Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Old 08-11-2016, 12:54 PM   #21
Thinks s/he gets paid by the post
 
Join Date: Feb 2013
Location: Toronto
Posts: 1,204
Quote:
Originally Posted by harley View Post
The problem with the calculator (as with all calculators) is the assumptions it makes. It assumes high cholesterol increases the risk of heart disease, although there is a lot of evidence it doesn't. It doesn't ask many meaningful questions at all. So I certainly wouldn't base a medication regime off of it.
Interestingly, the truth in medicine might lie in the opposite direction. The advantage of a calculator is that it sticks with the KISS principle and doesn't get bogged down and distracted by alot of questions that don't actually have predictive value. Granted that everyone is an individual and allowances may be made, a calculator like this can be very good a boring down to the bottom line number of risk. Bearing in mind that a 23% risk of having something happen still means that there is a 77% chance that it won't. (I would think for a 71 year old male that is a pretty good number - you are past the average life expectancy for your birth cohort). If I had an MD that was unaware of a calculator like this, I would be concerned. All good MDs are doing calculations like the ones this calculator is doing every time they ask a question, do a physical exam maneuver or see a test result. Calculators just make it more formal and standard and bring focus to factors that have been shown to be the most predictive.
__________________

__________________
6miths is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 08-11-2016, 12:55 PM   #22
Thinks s/he gets paid by the post
 
Join Date: Apr 2005
Location: Midwest
Posts: 1,383
Quote:
It assumes high cholesterol increases the risk of heart disease, although there is a lot of evidence it doesn't.
Another problem with cholesterol is, even IF it is any kind of risk factor, it also is a function of time. ei Cholesterol must be elevated for 20 years for an assumed rate of occlusion to occur etc etc. Doctors and diet nazis treat it as if it were your temperature. It's high **today**! Oh my god we need to lower it. So you skip breakfast and tomorrow it's 5 points lower and they reassess your risk as NOW being lower.
__________________

__________________
razztazz is online now   Reply With Quote
Old 08-11-2016, 12:58 PM   #23
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Chuckanut's Avatar
 
Join Date: Aug 2011
Location: West of the Mississippi
Posts: 5,763
Or this:

Cardiovascular Risk Factors and Age: Is it all about the cholesterol?

It's not as clear cut as we are lead to believe.


Quote:
The risk of CVD increases with age. However, most intervention trials testing the efficacy of preventive measures have focused on middle-aged individuals. This may be misleading because risk factors may vary with age. Hence, a particular risk factor may have more impact on a young individual than an older person. In theory, this might, for example, mean that high cholesterol matters more when we’re young than when we’re older
.
__________________
The worst decisions are usually made in times of anger and impatience.
Chuckanut is online now   Reply With Quote
Old 08-11-2016, 01:03 PM   #24
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Chuckanut's Avatar
 
Join Date: Aug 2011
Location: West of the Mississippi
Posts: 5,763
I used the new risk calculator. I was, of course, a person who needed statins according to the calculator.

So, I started playing with the calculator. Instead of my borderline numbers I put in very healthy numbers - low LDL, Low total cholesterol, non smoker, normal BP, etc. No matter how good my answers got, once I hit the age of 63, I should take a statin according to the calculator.

Obviously, there is more money to be made treating healthy people with a preventive drug, than treating diagnosed sick people with the same drug. So....... draw your own conclusions.
__________________
The worst decisions are usually made in times of anger and impatience.
Chuckanut is online now   Reply With Quote
Old 08-11-2016, 01:05 PM   #25
Administrator
W2R's Avatar
 
Join Date: Jan 2007
Location: New Orleans
Posts: 37,117
Quote:
Originally Posted by friar1610 View Post
I have slightly elevated cholesterol but my docs have never suggested statins. I'm curious if any older guys with "normal" cholesterol have been prescribed statins.
Not me; my cholesterol is high without my medication (normal now, due to the medication).

I am not a guy. However, if I was a guy with "normal" cholesterol and my doctor wanted me to take statins, I'd be looking for another doctor.
__________________
Fairy tales are more than true: not because they tell us that dragons exist, but because they tell us that dragons can be beaten.

― N. Gaiman (2002)








W2R is online now   Reply With Quote
Old 08-11-2016, 01:12 PM   #26
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Amethyst's Avatar
 
Join Date: Dec 2008
Posts: 5,124
I'm shocked that it ignores family cardiac and diabetes history.


Quote:
Originally Posted by friar1610 View Post
OP here. Some excellent responses and web sites to check out. A couple of people asked about a real risk assessment for cardiac problems. This web site was referenced in the doc's talk:

ACC/AHA ASCVD Risk Calculator

It's supposed to assess cardiovascular risk based on American Heart Association/American College of Cardiology guidelines. I did the assessment using my actual data and it said I had a 10 year 23% risk for heart disease or stroke. (I am 71 now.) It also said there was insufficient evidence that starting a low-dose aspirin would help but recommended a moderate to high intensity statin.

I was a little bothered by the high percentage since I consider myself to be in pretty good shape for an old guy. I then played around with the variables that I can presumably control (like cholesterol) and found very small decreases (like from 23% to 21%) in my risk if I get my cholesterol down to ideal levels. So I concluded that at my age the benefit would be modest indeed if I were to start a statin AND if it were to have the desired effect. My biggest risk factors are apparently my sex and age which I can't do much about.

I also noted that the calculator didn't ask anything about physical/aerobic exercise (which I do a lot of) although I suppose that could indirectly be factored into the blood pressure number. Nor did it ask about weight/BMI.

I've had several primary care docs over the past 25 years and have always had cholesterol on the high side. Since none of them have recommended a statin I guess I should trust their collective judgment more than an on-line calculator or a speaker's breakfast talk.
__________________
If you understood everything I say, you'd be me ~ Miles Davis
'There is only one success to be able to spend your life in your own way. Christopher Morley.
Amethyst is offline   Reply With Quote
Old 08-11-2016, 01:50 PM   #27
Thinks s/he gets paid by the post
 
Join Date: Feb 2013
Location: Toronto
Posts: 1,204
Quote:
Originally Posted by Amethyst View Post
I'm shocked that it ignores family cardiac and diabetes history.
Yes, this can be one of the strengths of these calculators. It can get right at what the risk factors have been shown to be. It asks if you have diabetes which on a 10 year time horizon is likely the important question. It also turns out that smoking, risky lipid profiles, high blood pressure and race run in families and these are the independent risk factors that have been identified so far as having the greatest contribution to the overall risk. The good news is that you can alter some of these things, most powerfully with non-pharmacological measures.

Friar1610 was surprised that weight/BMI wasn't included but again the high BP, diabetes and risky lipid profiles that frequently go along obesity are the more predictive factors. (And BMI is not individually an always reliable indicator of obesity.)
__________________
6miths is offline   Reply With Quote
Old 08-11-2016, 02:00 PM   #28
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
braumeister's Avatar
 
Join Date: Feb 2010
Posts: 7,349
A significant point that has been posted here several times is that of those admitted to a hospital with a heart attack, half have high (above the "desired" level) cholesterol and half do not. A fairly large percentage have levels well below the standard "normal" level.

To me, that says your cholesterol levels are not really important in assessing your cardiac risk.
__________________
braumeister is offline   Reply With Quote
Old 08-11-2016, 06:13 PM   #29
Recycles dryer sheets
 
Join Date: Jan 2016
Posts: 133
I am convinced most doctors do not do any risk analysis at all. For most things, it is all dictated by "standard of care". If you have x, then they do y. If they don't, the insurance company and AMA will come down on them. If they don't write you an RX for statin under certain circumstances, they are dinged on their review.
__________________
CountryGal is offline   Reply With Quote
Old 08-11-2016, 08:43 PM   #30
Thinks s/he gets paid by the post
Rustic23's Avatar
 
Join Date: Dec 2005
Location: Lake Livingston, Tx
Posts: 3,503
https://www.amazon.com/New-Low-Carb-...rb+the+new+way

This book is a "Diet Book", well really more medical than diet. Dr. Thompson is a "Preventive Cardiologist" (relative to my DW). This is one of the few diet books worth reading.

If you want to know about cholesterol and how it effects the heart. Read this book. He is also a big believer in statins. Exercise (walking), daily statin, cut down potatoes, rice, bread and sugared drinks. I don't think he addresses aspirin.

I'm sure he would prefer you buy the book, but if you look at the Amazon preview you can read a good part of the book.
__________________
If it is after 5:00 when I post I reserve the right to disavow anything I posted.
Rustic23 is offline   Reply With Quote
Old 09-13-2016, 10:20 AM   #31
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
harley's Avatar
 
Join Date: May 2008
Location: Following the nice weather
Posts: 6,204
According to this article Drafter of U.S. Dietary Goals Was Bribed by Big Sugar to Demonize Fat - Hit & Run : Reason.com, newly released historical documents show the Sugar Research Foundation paid scientists to blame fat and cholesterol, not sugar, for coronary heart disease. I'm not trying to make any particular political point here, but it really does show that gov't and even medical recommendations for diet just can't be trusted. There's too much influence by interested parties to know if we're getting the whole story on any topic. I have my ideas about diet, but they're only for me. Everyone else needs to make up their own minds. It's just a shame so much policy like school lunches and all is influenced by faux science. My DGD isn't allowed to bring a cookie or a candy in her school lunch, but she can bring a blueberry muffin. And schools are supposed to teach logic and critical thinking!
__________________
"Good judgment comes from experience. Experience comes from bad judgement." - Will Rogers
DW and I - FIREd at 50 (7/06), living off assets
harley is offline   Reply With Quote
Old 09-13-2016, 10:40 AM   #32
Thinks s/he gets paid by the post
 
Join Date: Jun 2014
Posts: 1,030
Bottom line is that high cholesterol does not cause hart attacks or stroke, etc but it sure is a good con for the drug companies who are making a fortune from it. I am a believer in drugs when needed such as I take HBP meds because they are proven to be a life saver.
__________________
Teacher Terry is offline   Reply With Quote
Old 09-13-2016, 11:55 AM   #33
Thinks s/he gets paid by the post
Sunset's Avatar
 
Join Date: Jul 2014
Location: Chicago
Posts: 3,606
Quote:
Originally Posted by Teacher Terry View Post
Bottom line is that high cholesterol does not cause hart attacks or stroke, etc but it sure is a good con for the drug companies who are making a fortune from it. I am a believer in drugs when needed such as I take HBP meds because they are proven to be a life saver.
+1
Always amusing to read the very tiny print flashed on the tv ads for cholesterol drugs, because if you read the fine print, you wouldn't buy the drug.
__________________
Sunset is offline   Reply With Quote
Old 09-13-2016, 12:28 PM   #34
Recycles dryer sheets
 
Join Date: Aug 2014
Location: Phoenix
Posts: 381
Quote:
Originally Posted by Teacher Terry View Post
Bottom line is that high cholesterol does not cause hart attacks or stroke, etc but it sure is a good con for the drug companies who are making a fortune from it. I am a believer in drugs when needed such as I take HBP meds because they are proven to be a life saver.
The drug companies can't be making much off my generic atorvastatin: under my barebones Medicare Part D drug plan, I pay nothing for a three month mail order supply. (I just turned 65.)

I've been on atorvatatin for a couple of years now after my cholesterol was averaging between 210 and 220 even with regular daily exercise. My doctor suggested I try it however, at the lowest 10 mg dose, I experienced a noticeable increase in the level of my normal aches and pains even though my cholesterol dropped dramatically. We decided to stop the statin and the aches and pains returned to normal. Months later I tried a half a tablet a day and didn't notice an increase in the aches and pains but the effect on my cholesterol was still significant bringing it down to 151. I also take a baby aspirin each day. Heart disease runs in my family - my father died at 65 from his second heart attack and my mother had one in her eighties but survived. My brother just had a heart valve repaired. I've had no problem with bleeding taking the aspirin.

There's another wrinkle in the use of aspirin: its potential to reduce the incidence of certain cancers including esophageal, colon, rectal and prostate. See https://www.mdanderson.org/publicati...revention.html for a discussion. I'm on a three year colonoscopy regime because I typically have multiple polyps to be removed. I also have Barrett's esophagus that increases my risk for esophageal cancer. I've known people who have died from both cancers and they are horrible ways to go. So I'll continue to take my chances with a daily aspirin as I think the benefits outweigh the risks.
__________________
Ian S is offline   Reply With Quote
Old 09-13-2016, 03:13 PM   #35
Thinks s/he gets paid by the post
Helen's Avatar
 
Join Date: Oct 2004
Location: Portland
Posts: 1,321
Quote:
Originally Posted by CountryGal View Post
After over 30 years of high Cholesterol (no statins), I was surprisingly able to drop it 70 points with a clean mostly plant based diet. I don't believe I have a statin deficiency and when they did further testing (at my insistence) my LDLs were actually the large kind (good) and not the small dense kind that cause issues.
I switched from a pescatarian diet to a mostly whole food, plant based diet and within six weeks my LDL had dropped by 22%!

I used to be a heavy smoker and at one point my total cholesterol was 312. When I was talking to my neurosurgeon about the results of my angiogram (for a brain aneurysm), he said my arteries looked better than 95% of his patients. Meanwhile, my primary care doctor kept trying to get me to take statins.

Unless I have a heart attack or develop heart disease I am not going on statins (and I don't think I would tolerate them according to my 23andme results.)
__________________
Helen is offline   Reply With Quote
Old 09-13-2016, 03:41 PM   #36
Thinks s/he gets paid by the post
Dash man's Avatar
 
Join Date: Mar 2013
Location: Limerick
Posts: 1,386
Well, I was recently put in 40mg of the Lipitor generic and have no additional aches or pains. My LDL cholesterol dropped to 38. I also dropped all processed foods, all wheat products and most sugar from my diet. I did cheat a little on vacation. I don't have any symptoms but have been diagnosed with Coronary Artery Disease and Carotid Artery Disease from a Coronary Calcium Score, a nuclear stress test and a carotid ultra sound.


Enjoying life!
__________________
Dash man is offline   Reply With Quote
Old 09-13-2016, 04:24 PM   #37
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
harley's Avatar
 
Join Date: May 2008
Location: Following the nice weather
Posts: 6,204
Quote:
Originally Posted by Ian S View Post
The drug companies can't be making much off my generic atorvastatin: under my barebones Medicare Part D drug plan, I pay nothing for a three month mail order supply. (I just turned 65.)
This is a common logic fallacy. Just because you aren't paying anything to the drug company doesn't mean they aren't collecting. The gov't or your pharmacy plan is paying, possibly through the nose. Probably not for generic atorvastatin, but you don't really know because the cost is hidden from you.

Go order it from a pharmacy without using any insurance and see how incredibly cheap it is(n't).
__________________
"Good judgment comes from experience. Experience comes from bad judgement." - Will Rogers
DW and I - FIREd at 50 (7/06), living off assets
harley is offline   Reply With Quote
Old 09-13-2016, 06:43 PM   #38
Thinks s/he gets paid by the post
 
Join Date: Mar 2010
Location: Kerrville,Tx
Posts: 2,304
Quote:
Originally Posted by harley View Post
This is a common logic fallacy. Just because you aren't paying anything to the drug company doesn't mean they aren't collecting. The gov't or your pharmacy plan is paying, possibly through the nose. Probably not for generic atorvastatin, but you don't really know because the cost is hidden from you.

Go order it from a pharmacy without using any insurance and see how incredibly cheap it is(n't).
If you check the $10 lists at Walmart or go to Costco and they provide prices for name brands and generic alternatives and the like you can see which drugs are inexpensive. Avorstatin comes in at $20 full price for 30 tablets for example at Costco. The Lipitor equivalent comes in at $350 a month.

Of course there is another good reason for prefering generics over branded meds, Consider all the adds about drug problems, if a drug is going to present problems it is likley to do to so before becoming generic as the population taking the drug expands from the drug trials to full use and more folks are exposed to drug side effects.
__________________
meierlde is online now   Reply With Quote
Old 09-13-2016, 08:09 PM   #39
Recycles dryer sheets
 
Join Date: Aug 2014
Location: Phoenix
Posts: 381
Quote:
Originally Posted by harley View Post
This is a common logic fallacy. Just because you aren't paying anything to the drug company doesn't mean they aren't collecting. The gov't or your pharmacy plan is paying, possibly through the nose. Probably not for generic atorvastatin, but you don't really know because the cost is hidden from you.

Go order it from a pharmacy without using any insurance and see how incredibly cheap it is(n't).
It's still cheap: about $10 for a month's supply through a bricks and mortar pharmacy. I also am on another drug: pantoprazole for my GERD. Lo and behold, a three month's supply via mail order is also free to me with my Part D drug plan. The drug plan that costs me less than $19 per month (no government subsidy). So no, these generics are cheap and so the margins for the drug companies have to be razor thin.
__________________
Ian S is offline   Reply With Quote
Old 09-14-2016, 08:15 AM   #40
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Chuckanut's Avatar
 
Join Date: Aug 2011
Location: West of the Mississippi
Posts: 5,763
A recent podcast from the People's Pharmacy reported that an Italian study found that a Mediterranean Diet is just as protective of health as taking a statin. Look up show 1048.

So, more fish, veggies, fruit, nuts, and olive oil. Less processed foods, sugar, and factory meats.
__________________

__________________
The worst decisions are usually made in times of anger and impatience.
Chuckanut is online now   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Cardiac CT Scan for Calcium tangomonster Health and Early Retirement 97 07-22-2016 08:25 AM
Preventive full body scan anyone? Lisa99 Health and Early Retirement 26 08-12-2014 08:46 PM
my father is in the cardiac care unit simple girl Other topics 7 05-15-2008 07:54 AM
preventive care Khan Health and Early Retirement 17 12-23-2006 07:46 PM
Who takes statins? Which ones? BUM Other topics 51 06-04-2005 11:58 AM

 

 
All times are GMT -6. The time now is 07:25 PM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.