LDL Measurements and Statin Use Poll

[Chuckanut]

True, but sometimes people also benefit from the profit motive of Big Pharma. If (theoretical example), my personal/family history suggested a 25% risk of heart attack (or worse) in next decade and a drug could reduce that risk to <5% (inc all drug side-effects) at a cost of $4/month I would consider that a bargain.

I agree. A 25% chance of a heat attack in the next 10 years would put one in a high risk group I would think. Mot of us are, I hope, comfortably under 10%.

 

[Chuckanut]

and, this is where the big increase in people recommended to take statins come from - all the people who due to age (anyone age 71 or older) or gender (white men who are 63 or older) have a greater than 7.5% risk even if all other risk factors calculated are optimal. Most of those people would be nowhere close to the old 20% level.

bingo!

 

[Animorph]

The big thing is that some people will have a risk of over 7.5% even with optimal risk factor levels. For example, DH is 66. A 66 year old white male with optimal risk factors has 9.6% 10 year ASCVD risk. So this would say that DH should be prescribed statins basically because he is 66 years old and a male (the risk for a 66 year old white female is 4.5% for 10 years).

And, this is where the big increase in people recommended to take statins come from - all the people who due to age (anyone age 71 or older) or gender (white men who are 63 or older) have a greater than 7.5% risk even if all other risk factors calculated are optimal. Most of those people would be nowhere close to the old 20% level.

Yeah, and that seems kind of weird. Theoretically, at age 70 you could have a total cholesterol of 130 and a BP of 110 and it would tell you use statins. What are the statins supposed to be doing for you at that point? Certainly not just lower you cholesterol, which would seem useless at that point.

 

[rbmrtn]

Since most statins are off patent now, sounds line they trying to make it up in volume.

 

[donheff]

Since most statins are off patent now, sounds line they trying to make it up in volume.

+1 fits the data.

 

[ERhoosier]

Since most statins are off patent now, sounds line they trying to make it up in volume.

One of the only 2 statins recommended for "high-intensity" therapy in latest ACC/AHA Guidelines, rosuvastatin (Crestor), is still under patent in US until 2016.
Crestor patent expiration date, patent status, and tentative generic approvals | IPR: rosuvastatin calcium

 

[Katsmeow]

Yeah, and that seems kind of weird. Theoretically, at age 70 you could have a total cholesterol of 130 and a BP of 110 and it would tell you use statins. What are the statins supposed to be doing for you at that point? Certainly not just lower you cholesterol, which would seem useless at that point.

Apparently from what I read one of the major effects of statins is to decrease inflammation. Increasingly, it is believed that inflammation has a lot to do with heart disease. So a lot of the benefits seen from statins (I know that there is controversy over the benefits of statins for people without heart disease) is in reducing inflammation. So the use of statins could lower risk in people who have normal cholesterol levels. The idea is that statins should be seen as medications to lower heart disease risk rather than as aiming to lower cholesterol. Lowering cholesterol is not necessarily the same as lowering heart disease risk.

I think a lot of the controversy is over what level of heart disease risk should trigger taking statins.

For example this article

http://well.blogs.nytimes.com/2013/11/12/3-things-to-know-about-the-new-cholesterol-guidelines/

says:

In fact, statins seem to lower risk regardless of your cholesterol levels. This fact has led many of us to think about statins as risk-reduction medications rather than just medications that modify cholesterol levels. Regardless, the evidence that statins lower risk is very clear.

Also this article:

Statins And Cholesterol Level Recommendations - Business Insider

Statins like Lipitor work by controlling the proteins in our liver that naturally produce cholesterol, a process that is regulated by the amount of cholesterol already in your blood.


Studies have shown the drugs to reduce a patient's risk of heart attack and stroke, outside of their ability to lower cholesterol levels. This is likely because of their anti-inflammatory and plaque-stabilizing properties, according to the guidelines.


The problem with statins is that they don't impact cholesterol from eating animal products. So, unless you switch up your diet, they are probably not all that effective at lowering your cholesterol levels, unless you have defective cholesterol-making proteins.

Read more: Statins And Cholesterol Level Recommendations - Business Insider
​

I found that interesting. FWIW, I was apparently one of those few people who had a dramatic non-diet related decrease in cholesterol levels and LDL level solely from taking a statin (but, ironically, under the new guidelines I don't seem to meet the critera to take statins).

 

[mountaintosea]

My experience is Kaiser automatically puts it's patients on statins when certain numbers are hit. I refused. Triglycerides are low, HDL is high, but they didn't like LDL. So I was harassed with phone calls telling me to pick up my drug at the pharmacy. My Mom's advice at age 88, don't take them! She took them for awhile and went off and feels better.

 

[imoldernu]

New information
NYT article that changes the position of the AHA on the recent changes in guidlines for stain use
http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?partner=MYWAY&ei=5065&_r=0&pagewanted=all.

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

 

[rbmrtn]

Something didn't look right, in playing with the calculator if I change TC from 179 to 180 the lifetime risk jumps from 5% to 35%. I would think a change of 1 in TC is outside of the ability to accurately measure it.

 

[ERhoosier]

Something didn't look right, in playing with the calculator if I change TC from 179 to 180 the lifetime risk jumps from 5% to 35%. I would think a change of 1 in TC is outside of the ability to accurately measure it.

Indeed. IN US, the measurement standard appears to allow for 3% bias, or a TOTAL error of up to 8.9%.

http://www.cdc.gov/labstandards/pdf/crmln/RevisedTCprotocolOct04.pdf

 

[Chuckanut]

The idea is that statins should be seen as medications to lower heart disease risk rather than as aiming to lower cholesterol.

I would go further than that and say the ideal for any drug should be - Does it significantly increase one's life-span and/or overall quality of life?

 

[Lsbcal]

Something didn't look right, in playing with the calculator if I change TC from 179 to 180 the lifetime risk jumps from 5% to 35%. I would think a change of 1 in TC is outside of the ability to accurately measure it.

The latest news is that the calculator has problems: http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?hp&_r=0

My numbers looked way higher then I would have thought from the Excel calculator I downloaded. So I'm not surprised. They should have asked me.

 

[HFWR]

I would go further than that and say the ideal for any drug should be - Does it significantly increase one's life-span and/or overall quality of life?

And, IMHO, the answer for statins is mostly NO...

 

[Animorph]

The wonders of spreadsheets!

If you have the spreadsheet you can right click the "Omnibus" tab and select "Unhide...". Select "10-Year ASCVD" and click OK. And then one more time to unhide the "Lifetime Risk Data" tab. That's as far as I got before lunch, but we should be able to find the formulas that are giving step changes in risk for small changes in inputs.

 

[Katsmeow]

The latest news is that the calculator has problems: http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?hp&_r=0

I see 2 issues with the calculator. One of them is addressed by the above article. Apparently they applied the calculator to people in other studies that had been followed for over 10 years. They went back and figured out what risk the calculator said they would have had and then looked to see how many had a heart attack or stroke within 10 years. It was a much lower number than predicted.

The other issue is the one that I and rbmrtn saw. In some instances you can change a number by 1 or 2 and there is suddenly a huge increase in risk. That seems questionable as well.

 

[Chuckanut]

Well, before you decide you need a drug make sure the heart calculator is working properly: http://www.nytimes.com/2013/11/18/h...lesterol-appears-flawed.html?hpw&rref=us&_r=0

 

[harley]

I would go further than that and say the ideal for any drug should be - Does it significantly increase one's life-span and/or overall quality of life?

And, IMHO, the answer for statins is mostly NO...

And most of the ones that do increase the quality of life are illegal.

 

[HFWR]

And most of the ones that do increase the quality of life are illegal.

We're working on that...

 

[eytonxav]

We're working on that...

Don't hold your breath waiting for that in TX. Me thinks you'll need to move to California or Colorado.

 

[HFWR]

Don't hold your breath waiting for that in TX. Me thinks you'll need to move to California or Colorado.

Or at least vacation there a lot...

 

[ERhoosier]

And, IMHO, the answer for statins is mostly NO...

Let's not throw out the baby with the bathwater. There are large groups of folks for whom there is overwhelming agreement that statins reduce future risk of serious cardiovascular events/death . No problem with that, but I do have an issue with some who seem to think we may need to put statins in the public water supply

 

[Chuckanut]

Here is one doctor's review of when most men and women will end up taking meds based upon the new current calculator. He found 63 the age where regardless of how healthy a man is, the calculator indicated a high enough risk to require meds. For women it was 70.

You need a statin

The calculator is now suspected of being flawed.

 

[bjorn2bwild]

And most of the ones that do increase the quality of life are illegal.

Don't hold your breath waiting for that in TX. Me thinks you'll need to move to California or Colorado.

Manufacture of cannabinoids for perssonal use is 50 states legal.
Forever to be known as the endorphin high, I am pretty sure that frequent indulgence will prove to be healthier than lifetime commitment to a pharmaceutical product.

 

[sengsational]

Manufacture of cannabinoids for perssonal use is 50 states legal.
Forever to be known as the endorphin high, I am pretty sure that frequent indulgence will prove to be healthier than lifetime commitment to a pharmaceutical product.

You can legally brew your own beer in all 50 states, but I kinda would be surprised if the other manufacturing process wouldn't land you in jail or the pen in most states.

But to comment on the recent guidelines, they seem to be saying these drugs now simply have the side effect of lowering LDL, and the health benifit is from reducing inflamation. So it would seem that they need to put their fancy expensive (or formerly fancy expensive) drugs up against a baby aspirin and see which one wins!