le D^r de Lorgeril warns of potentially serious side effects of statins. In your opinion, can these drugs be harmful to health?

D^r André Carpentier – Generally speaking, statins have few side effects. For the vast majority of people, they are well tolerated. Overall, about 5% of patients experience side effects from these drugs. Muscle pain tops the list. Obviously, you have to adapt the therapeutic approach according to the side effects: lower the dose, adjust another drug or simply stop it and try something else.

Having said that, yes, I have seen people very sick from these drugs. Statins can cause severe hepatitis and muscle destruction. But we’re talking about one case in tens of thousands of people, so it’s extremely rare. And no matter what kind of medication you take, the risk of hepatitis is always there, usually. When compared to the number of patients who benefit from it, this risk is, in my opinion, acceptable when the drug is prescribed properly.

Nowadays, we know who is at greater risk for these serious effects, and monitoring is more rigorous. In the case of muscle problems, there are warning symptoms that advise the patient and the clinician that it is best to stop the medication.

PasseportSanté.net – Are cholesterol medications being abused?

D^r André Carpentier – In a way, I can understand that some people are speaking out against this. There was indeed a current of thought, after the publication of studies around 2004, which pushed cardiologists to say “let’s give statins to everyone, at such dose, and that’s it”. I do not agree. Rather, I believe that it is important to individualize the treatment.

First, doctors must prescribe these drugs to people whose risk of cardiovascular problem is high enough for the cost / benefit ratio to be acceptable. Then they should check the effect of the treatment on the cholesterol level and readjust if necessary. About 20% of people who take these kinds of drugs respond less well. For example, some people may take cholesterol medications unnecessarily.

The reason many doctors advocate statins is that there is nothing more effective. A small dose of statins lowers cholesterol by 30%, on average, while taken together, people’s efforts to move more and eat better only lower it by about 15%, on average. And while some people respond very well to the diet, the majority of people don’t. Obviously, eating healthy is not useless, because it brings a lot of benefits. But for cholesterol, this is usually not enough. About strict vegetarianism, it’s different. The Ornish diet [a vegetarian diet that includes only 10% fat], for example, works very well for many people. But, not everyone is ready to make such drastic dietary changes.

One approach does not exclude the other. I am not an advocate for drugs, but the evidence is there. For the majority of people, drugs are helpful.

Interview by Marie-Michèle Mantha

February 25, 2008

1. Dr. Michel de Lorgeril. Tell your doctor the cholesterol is harmless and he will treat you without medication., Éditions Thierry Souccar, France, 2007, 414 pages.

In October 2007, on the occasion of the publication of his book, D^r de Lorgeril granted us an interview: Risk of heart attack: cholesterol is not the culprit.

2. The D^r André Carpentier works at the Center hospitalier universitaire de Sherbrooke (Quebec). His research focuses on diabetes and cardiovascular disease. Some of these focus on non-pharmacological interventions, such as diet and exercise. He also collaborates in international clinical trials on various pharmacological molecules, including cholesterol-lowering drugs. In 2006, he participated in the evaluation of national recommendations for the prevention and treatment of cardiovascular disease for the Canadian Cardiovascular Society.