Have you lowered cholesterol without statins?

[Lsbcal]

Actually, statins have been confirmed as causal for lowering cholesterol - that is accepted science. The assumption about reducing CVD is what is questionable.

But what about tests like CT heart scans? Are there no studies that link this kind of test with statin useage?

 

[harley]

If there is this overwhelming evidence that Statins don't work, wouldn't you think most doctors would stop prescribing them? My PCP is as about as anti-drug as you can find in a doctor. Trying to get an antibiotic or a pain pill stronger than a Advil from my doctor is like pulling teeth. But, as soon as he saw my test results (CT Scan, etc) he started up the Atorvastatin. My Cardiologist upped the dosage. When I brought up the fact that my dosage was increased to my PCP, he thought it was a good decision. Are all of these doctors stupid? Do they just not read these studies? Are they getting kickbacks from Big Pharma? I doubt it.

In your case, with a CT Scan, maybe there was good reason. But IMO a blood test with high numbers shouldn't be the be all and end all in prescribing.

I think it's just hard to stop inertia. I know that when I was in Kaiser Permanente I had docs tell me that they had to follow the corporate policy no matter what they personally believed. As a matter of fact, the doc that turned me on to the Eat Fat, Get Thin book made me swear I wouldn't tell where I got the info, as he could lose his job for that. And I do think a lot of docs don't read the new studies. They're busy people. But mostly I think docs are just like most people and get into habits. Plus, it's safer to prescribe statins just in case something happens. Just like my old job in network security, you have to follow best practices. And it takes a long time to change them.

And yes, I do think there were a lot of kickbacks from Big Pharma, not to the individual docs but to the decision makers. But that's just my personal opinion and isn't worth much to anyone else.

 

[gerntz]

No no. See your response is ignorant. You don't know everybody. The statement that people get their blood tested for years many many times before doctors prescribe drugs is incorrect . And finding some people in that situation only proves me right. It id not definitive of the medical applications of cholesterol mining. Every doctor I have every had bring up the subject did so on ONE BLOOD TEST. Numbers = X = need drugs = Have risk=Must lower. No doctor will test your blood for years before interfering unless he's one who is not on the cholesterol bandwagon. By total Cholesterol was just over 200. I have never had "really high" cholesterol and the numbers go up an down without me doing anything. I go different numbers same day.. 2 different tests. Doctor's office test always the higher number

No, when I was on statins I had to have my blood tested for LIVER DAMAGE every 60 days. Every single blood test was either abnormal or right at the limits and every single doctor told me I needed to stay on the drugs And this was the experience of everyone I knew at the time.

So your experience is the only one out there? I already know better

I'm not questioning whether statins are right for you & what one doctor recommended for you after one test.

I had blood tests every one to two years as part of checkups for a number of years. My total started around 200 with HDL around 37-42 & gradually increased to about 250 over 810 years. That's when he said I should start. I had studied the issue & concurred.

I have no idea why you think my situation is unique. I know it's not as my spouse who has a different PCP went thru the same routine about 5-10 years delayed to me. And I have multiple acquaintances who went thru same.

I'd would have never stated on them after one test. And I'd have run quickly had that been reco'd. And I can't begin to imagine that a non quack would start someone without repeating the test. Sorry for your luck though.

 

[Lsbcal]

If there is this overwhelming evidence that Statins don't work, wouldn't you think most doctors would stop prescribing them? My PCP is as about as anti-drug as you can find in a doctor. Trying to get an antibiotic or a pain pill stronger than a Advil from my doctor is like pulling teeth. But, as soon as he saw my test results (CT Scan, etc) he started up the Atorvastatin. My Cardiologist upped the dosage. When I brought up the fact that my dosage was increased to my PCP, he thought it was a good decision. Are all of these doctors stupid? Do they just not read these studies? Are they getting kickbacks from Big Pharma? I doubt it.

Did your doc suggest that you also see a Cardiologist? I have to see my PCP in a few days to discuss the CT heart scan results. Not great numbers.

 

[harley]

I'd would have never stated on them after one test. And I'd have run quickly had that been reco'd. And I can't begin to imagine that a non quack would start someone without repeating the test. Sorry for your luck though.

I think you just defined 95% of all doctors as quacks.

 

[donheff]

But what about tests like CT heart scans? Are there no studies that link this kind of test with statin useage?

I am not sure but I don't think so. I believe recent studies have shown better benefits for statins than previously. They used to only show improvements in people who had previous coronary events. Now I think the relationship has been shown to some degree in people who have not had previous events. But the association with improvements in CVD is weak compared to the association with lower cholesterol numbers which is clear.

Many of us are not convinced that statins in marginal cases (like mine) are worth the risk of side effects. And many people who have side effects are even more opposed. I would never presume to recommend that someone not take a statin. It is accepted medical practice and I have zero qualifications. DW, who is at much higher risk than me took them as long as she could in the face of significant side effects and is using Repatha now.

Edit: My PCP agrees with my decision not to use statins even though the quidelines say I should. I haven't asked my cardiologist but I think he would say take em.

 

[harley]

I would never presume to recommend that someone not take a statin. It is accepted medical practice and I have zero qualifications.

+1. I only argue (wrt statins, rather vehemently) that people should be aware that there is disagreement with the gospel, and they should educate themselves before making the decision. That's true with any prescribed drug or medical procedure.

 

[MRG]

+1. I only argue (wrt statins, rather vehemently) that people should be aware that there is disagreement with the gospel, and they should educate themselves before making the decision. That's true with any prescribed drug or medical procedure.

+1
I had a cardiologist push me very hard to go on one. My PCP and I talked, his comment was he wouldn't take one if he had my numbers. I'm OK with that.

 

[PatrickA5]

Did your doc suggest that you also see a Cardiologist? I have to see my PCP in a few days to discuss the CT heart scan results. Not great numbers.

If the CT scan isn't very good, then I'd assume your PCP would probably send you to a Cardiologist.

My PCP didn't mention statins at all after my original blood test showed high lipid numbers. He mentioned diet, exercise, etc. It was only after having a CT scan of the head/neck showed Cerebrovascular disease and a echocardiogram suggested possible coronary artery disease that my PCP put me on statins (low dosage).

A couple of years later my DW (through her work) had access to a really cheap CT Heart scan, so I signed up. I took the results to my PCP and he thought I probably should go ahead and see a Cardiologist. I did some more testing through the Cardiologist who confirmed the coronary artery disease (and cerebrovascular disease) at which time he upped my dosage based on the test results. None of the doctors recommended statins based on the results of a blood lipid test.

 

[Anna J]

In my late 30's, I tested high for ldl and within range for hdl. Since I was in good shape and exercised regularly, My Dr. had me keep a food journal for 3 weeks and go back to talk to her about my diet. She said that I ate healthy and that I am one of the unlucky people that have high cholesterol due to hereditary reasons. I did not want to go on meds and looked into what foods would help lower my ldl and higher hdl. I only changed a few tweeks to my diet like eating more avacados, walnuts and olive oil (to help raise my hdl) and cut back on BUTTER...which is a weakness for me, and eat lean cuts of meat and chicken without the skin. Just with these few things, I was able to balance out my #'s and not go on meds. It was a lot easier than I thought and have been fine with my cholesterol since (I am 46 now).

 

[tfudtuckerpucker]

So there's the dilemma. Fish oil seems to be pretty effective in reducing ldl levels. But reducing ldl (by fish oil or statins) does not seem to reduce CVD, except if you have other risk factors. Statics can have nasty, permanent side effects. And fish oil apparently increases rate of prostate cancer (especially agressive prostate cancer). So maybe it's better to take neither?

 

[Lsbcal]

So there's the dilemma. Fish oil seems to be pretty effective in reducing ldl levels. But reducing ldl (by fish oil or statins) does not seem to reduce CVD, except if you have other risk factors. Statics can have nasty, permanent side effects. And fish oil apparently increases rate of prostate cancer (especially agressive prostate cancer). So maybe it's better to take neither?

Took a very quick look at that first link. Did it show that fish oil reduced ldl in its group? Or just that it didn’t reduce CVD? BTW, I never did fish oil so no bias.

 

[Katsmeow]

I think you can try and see. I have had some success with lowering it somewhat. My cholesterol in the past was around 250 with slightly lowish HDL and fairly high triglycerides and somewhat elevated LDLs. I did take Lipitor off and on for a few years. For me, it had an extremely dramatic affect at the lowest dosage. When I would go off I would go back to where I had been.

Several years ago I did stop taking it (although I had no side effects from it). My cholesterol was tested last week and it was around 225 with slightly elevated LDL. My HDL is good and triglycerides are low. I have been as low as 201 though.

It certainly helped me to lose weight and exercise. I don't eat red meat or much saturated fat (I haven't for many years). I do eat lowish carbs and not much sugar. However, my doctor doesn't feel I need to take a statin since I don't have any other risk factors.

 

[Jerry1]

About five years ago I dumped sugar and highly processed foods and went low carb to lose weight. I ate a ton of meat and a good amount of saturated fat. At the same time I dropped statins after researching them to help DW decide whether to drop hers (due to muscle pains). After six months lowish carb my triglycerides had plummeted, my HDL was way up and my LDL was moderately higher. It is impossible to know what the numbers would have been if I just stopped statins and kept eating sweets, etc. But, I am happy to stay off the statins.

^^This^^

I go to a holistic doctor who is an MD. His mantra - No grains, no dairy and drastically reduce sugar. Basically you end up on a low carb diet similar to a paleo diet or that of a diabetic. When faced with a decision on whether or not to take medications and a natural alternative is present, you have to ask yourself, what's the harm in trying the alternative. As long as you have time (not an emergency situation) and the alternative has no side effects (I don't know any from a low carb diet), why not try the alternative? You know there are possible potential side effects of the statins and in my opinion, if you stick with the diet, in six months, you'll see such a level of improvement, that your doctor will not be recommending statins. Of course all of this should be done with medical supervision. You may have a particular need to keep you from becoming vitamin or mineral deficient.

Personally, my numbers are way better, but I struggle to give up sweets so they're not as good as they could be. I also need to exercise to get my good to bad cholesterol ratio in check. I have eliminated my blood pressure medicine and avoided statins.

See also:
What you need to know about cholesterol—Total and LDL | Dr. William Davis

 

[tfudtuckerpucker]

Took a very quick look at that first link. Did it show that fish oil reduced ldl in its group? Or just that it didn’t reduce CVD? BTW, I never did fish oil so no bias.

That link didn't show the reduction in ldl, but here's a better one.

The point I meant to make is stated better here
"Results of recent outcomes trials of long-chain omega-3 fatty acids, fibrates, and niacin have been disappointing, failing to show additional reductions in adverse cardiovascular events when combined with statins. "

Here's another interesting article, that discusses ldl particle size and impact on CVD. But it's also disappointing, with this statement: "no clinical outcome trials to date have determined whether normalization of particle composition or reduction of particle number optimizes CVD risk reduction beyond that achieved through LDL-C lowering."

So I have been disappointed that the science is not clear on the matter- does lowering triglycerides and ldl not impact CVD or not? Am I wasting money on supplements, and also adding risk of side effects from them, if they provide no benefit?

 

[Winemaker]

In the long run, we are all dead.
Everything in moderation, including moderation.
It won't be tofu that killed me.

 

[Lsbcal]

Here is one link to a very readable article on a study that shows: Statins reduce deaths from coronary heart disease by 28% in men according to longest ever study.

Now, researchers have completed analyses of the 15-year follow up of 5,529 men, including 2,560 with LDL cholesterol above 190 mg/dL of the original 6,595, chosen because they had no evidence of heart disease at the beginning of the present study.

Participants were aged 45-64 years. During the five-year initial trial they were given pravastatin or placebo. Once the trial ended the participants returned to their primary care physicians, and an additional 15-year period of follow-up ensued.

The 5,529 men were split into two groups: those with 'elevated' LDL (between 155 and 190mg/dL) and those with 'very high' LDL (above 190mg/dL). The standard 'ideal' level of LDL for high risk patients is below 100mg/dL, but this varies depending on individual risk factors.

The conclusion:

Professor Ray said: "This is the strongest evidence yet that statins reduce the risk of heart disease and death in men with high LDL. Our study lends support to LDL's status as a major driver of heart disease risk, and suggests that even modest LDL reductions might offer significant mortality benefits in the long-term. Our analysis firmly establishes that controlling LDL over time translates to fewer deaths in this population."

FWIW, I'm well below these LDL levels in that study.

 

[Rianne]

DH was DX diabetes about 7 years ago. Blood sugar close to 400, he was way overweight, high cholesterol. PA said they treat this DX like a heart attack, very seriously. Scared the crap out of him.

He started walking, eating right and within a year he was cleared of diabetes. No more daily blood pricks in his finger. They still wanted him on statins, he refused. He is healthy and active today. The docs keep trying to get him on statins, he keeps refusing.

 

[braumeister]

Here is one link to a very readable article on a study that shows: Statins reduce deaths from coronary heart disease by 28% in men according to longest ever study.

That may be a valuable study but as reported I have two problems with it.
First, it was funded by companies that make statins (just sayin').
Second, they don't publish (that I can find) the actual data and only talk (as usual) about relative risks, not absolute differences.

What I mean by that is this:
If four people out of 100 die with placebo compared to just three with treatment, then the treatment lowers your risk by 25% (or skipping the treatment increases your risk by 33%). That's relative risk and doesn't tell me what I want to know.

 

[plsprius]

For those interested in reviews of the science, I recommend the "Number Needed to Treat" website. They have unbiased reviews of drug treatments for many conditions, including statins with/without known heart disease. See here:

Statins for Heart Disease Prevention (With Known Heart Disease) – TheNNTTheNNT

Statins for Heart Disease Prevention (Without Prior Heart Disease) – TheNNTTheNNT

Overall, the benefits and risks are BOTH probably less than you think. In my own case, I used a statin for 10 years without side effects. Since switching to a plant-based diet 5 years ago, I have gradually decreased the statin dose, and in 2017 stopped completely. Fortunately, with that way of eating, cholesterol is no longer of concern, and typically my total cholesterol is under 150, up only a bit from the statin numbers.

The NNT website is great for clearly explaining a lot about the limited benefits of drugs for otherwise healthy people (needed for many, obviously).

YMMV, of course!

 

[tfudtuckerpucker]

That may be a valuable study but as reported I have two problems with it.
First, it was funded by companies that make statins (just sayin').
.

I think the whole statin issue is at risk of being influenced by the money. Lipitor, for example, has generated $141 Billion (!) so far, though it's down to a mere $1.8 Billion last year.

I've seen various studies, showing contradicting results from statins, for persons without CHD or risk factors. Most are in the noise level of measurement. But I think the side effect risks have been understated. Lately I noticed a 25% increase in new-onset diabetes, caused by statins. This may be acceptable for those with other CHD risk factors, but not for me.

 

[donheff]

Here is one link to a very readable article on a study that shows: Statins reduce deaths from coronary heart disease by 28% in men according to longest ever study.

Thanks Lsbcal. I think this is the study that made me vaguely remember that evidence was improving for statin effectiveness in people without previous CVD.

That may be a valuable study but they... only talk (as usual) about relative risks, not absolute differences...

What I mean by that is this:
If four people out of 100 die with placebo compared to just three with treatment, then the treatment lowers your risk by 25% (or skipping the treatment increases your risk by 33%). That's relative risk and doesn't tell me what I want to know.

They do bury a little absolute risk data in the article. They mention that the very high (190+) ldl cohort was initially viewed to have a 7.5% ten year risk but found the actual risk to be 7.5% for five years and 15% for ten. That would indicate that of 15 people out of 100 expected to have a CVD event, 4 of those could be avoided with statins. If the study holds up that is pretty significant, particularly for people with very high ldl. I am still leery of statin side effects and with a much lower (albeit moderately high) ldl coupled with otherwise good risk factors, I plan to stay away for now. By the time the studies all sort out, I will probably be too old to bother if I change my mind about statins.

Edit: Since most published research is false I am skeptical that one study that shows such good results will hold up for long. We have had a boatload of previous studies that didn't find this association.

 

[CyclingInvestor]

I will have to throw in a pro-statin vote. 11 months in with no side effects, cholesterol down from 234 to 111, HDL holding steady around 40, triglycerides down from 596 to 79. Of course several other life style changes make useful comparisons difficult - carbs way down, more meat especially fish, more exercise, weight loss, etc - but that kind of drop is hard for me to ignore.

 

[FIRE'd@51]

I will have to throw in a pro-statin vote. 11 months in with no side effects, cholesterol down from 234 to 111, HDL holding steady around 40, triglycerides down from 596 to 79. Of course several other life style changes make useful comparisons difficult - carbs way down, more meat especially fish, more exercise, weight loss, etc - but that kind of drop is hard for me to ignore.

It would be interesting to go off the statins and maintain the current lifestyle, and then recheck your numbers in 6 months. I suspect the "carbs way down" is the most significant factor in the reduction of your numbers.

 

[iloveyoga]

Yes, I cut way down on eggs and red meat. Thanks for the statin info.

And cheese! I was eating too much of it anyway. I did lower my numbers and I think they will be even better next time.