Cholesterol-lowering therapy sure has been taking a beating lately. For many years, it was accepted that cholesterol medications are good because they reduce “bad” LDL cholesterol. Over time, lowering LDL would lead to fewer heart attacks and strokes, which is a good thing.
However, recently some have been preaching against this gospel. The premise of a widely-cited BusinessWeek article was that statins do little for people without pre-existing heart disease.
In addition, we have the furor over the ENHANCE trial. Overall, the study failed to show that the combination drug Vytorin had any influence on the build up of fatty plaques in the arteries. Arterial plaque is a major (and physical) indication that a person is at risk for a heart attack or stroke.
While these studies have generated a lot of attention, what’s more interesting is what they tell us about the ability of surrogate markers to predict death and disease. Surrogate markers like high cholesterol and hypertension are commonly used to indicate whether a person has a higher risk of dying from heart disease. However, it is important to note that the relationship between a surrogate marker and the ultimate endpoint of death is often not linear.