Drug Surplus

I am perusing the notes for tomorrow's clinical biochemistry lecture. We are going to be discussing high cholesterol and how to properly assess risk for the condition. I love cholesterol.

Let me tell you why:

High cholesterol runs in my family, on my mother's side (German). My great-grandmother, who passed away recently at the age of 101, lived most of her life with a total cholesterol level greater than 200 mg/dL. The healthy average is around 160 mg/dL. Hypertension runs on my dad's side of the family (Nigerian). His blood pressure was 200/140mm Hg (normal 120/80), before he cut salt out of his diet and it fell back to normal. My generation, a chimeric mix of German and Nigerian traits, is now at a high risk of getting both conditions, which is a well studied recipe for early death.

But so far, at age twenty-two, I'm pretty healthy. My blood pressure has always been normal. I exercise a lot. I am slightly overweight, but that's just because BMI is useless for people afflicted with big bones. My diet is pretty healthy; I eat many more servings of fruits and vegetables than the average American my age. But I am at an "increased risk" for heart disease because I have diabetes mellitus. I still do not understand why I am at an increased risk if I am a type I diabetic. I don't think I've ever been told or have ever read that type I diabetes puts people at an increased risk for cardiovascular disease. So why do I have to worry about my cholesterol?

Well, first, my cholesterol actually was a little high. The first time I can recall being conscious about my cholesterol was when my lipid panel was reviewed by my adult endocrinologist. She immediately put me on Lipitor. At the time I thought whatever would make me healthier, I'd do. As a "lay person," I trusted my physician entirely. When I did my lipid panel screening again, about a half year later, my numbers were lower--they were better--and she kept me on Lipitor. I became suspicious. So I checked my numbers. The lab results always provide a normal range, so I reviewed it. Both times, my numbers were excellent. I mean, not excellent, but they were normal and I was healthy.

So why the Lipitor?

A risk assessment is used to judge whether or not a patient should consider changing their lifestyle (eating, exercising) habits or if they need to be more pro-active and be placed on a drug-enhancing regimen (Lipitor), Diabetes--but they never say which type--is considered a high risk factor. But that's the only risk factor I have. The risk assessment formula says that if I have 0-1 risk factors, my low density lipoprotein (LDL, the bad cholesterol) goal should be: <160 mg/dL. Guess what? It was! HIPPA be damned, I'll tell you what my LDL cholesterol was: 132 mg/dL. If it had been above 160 mg/dL, according to the assessment chart, a lifestyle change would have been recommended. Only at 190 would I need a more intensive pharmaceutical intervention. So why was I put on Lipitor?

Well, it helped. My total cholesterol was 190, my HDL was 43, and my Triglyceride was 77. A year later with Lipitor, my total cholesterol was 195, my triglyceride was 56, as was my HDL. And my LDL was a greatly reduced 128 (sarcasm).

But you know what made me even healthier according to the scale and charts and assessments? First, I gave up on Lipitor after my second lipid panel screening. Why? Because the pharmacy said I didn't have any more prescriptions and I didn't feel like calling my doctor to get me more. Second, I turned twenty-one. And around six months into being twenty-one, I realized that I loved red wine. I also started cooking more often and realized that olive oil is a good substitute for butter in almost everything. At age twenty-two I had another lipid panel screening. This time, my total cholesterol was 167, HDL 64, triglyceride 55, LDL 92.

Hmmm....

I know they're just numbers, but "statistically" I was much healthier.

What am I suggesting? That diabetics be given red wine earlier than age twenty-one? No. Never. Although...

In all seriousness, drugs are great. But they aren't a cure-all. Especially when it's something that can be heavily modulated by simple lifestyle choices. Look at America. There are serious health issues we need to address. But should we prescribe drugs after a problem arises? Or should we try to tell people what they can change in their kitchen and in their lives to make them healthier by their own volition? Drugs are great, and I don't want to argue against their over prescription in America, but when I'm placed on a drug to lower cholesterol, it would be great if I was told how this problem arose and what I can do, myself, to make it better.

Boiled down, what happened to me was simply a problem with patient empowerment. If you give your patients advice that is comprehensive but also understandable, their adherence should be higher, and as a result, they should be healthier. Doctors are important. We need more of them. But perhaps what's even more vital than quantity is quality, specifically as it deals to communication. A patient should know that sometimes, they are their own best medicine.