Cholesterol-Cutters Clog Market Drugs Among Fastest-Growing Segment Of Health Industry

High cholesterol can kill you slowly and quietly, but the companies that make prescription drugs to lower it are being anything but quiet as they try to convince Americans these medicines can save their lives.

Newspapers, magazines and television are peppered with advertisements with feel-good images of “Happy Birthday Dad” cards and smiling gray-haired men chasing their grandsons on the beach.

“It’s your future. Be there,” says one.

In 1996, cholesterol-cutters like Zocor, Mevacor and Pravachol were among the fastest growing in the industry, with sales rising 30 percent to about $3 billion, according to Source Informatics, a Phoenix-based researcher.

In February, a new more-potent competitor called Lipitor blasted onto the scene following months of subtle promotion to doctors. By early this week, it had already grabbed a stunning 5 percent market share, among the five drugs in its class, said Source Informatics.

“They’ve had everybody salivating for it,” said Dr. Richard Pasternak, director of preventive cardiology at Massachusetts General Hospital in Boston.

Doctors have believed for decades that high cholesterol contributes to heart disease by causing a buildup of fatty plaque in coronary arteries that rob the heart of oxygen. So why the clamor to treat it now?

Well, for the first time, there’s scientific proof that cutting cholesterol does save lives.

Since 1994, three major studies in Scandinavia, Scotland and the United States showed that the family of cholesterol-lowering drugs called “statins” can reduce deaths from heart attacks by 24 percent to 42 percent, even in people with no symptoms of heart disease.

Yet, high cholesterol remains a grossly undertreated condition. Merck & Co., maker of Zocor and Mevacor, estimates that only 30 percent of the 13 million Americans with symptoms of heart disease are reducing their cholesterol. An additional 16 million with high cholesterol, but no symptoms of heart disease, are untreated.

By advertising their drugs directly to consumers, companies like Merck and Bristol-Myers Squibb Co., maker of Pravachol, are motivating patients to get treatment, said Hemant Shah, an industry analyst in Warren, N.J. “Cholesterol is silent. Most people don’t think about cholesterol because it doesn’t hurt them; there’s no pain involved,” Shah said.

Doctors didn’t always agree that using drugs to lower cholesterol is a good idea. One study - later discredited - even spurred fears that the drugs could increase gastro-intestinal cancers.

“Then there was this bizarre hard-to-explain phenomenon of accidents and violent deaths, people running their cars through railings, homicides, suicides,” said Massachusetts General’s Pasternak of incidents involving users of cholesterol-cutting drugs.

These concerns were already eroding at the time of the latest three studies - which involved more than 15,000 people and found no evidence that the statins caused gastrointestinal cancer or strange behavior.

“These are very safe drugs,” said Dr. Richard Steingart, chief cardiologist at Winthrop-University Hospital in Mineola, N.Y. The only significant side effects are liver and muscle damage, but these were seen in less than 1 percent of patients, he said.

While ad campaigns pluck out statistics to claim the superiority of each drug, cardiologists say all five statin drugs work the same way. They inhibit an enzyme in the liver that the body uses to produce cholesterol.

All must be taken in conjunction with lifestyle changes: Smokers should quit, and couch potatoes should lose weight and exercise.

The drugs do differ somewhat in potency and price.

Typical dosages of Zocor can cut cholesterol by about 35 percent to 40 percent, while Pravachol and Mevacor come in at about 30 percent. Zocor and Pravachol have a wholesale list price of about $1.89 per day while Mevacor averages $2.08.

Lescol, by Novartis AG of Switzerland, cut cholesterol by just 25 percent to 30 percent, but its average cost is just $1.15 per day.

Lipitor cuts it by 40 percent to 60 percent and - unlike the others - also cuts triglycerides, another blood fat. It lists for about $1.82 a day.

While the early figures show Lipitor eroding sales of the other statins, financial analysts predict that, in the long run, sales of all will grow, making a big contribution to the drug industry’s profits, already growing at an average of nearly 20 percent a year.

“Even if you’re losing market share, if your growth is accelerating, that’s obviously good,” said Jack Lamberton, analyst with NatWest Securities in New York.