Statin Wars?

[f35phixer]

[QUOTE=razztazz;2291124]It's not a statin itself, but I found out there is a pill that combines it with a statin to increase effectiveness. The way sulpha and amoxcilan are a "two-fer" in Bactrim. That might be what f35phixer is referring to. And the symptoms listed are consistent with statins.

[QUOTE]f35phixer View Post
Dr. Put me on Ezetimibe - YES IT IS A STATIN ALSO!!! We decided to take me off for >6 months, see how my head felt, it felt much less stupid! We had cognitive tests, CAT or MRI SCANS on head all come back as normal for a 58yr old... During that time, my cholesterol when back up to >250 from ~ 155.

Quote:

Did the doctor say just what the risk difference is between 250 and 155 for the remaining 25-30-ish yrs of your life? I always ask that and they can never give me a good answer.

My mistake , I goggle and it said can be combined statin pill, misread it..... that just confirms more how well my brain feels... ill go back in nov and see what blood shows, if it’s lower and brain isn’t stupid I say win win....

[bmcgonig]

This should be fun:


"Boris Johnson’s*new Chief Medical Adviser*should carry out an immediate review into*statins*to help clarify whether millions of patients are actually benefiting from the cholesterol lowering*drug, according to the chair of the science and technology committee.

Norman Lamb said the move was necessary due to*the number of neverending contradictory claims being made about the drug*– by far the most common in the UK with more than eight million people prescribed them.
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.
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The group’s central argument is a lack of transparency over the raw data in statins trials dating back several years has prevented a clear picture emerging for the public over the benefits of the drug compared to any side effects, which they argue have been “underplayed""



https://inews.co.uk/news/health/stat...r-norman-lamb/

[marks]

I find this conversation very interesting, and would like to ask a simple question: For primary prevention, how much will taking a statin reduce my chance of having a CVD event?

In the linked video, Dr. David Diamond analyzes some of the most influential statin papers and explains that the absolute risk reduction is about 1%. The rates of reduction touted by drug companies and others of 36% or more are usually referring to relative risk, which in my opinion is very deceptive.

I would appreciate any criticisms of the points raised in the video.

https://youtu.be/psnkNqLA4Os

[beowulf]

The real question is whether high cholesterol increases the chances of a CVD event. If it doesn’t, then reducing cholesterol is a waste of money. If high cholesterol increases your chance of a CVD, then reducing it makes sense.

[marks]

Quote:

Originally Posted by beowulf The real question is whether high cholesterol increases the chances of a CVD event. If it doesn’t, then reducing cholesterol is a waste of money. If high cholesterol increases your chance of a CVD, then reducing it makes sense.

I totally agree. I was trying to make the point that if significantly lowering LDL yields at best a 1% in event reduction, that maybe LDL is not the correct target.

Mark

[sengsational]

Quote:

Originally Posted by beowulf The real question is whether high cholesterol increases the chances of a CVD event. If it doesn’t, then reducing cholesterol is a waste of money. If high cholesterol increases your chance of a CVD, then reducing it makes sense.

Well, as I think through this, I'm not sure that it's a waste of money in all cases. If we're talking about otherwise healthy people who have very few risk factors that would be taking a statin because when their age and LDL-C is plugged into a calculator (which itself is based on a protocol derived through this opaque processing of studies, referenced above), then yes, probably a waste of money. But there are so many other things to consider besides "high cholesterol".


Let's try this analogy, just for fun...


A long time ago the cops went out and saw a lot of crime (CVD) (picture Chicago gangsters). They suspected the Cholesterol Crime Family (CCF). Although some of them ran legit businesses (HDL-C), some looked more shady (LDL-C). The papers, at first, ignored the details and had headlines about how the CCF was getting away with a lot of crime (CVD). The cops turned over the evidence to the DA's office (pharma). The DA's office had techniques to prosecute these kinds of cases where there wasn't quite enough evidence to indite (compounds randomly arrived at that needed to be matched with a health issue). The DA's office came up with the theory of the crime: LDL-C causes CVD. Meanwhile, the papers ran headlines about how how the entire bunch of immigrants from the country of "FatLanders" were ruining everything. The stories of the FatLanders and the Cholesterol Crime Family sold a lot of papers, but it turns out all of this was just wrong. But now the DA's office was invested. They don't want to look incompetent, so they keep pounding. The cops keep digging and realize that the CCF isn't really a crime family after all. Even LCL-C is pretty much off the hook as there's no increase in crime where they are, except there's still one suspect, a guy with small particle size who goes by the name "beady-eyes", seems to be around more when there's crime, but the guy who goes by the name "fluffy" comes out clean. The cops report this to the DA, but they don't want to hear it. They've got their theory of the crime and they're going after the whole LDL-C clan. Meanwhile, the cops have hired a new detective and they're getting more interested in analyzing the crime at a higher level, beyond just CVD, they realize that a bunch of less obvious but earlier crimes occur in the area of inflammation. They're less convinced that these inflammation crimes are caused by the LDL-C clan and want to work on finding suspects. The problem is that the DA's office doesn't support this effort, nor does the chief of police. So the new detective is standing there with collected evidence, but the higher-ups are rolling with the old case against LDL-C.


Stay tuned for the next episode: A new DA gets elected and the old case get's thrown out.

[stephenson]

Ya know - I wish there were more qualified technically trained medical doctors commenting on this topic, here.

[RAE]

Quote:

Originally Posted by marks I find this conversation very interesting, and would like to ask a simple question: For primary prevention, how much will taking a statin reduce my chance of having a CVD event? In the linked video, Dr. David Diamond analyzes some of the most influential statin papers and explains that the absolute risk reduction is about 1%. The rates of reduction touted by drug companies and others of 36% or more are usually referring to relative risk, which in my opinion is very deceptive. https://youtu.be/psnkNqLA4Os

Yes, Dr. Diamond is absolutely correct about the absolute risk reduction being about 1%. And, to even achieve a "possible" risk reduction of 1%, you need to take a drug (statin) that has all sorts of potential negative side effects (muscle pain, diabetes, cancer). I guess everyone can make up their own mind about whether it's worth it or not - for me, it's absolutely not worth it.

I've stated this before, but I think it's important to remember that at least half of all people that have a major coronary event, have a total serum cholesterol level that would be considered "normal" (not high).

You see media articles (and press releases from the drug companies) all the time citing risk reductions of 20,30, 40 percent from taking a certain drug........and in almost every case, they are talking about relative risk reduction (but they don't make that clear). I always do some digging to find out what the absolute risk reduction is, and in many cases, it's similar to statins, or even less than 1%.

[ls99]

Just for fun.
AFIK neither HDL nor LDL are cholesterol.
Thus can not possibly be bad or good chloesterols. They both are transporters of cholesterol molecules. And cholesterol molecules are required by every cell of the body.

[ExFlyBoy5]

Quote:

Originally Posted by big-papa Have you had a CAC (Coronary Calcium) test? It's what convinced me to lower my cholesterol. I had 3 tests spaced out over several years and the score was increasing. After lowering my cholesterol the progression stopped. Your mileage may of course vary.

The discussion here as well as the attached Youtube video (done by an engineer...I like that type of "thinking") convinced me to get a CAC scan. I get it next week and costs a whopping $50. I am anxious to see that it tells me and how it compares to the Framingham screen.

The overarching question that I have is WHY heart disease is still the #1 killer in the US (1 in 4 deaths) when statins have been around for such a long time?

https://www.youtube.com/watch?v=UZoQiDaWnuE

Quote:

Originally Posted by Scratchy RAE, the study you quote below is from 2010. It is simply outdated information. Here is a link to the USPSTF 2016 Recommendation: https://www.uspreventiveservicestask...ve-medication1 The AHA/ACC Guidelines are even more current, last updated March 2019, also found benefit for statins for primary prevention of cardiovascular disease in some adults.

And yet even this recommendation has a caveat:

Quote:

To determine whether a patient is a candidate for statin therapy, clinicians must first determine the patient’s risk of having a future CVD event. However, clinicians’ ability to accurately identify a patient’s true risk is imperfect, because the best currently available risk estimation tool, which uses the Pooled Cohort Equations from the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the assessment of cardiovascular risk,1 has been shown to overestimate actual risk in multiple external validation cohorts.2-4 The reasons for this possible overestimation are still unclear. The Pooled Cohort Equations were derived from prospective cohorts of volunteers from studies conducted in the 1990s and may not be generalizable to a more contemporary and diverse patient population seen in current clinical practice. Furthermore, no statin clinical trials enrolled patients based on a specific risk threshold calculated using a CVD risk prediction tool; rather, patients had 1 or more CVD risk factors other than age and sex as a requirement for trial enrollment.

[eytonxav]

70 yo diabetic and have been on a statin for 20 years, originally due to high cholesterol and blood pressure and a family history of heart disease. Just had a CAC last week and it was 0, same as my last one that was about 6 years ago. My LDL is 46. A1C is low prediabetic, but at least my blood lipids are not raising a concern with my PCP. Anyway, even with a perfect CAC, I understand an individual could still have a blockage.

[ExFlyBoy5]

Quote:

Originally Posted by DFW_M5 Anyway, even with a perfect CAC, I understand an individual could still have a blockage.

How would this be possible? If there is blockage, it would think it would be visible on the CT. I am not trying to be snide, I am really curious.

[sengsational]

I'm curious too. I believe that you can have calcified plaque and plaque that hasn't yet calcified and that only the calcified is what shows up on that test. I had the calcium score and the CIMT (carotid-artery intima–media thickness) tests. My doc said that the CIMT would show signs first, and only later, after calcification would calcium score go up.

[RAE]

[QUOTE=ExFlyBoy5;2292473
The overarching question that I have is WHY heart disease is still the #1 killer in the US (1 in 4 deaths) when statins have been around for such a long time?[/QUOTE]

Maybe because LDL-C is not causative for coronary disease, but just a marker for some other issue that statins don't/can't address??

[RAE]

You can have a low score on the CAC test and still be at risk for heart disease, because not all diseased arteries have calcium deposits. Conversely, you could have a fairly high score on the CAC test even if your arteries do not have signs of heart disease.

This is from the Univ. of Michigan Health website:

Key points to rememberA coronary calcium scan checks for calcium buildup in the coronary arteries. Calcium in these arteries may be a sign of heart disease. A high score on a calcium scan can mean that you have a higher chance of having a heart attack than someone with a low score.

• The results of a coronary calcium scan may prompt you to make some lifestyle changes, such as exercising, eating better, losing weight, and quitting smoking. You might also decide to take medicine such as cholesterol or blood pressure medicine.
• People who are at medium risk for heart disease will get the most benefit from this test. Your doctor can help you find out your risk. Knowing your risk for a heart attack is a key part of your decision to get a scan.
• A calcium scan is not helpful to patients who have a low or high risk of heart disease.
• A calcium scan can give your doctor more information about your risk for heart disease. If you have a high score, you and your doctor may decide to start or change treatment to lower your risk.
• You could get a high score from the test even if your arteries do not have signs of heart disease. This could lead to other tests or treatments that you don't need.
• Not all arteries that have early signs of heart disease have calcium. So you could get a low calcium score and still be at risk.

[eytonxav]

Quote:

Originally Posted by ExFlyBoy5 How would this be possible? If there is blockage, it would think it would be visible on the CT. I am not trying to be snide, I am really curious.

Perhaps I used the wrong term in saying blockage. However, in reading the report details, it provides a diagram of the coronary artery system and explains the lack of markings for any coronary artery calcifications does not imply the presence, absence, location or extent of arterial stenosis or any other condition than the presence of coronary artery calcification.

[Helen]

https://www.europeanscientist.com/en...-side-effects/

This article fits well with this thread and the video that was posted a page or so ago.

Quote:

Why It’s now time for a full public parliamentary inquiry into the controversial drug and fully expose the great cholesterol and statin con Earlier this week, the Chair of the British Parliament Science and Technology Committee, Sir Norman Lamb MP made calls for a full investigation into cholesterol lowering statin drugs. It was instigated after a letter was written to him signed by a number of eminent international doctors including the editor of the BMJ, the Past President of the Royal College of Physicians and the Director of the Centre of Evidence Based Medicine in Brazil wrote a letter calling for a full parliamentary inquiry into the controversial medication[1]. It’s lead author Cardiologist Dr Aseem Malhotra makes the case for why’s there’s an urgent need for such an investigation in European Scientist.

[Old Microbiologist]

RAE IMHO it is all going to finally come around to being a problem in the intestinal microbiome. This could be caused by the horrible corporate food production process which uses numerous chemicals, hormones, and antibiotics all while reducing diversity of food products. This was our main reason to move to Hungary where essentially everything is organic as they only permit short acting pesticides. All animals are grown free range and there are no chemical additives to anything. GMO is forbidden here completely. That said the Hungarians themselves have poor health because of the way they prepare their foods, lack of work safety practices, alcohol consumption (home made palinka which IMHO is very dangerous stuff) etc.

I take no medications at all since moving here. In my retirement I spend a lot of time hiking in the forests, sailing on Lake Balaton, and working out. Both my wife and I had serious side effects to statins when we lived in the US. I developed cataracts caused by high dose lipitor in a 3 month period causing near blindness. My wife developed 26 gallstones within 3 months of taking statins. We both stopped taking them simultaneously and her gallstones passed without needing surgery. She was scheduled for surgery but an ultrasound on her admission showed no gallstones at all so they had passed after stopping the statins. We both had muscle pains as well which disappeared after stopping the statins.

Personally, I am "lucky" as I have a genetic bleeding disorder with impaired platelet aggregation which slows coagulation to 15 minutes. It has been a problem most of my life but not a serious one. It seems (statistically) this defect also prevents CVD events. So, I don't bother with the daily aspirin which causes the same thing. My wife had last year right atrial fibrillation and arrhythmia. She is now taking medications for controlling that which include Elequis, an oral anticoagulant. Interestingly, they scoped her cardiac arteries and found zero plaque in any arteries despite her cholesterol being over 600. In her case it is likely genetic as her HDL is also over 300 so there are no standard charts that cover her. There is a fractional rural population of people in Italy with similar numbers who have zero heart disease. Again that is genetic and attempts to replicate this in others have been unsuccessful.The hypothesis that HDL is protective didn't pan out using engineered HDL replicating this genetic variant. As in all things human it is complicated by diet, lifestyle, and genetics.

We happen to live 1/2 mile away from the National Cardiological Institute and are friends with the Director. My wife's cardiologist is chief of inpatient care and does a wide variety of research. The institute is excellent and provides excellent care which is state of the art. I have had quite a few discussions with them about statins, platelet function etc. Even these cardiologists are aware of the problems with the lipid hypothesis and are open to alternate theories. My wife's cardiologist is a world expert (more than 50 publications) on platelet function so of course his focus is there. There is a huge difference on treatment versus preventative care. Statins fall into the latter category and there seems to be a lot of debate regarding effectiveness. So, personally based on my own history, I would never take them. Had I never done so I would not have needed cataract surgery at the age of 52.

[Blueskies123]

"Had I never done so I would not have needed cataract surgery at the age of 52."


I read these statements and am dumbfounded. How is it that statins cause cataracts and gallstones? Could it be these things would have happened even if you did not take the statins?

[eytonxav]

Quote:

Originally Posted by Blueskies123 "Had I never done so I would not have needed cataract surgery at the age of 52." I read these statements and am dumbfounded. How is it that statins cause cataracts and gallstones? Could it be these things would have happened even if you did not take the statins?

Just goes to show there are no absolutes, unless definitively proven otherwise