Other cholesterol-lowering drugs

Other organisations tested other drugs. The World Health Organisation sponsored its own trial with Clofibrate (Atromid). This too was targeted against cholesterol and was confidently expected to lower blood cholesterol levels by 30%.

As with cholestyramine, the levels were lowered by much less than the expected amount and at the end of the trial it became clear that there had been many more deaths in the group taking clofibrate than in the control group — notably from gallstones, and cancer of the liver and digestive system.

In the WHO clofibrate trial, as the Table demonstrates, Clofibrate killed more than it saved.

Among other drugs to be tested were:

• The female hormone Oestrogen on the theory that if premenopausal women did not get heart disease, perhaps oestrogen would protect men. But the hormone caused heart attacks rather than preventing them.
• The hormone Dextrothyroxine, which lowers cholesterol levels, abandoned quickly when an increase in mortality was noticed in the treatment group.
• The vitamin Niacin, which looked promising, but although there appeared to be a reduction in non-fatal heart attacks, there were marked side effects: skin disorders such as darkening, itches and rashes, as well as digestive problems and gout.
• Gemfibrozil (Lopid) was tested and again an increase in deaths was noticed in the treatment group although this time the numbers did not reach statistical significance.
• Compactin which worked in a similar way to triparanol was withdrawn hurriedly and in some secrecy. The reason this time appears to be connected with cancer in dogs.
• Lastly, despite the previous experiences with triparanol and compactin, yet another inhibitor, Lovastatin, was approved for lifetime use on the general public after tests of very short duration only. Lovastatin was the first of the statins

A study of all trials into cholesterol lowering by drugs up to 1987 showed an increase in mortality in those treated with drugs of 13.6%.

In 1993 a meta-analysis of all randomised controlled trials of cholesterol-lowering treatments showed that only those with very high risk showed any evidence of benefit. In all others mortality was increased. Its authors conclude that:

"Currently evaluated cholesterol-lowering drugs seem to produce mortality benefits in only a small proportion of patients at very high risk of death from coronary heart disease . . . a cautious approach to the use of cholesterol lowering drugs should be advocated".