Preventive cardiac care >65 years of age: statins?

[friar1610]

The speaker at our old guys' breakfast group today was an MD. He said that we all had 2 risk factors for heart disease/stroke (sex and age). This did not surprise me as I've heard that before. What did surprise me is that he said those risk factors are enough to have us all on daily low-dose aspirin AND a low-moderate dose of a statin regardless of our cholesterol numbers. I know there is a difference of opinion on the value of low-dose aspirin after a certain age. But the statin recommendation caught me off-guard. I did a bit of web research and found that this is indeed consistent with current guidelines. 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.

 

[razztazz]

I was 41 with cholesterol of 225. One second of data for a lifetime of drugs. Life nearly destroyed by statins. Adverse reactions blithely ignored. Further destruction. Stopped unilaterally. Took 10 years to recover 80% the rest will never go away. One MD wanted to put a stent in my aorta. Kept telling me my statins symptoms (all clearly listed in the paperwork) were because my aorta was blocked. Went on Atkins diet. Cholesterol soared but I felt better than I had in years. Just turned 59. Still waiting to have that heart attack.

Had heart scanned a few yrs back. Minor plaque burden. Obviously put there back when I smoked ciggies 1980-1991. Nearly zero risk for strokes, carotids clear as baby's.

Doctors still bug me about cholesterol. I ask: So, what's my risk? they can never tell me. They actually tell me a fat guy who smokes and gets no exercise has lower risk if his cholesterol is low. So I ask, what's the fat guy's risk? He can't tell me. Rolls eyes like a child who's not getting his/her way.

Trade theoretical risk of a heart attack some day for a real risk of getting killed tomorrow. Like that's a good bet.

 

[CountryGal]

Research the dangers of statins with dr. Google. Then look up the benefit of diet for heart health. Fuhrman and Esselstyn come to mind. Dr. Fuhrman has a great book that came out this year - The End of Heart Disease. LOTS of great new info in it.

 

[Dawg52]

Research the dangers of statins with dr. Google. .

Research the dangers of any drug and you will find plenty.

I've been on a low dose statin for 10 years or so. When my doc recommended one, my overall number was not horrible but my bad cholesterol was border line high. I tried a better diet for a few months, but the bad number actually went up a bit. After going on the drug all my numbers have been great. But there are always new reports coming out contradicting the benefits of certain drugs and health practices so who knows.............

I plan to stay with it until advised different by the doc.

 

[mpeirce]

Research the dangers of any drug and you will find plenty.

Definitely look at a variety of sources.

Talk it over with your doctor, but also educate yourself.

This book by Dr. Malcolm Kendrick is worth reading:

The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It

 

[H2ODude]

Good friend had similar experience to Razztazz except problems subsided after a year or so. Just in general, I'm a big skeptic of prescription drugs unless there's a specific symptom and lots of evidence that it will have a largely positive impact. I guess I figure anything that is advertised so much has an awful lot of profit motive that may not be in my best interest.

My bad cholesterol was getting high, doctor basically was "meh. may want to watch diet." I did (primarily cut back on meat) and it dropped 40 points in about six months. IIRC his lack of concern was because there's no history of problems in my family. Meanwhile I'm not paying that much attention to it. Exercise regularly, weight almost nudges overweight BMI, but I'm more about enjoying life.

Just remembered that back in my 40's I did the phoresis platelet donation about once a month. They'd send a postcard with total cholesterol afterwards. I could always just about predict what it was going to be based on how much I'd been running.

 

[harley]

I was 41 with cholesterol of 225. One second of data for a lifetime of drugs. Life nearly destroyed by statins. Adverse reactions blithely ignored. Further destruction. Stopped unilaterally. Took 10 years to recover 80% the rest will never go away. One MD wanted to put a stent in my aorta. Kept telling me my statins symptoms (all clearly listed in the paperwork) were because my aorta was blocked. Went on Atkins diet. Cholesterol soared but I felt better than I had in years. Just turned 59. Still waiting to have that heart attack.

Had heart scanned a few yrs back. Minor plaque burden. Obviously put there back when I smoked ciggies 1980-1991. Nearly zero risk for strokes, carotids clear as baby's.

Doctors still bug me about cholesterol. I ask: So, what's my risk? they can never tell me. They actually tell me a fat guy who smokes and gets no exercise has lower risk if his cholesterol is low. So I ask, what's the fat guy's risk? He can't tell me. Rolls eyes like a child who's not getting his/her way.

Trade theoretical risk of a heart attack some day for a real risk of getting killed tomorrow. Like that's a good bet.

This is what it all comes down to. I've never found a doctor who can give a meaningful risk assessment for heart disease, at least not until after a heart attack. I too had adverse reactions to statins that were poo-pooed by my doctor. After reading a fair amount of books and research on both sides of the argument, I haven't been able to find anything other than weak correlation but no causation regarding cholesterol and heart disease. So, personally I wouldn't (and don't) take them. But to each his own.

 

[justlikebike]

Take a look at psyllium husks

I was diagnosed with AFIB a little over a year ago. One of the appointments before surgery was a CAT scan of my chest. Although my Cholesterol was normal, they did find a minor build up of plaque in one of my arteries. The Cardiologist suggested statins. When I mentioned this to my GP, she suggested psyllium husks. Said they have been proven to lower cholesterol and remove plaque from arteries but don't get the advertising that statins do. I put it in my cereal in the mornings and in a snack at night. Seems to help and the only side affect is regularity in my morning constitutional.

 

[athena53]

I was put on statins about 5 years ago and got bad tendonitis. Like, unable to lift a spoon to my mouth without searing pain, bad. Anti-inflammatories helped only a little. I was starting to feel similar pains around my knee joints. I realized that the onset of all this had been about 6 months before when I started statins, and after some research I threw them out. I am convinced I'd be an invalid by know if I'd been stupid enough to keep taking them. One great podcast I listened to noted that high cholesterol is an abnormal lab result and statins can reverse that. Period. That's not necessarily a reason to take them.


I still have to watch my triglycerides because I can go overboard on sugar, but I'm 63 and still doing sprint triathlons and 35-mile charity bike rides. My weight is the same as it was when I graduated from HS. I'll take my chances.

 

[Amethyst]

Since reading about it in this forum, I've been taking Cholestoff (plant sterols) for about 8 months. Possibly due to the Cholestoff (since my exercise and diet did not change) my total cholesterol dropped from 211 to 183. Unfortunately, my LDL hardly dropped at all, while my HDL went from 88 to 60 - the wrong direction! And my fasting blood sugar went from 88 to 94. So I don't know what to think. Maybe I can't have PBJ sandwiches any more.

With my family history, I'm more afraid of stroke than heart attack.

Amethyst

I was diagnosed with AFIB a little over a year ago. One of the appointments before surgery was a CAT scan of my chest. Although my Cholesterol was normal, they did find a minor build up of plaque in one of my arteries. The Cardiologist suggested statins. When I mentioned this to my GP, she suggested psyllium husks. Said they have been proven to lower cholesterol and remove plaque from arteries but don't get the advertising that statins do. I put it in my cereal in the mornings and in a snack at night. Seems to help and the only side affect is regularity in my morning constitutional.

 

[harley]

It's really not an issue of finding something besides statins to lower cholesterol. If you read and accept the theories put forth by people like Drs. Kendrick, Sinatra, Graveline, etc., they are saying cholesterol is not a problem for most people (btw, if you're looking for the problem, it's inflammation caused by sugar). So the question becomes do you need to lower your cholesterol or not. If you choose yes, and statins don't cause side effects, drive on. If you choose yes but have bad reactions to statins, I guess things like psyllium husks and fat control are the best option. But if you choose no, the question becomes moot. (Moot, not mute!). Sadly, for me at least, sugar control is much harder than popping a pill. But at least it doesn't cause muscle pain and weakness. I get that bad enough just from being 60.

 

[braumeister]

When I mentioned this to my GP, she suggested psyllium husks. Said they have been proven to lower cholesterol and remove plaque from arteries but don't get the advertising that statins do. I put it in my cereal in the mornings and in a snack at night. Seems to help and the only side affect is regularity in my morning constitutional.

Metamucil (I think they recently renamed it to just Meta) is essentially just psyllium husks mixed with maltodextrin, so your diet should definitely keep you regular. The effect on cholesterol is likely very small, though.

 

[CountryGal]

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.

For years I did Atkins and Paleo type diets, but was unable to drop the numbers. YMMV

If you do some research you will find a large percentage of folks with High Cholesterol have heart attacks, so the level is not the only data point we should look at. Look up the book "The Great Cholesterol Myth".

 

[MildlyEccentric]

The website thennt.com tackles both of your questions. The aspirin question is answered here and the statin question is answered here. Spoiler alert, the answer is any potential benefit is offset by the potential side effects. However, the answer changes if you have had a prior heart attack or have known heart disease.

BTW, I take both a statin and an aspirin daily. So far, I've not had any of the potential negative side effects from either the aspirin or the statin and my cholesterol has been lowered.

 

[6miths]

thennt.com site is quite good. Some would say on the conservative side but consistent with the 'first do no harm' approach. It is very well referenced and gives lots of extra 'high quality' resources for those looking to look further.

 

[Options]

Research the dangers of statins with dr. Google. Then look up the benefit of diet for heart health. Fuhrman and Esselstyn come to mind. Dr. Fuhrman has a great book that came out this year - The End of Heart Disease. LOTS of great new info in it.

+1
My cholesterol was average. Then I significantly elevated my good cholesterol while lowering bad cholesterol last year through diet alone. My primary care physician who is a cardiologist had previously recommended statins solely as a preventative measure. After reviewing my improved blood results trending over a period of time he withdrew his preventative statin recommendation.

 

[Teacher Terry]

I find it so ridiculous to recommend that everyone go on statins. I know a doc that recommends no one ever go on them. No proven benefits and lots of bad reactions.

 

[friar1610]

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.

 

[harley]

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.

 

[Chuckanut]

Here's an interesting discussion on statins:

Show 1044: The Truth about Statins and Heart Disease - The People's Pharmacy

We speak with two experts on statins and heart disease to get to the heart of the matter. They have different perspectives on the value of statins, but their views on what else we should be doing to protect our hearts are not as divergent as you might imagine.

IIRC, what the experts agreed on was a "Mediterranean diet" - more fish, legumes, veggies, fruits and less processed meat, smaller amounts of dairy'. And, of course, the other magic bullet - exercise.

 

[6miths]

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.

 

[razztazz]

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.

 

[Chuckanut]

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.

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

.

 

[Chuckanut]

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.

 

[W2R]

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.