Cholesterol madness

[donheff]

Why would we assume stats for babies would be the target for adults?

 

[youbet]

In Feb, I had some lower back pain and decided to stop the statins, so in May, when I had my annual tests, the LDL had risen to 3.93 from 0.66 so I am back on them and getting the lower back investigated.

Smart move getting the lower back investigated. I too was having lower back pain with symptoms of sciatica. I really wanted to blame the low dose steroid (5mg/day Atorvastin) I've been taking for years but after working with a physical therapist, we discovered my core body strength was poor. Fixing that required a LOT of work (for a guy who definitely isn't a gym rat) but the results have been great. At almost 72 yo, I'm back to joining DW on multi-mile walks without lower back pain stopping the fun and am enjoying much improved flexibility and mobility.

I'm OK with taking Atorvastatin in this very low dose. All my numbers are good and I have no discernable side effects. I've developed a "why rock the boat" attitude about it I guess. The only real pita is needing to use a pill cutter to half the 10mg pills to 5 mg since 10mg is as low dose as they come.

 

[youbet]

The vast majority of doctors have much less academic exposure to diet and nutrition than you would receive in a one semester introductory nutrition class. Medical school is extremely lacking in that realm of medicine. It is well documented that about 71% of the US population is overweight that includes the $40% of the population that are obese. I would first look at the physical condition of my doctor before listening to their recommendations. For some reason so many doctors choose to ignore the research described by the CDC, AMA, JAMA, Lancet, The New England Journal of Medicine, etc. and like to prescribe pharmaceuticals instead.

The US diet and eating habits have changed considerably in the past 50+ years to a great deal of processed simple sugars, fat, excessive amounts meat, and processed fast food with less whole grains, vegetables and fruit. The other part of the equation is there is also a large part of the population that is sedentary.

My PCP is a DO instead of the traditional MD and I've been quite pleased with him for the 30+ years I've been under his care. He's part of an independent practice unattached to any of the big area medical conglomerates.

I do see MD specialists from time to time (urologist, cardiologist, dermatologist) but count on the DO for routine check-ups, incidental minor treatments and solid lifestyle advise. He's definitely a diet and exercise guy.

When he and I decided that I really needed to lose some weight, he did refer me to a dietician (covered by a Medicare program). He and the dietician both are in the camp that a basic healthy diet (by historical standards) is the way to go rather than one that emphasizes extremes in carb/fat/protein ratios. So, working with the dietician and using "myfitnesspal" (free version), I tweaked carbs down and protein up a bit and counted total calories while doing some exercise. I slowly lost 70 lbs over about two years and am successfully holding steady now. We're thinking that perhaps another 10 lbs might be helpful and I'll use the same slow, steady and no extremes to do that.

DO Doc happily took me off BP meds after the weight loss and left the 5mg daily of Atorvastatin up to me.

 

[threegoofs]

Any doctor that prescribes a statin based on calculated LDL or without running the Apo B blood test should be fired.

Wrong.

Statins should be prescribed to high risk individuals irregardless of cholesterol levels.

Statins work. Extremely well.

And when I say work, I mean they work in reducing cardiovascular events and death, their effect upon cholesterol is secondary.

 

[yakers]

Wrong.

Statins should be prescribed to high risk individuals irregardless of cholesterol levels.

Statins work. Extremely well.

And when I say work, I mean they work in reducing cardiovascular events and death, their effect upon cholesterol is secondary.

That is what my cardiologist said. I wanted to come off statins, I have low LDL, and triglicerides and good HDL, good BMI, controling my blood sugar well through LCHF. But she said the anti inflammation properties are important for me, I had two ablation procedures. We compromised and I reduced the dose 50% but continue to take a statin. Have not had any negative side effects.

 

[athena53]

Why would we assume stats for babies would be the target for adults?

Because babies rarely get heart attacks. QED, right?

The other thing I read recently (but not new) is you can now go in (every two weeks for the rest of your life) for "LDL Apheresis" to remove the LDL from your blood, similar to how dialysis works.

Don't want to take a statin? They've got you covered.

I had a coworker who had familial high cholesterol. She was in her 20s, thin as a rail, practically vegetarian. I don't remember her total level but it was bad, and when she tried a zero-fat diet the level went down 10 lousy points. She was trying very hard to avoid getting on statins early. The procedure you described might work for someone like her.

 

[yakers]

Because babies rarely get heart attacks. QED, right?



I had a coworker who had familial high cholesterol. She was in her 20s, thin as a rail, practically vegetarian. I don't remember her total level but it was bad, and when she tried a zero-fat diet the level went down 10 lousy points. She was trying very hard to avoid getting on statins early. The procedure you described might work for someone like her.

Could be a life saving procedure for some? Worked with a lady from a family of high cholesterol, she was vegetarian and avoided all the identified prohibited foods religiously. Took plenty of meds and was stil at 300. He family all died in their 50s as did she. Wonder if this would have helped.

 

[Teacher Terry]

I knew someone with a 350 cholesterol level most of her life. Lived to 90. Auto correct is always changing my spelling)

 

[sengsational]

Wrong.

You and I have had this conversion before and it was less than helpful.



I'll concede that the small fraction of people with a familial hypercholesterolemia might be ok without the test, risk is simply not determined well with a calculated LDL-C, and dropping small change on additional blood tests to ascertain risk seems like the approach the best doctors are taking.

 

[RetMD21]

Do any of you look at risk calculators like : ASCVD Risk Estimator +

It is only for individuals without known atherosclerotic heart disease. Looks like I should be on a statin

 

[RAE]

Wrong.

Statins should be prescribed to high risk individuals irregardless of cholesterol levels.

Statins work. Extremely well.

And when I say work, I mean they work in reducing cardiovascular events and death, their effect upon cholesterol is secondary.

This is somewhat misleading. Here is the bottom line regarding statin use and mortality:

1. Statin drugs do not reduce the risk of death in 95% of the population, including healthy men with no pre-existing heart disease, women of any age, and the elderly.
2. Statin drugs do reduce mortality for young and middle-aged men with pre-existing heart disease, but the benefit is small and not without significant adverse effects, risks and costs.
3. Aspirin works just as well as statins do for preventing heart disease, and is 20 times more cost effective.

You can read more here: https://chriskresser.com/the-truth-about-statin-drugs/

 

[ivinsfan]

Wrong.

Statins should be prescribed to high risk individuals irregardless of cholesterol levels.

Statins work. Extremely well.

And when I say work, I mean they work in reducing cardiovascular events and death, their effect upon cholesterol is secondary.

If you don't mind possible crippling joint pain that does not always go away after stopping the drug. And I forgot to mention increased risk of dementia.

Define high risk in your terms.

 

[Teacher Terry]

If you also don’t mind diabetes.

 

[MikeWillRetire]

This is somewhat misleading. Here is the bottom line regarding statin use and mortality:

1. Statin drugs do not reduce the risk of death in 95% of the population, including healthy men with no pre-existing heart disease, women of any age, and the elderly.
2. Statin drugs do reduce mortality for young and middle-aged men with pre-existing heart disease, but the benefit is small and not without significant adverse effects, risks and costs.
3. Aspirin works just as well as statins do for preventing heart disease, and is 20 times more cost effective.

You can read more here: https://chriskresser.com/the-truth-about-statin-drugs/

According to a licensed acupuncturist.....

I'm going to listen to my doctor of 28 years. We basically grew up together. He knows me, my diet, my fitness, and my family history. I take a statin.

 

[I was misinformed]

You and I have had this conversion before and it was less than helpful.



I'll concede that the small fraction of people with a familial hypercholesterolemia might be ok without the test, risk is simply not determined well with a calculated LDL-C, and dropping small change on additional blood tests to ascertain risk seems like the approach the best doctors are taking.

I notice my doc included direct LDL in my next scheduled blood tests for the first time, without explanation. I have pretty good lipid numbers, so probably he has decided on this as standard procedure for all his patients now.

 

[I was misinformed]

Calcium score anyone?

These debates about statins and apparent bad side effects for many patients makes me wonder why CT scans are not more widely applied. At least if you believe my doc, the calcium score from such a test is a very good indicator of how much actual arterial disease one has developed. He says that it is particularly good for older folks (>60 y.o.) as by that point any deposits would have had time to have calcified. (Of course this is not completely obvious to me, as it seems possible that someone might have been clean for their first, say 50 years, but could develop problems at that point and have significant relatively recent, and hence not calcified, arterial deposits at age 60).

Anyways I like to believe my doc on this as I had a zero calcium score at age 61 (which apparently puts me in the "healthiest" few percent of males at that age).

Of course, the CT scan costs perhaps ~25 times the cost of a lipid panel blood test and involves some non-trivial radiation exposure. And perhaps, in the end, the calcium score is no more predictive of serious problems/mortality than just the blood test (I have no idea on any evidence in this regard)?

Anyways I would be curious if there is any experience/knowledge/wisdom on this subject folks here might share?

 

[googily]

Back to the diet portion of the conversation, I went low carb in early 2018 ( generally about 30-50g net a day), dropped 40 lbs, and am now maintaining a weight I haven't been since college. Would love to lose another 20, but maintaining is also a success.

As for my blood work, here's the before and after (early 50s F):

Feb 2017/March 2019
Total cholesterol:
249/245

HDL
48/58

LDL
153/167

Triglycerides
238/99

A1C now 5.2.

I go to One Medical, and this is what they told me in the email with my results:

"Your LDL cholesterol is in a normal range. For any LDL under 190, no medication is needed unless you have other cardiovascular risk factors (see below).

Your HDL cholesterol is normal.

Your triglycerides are normal.

Cardiovascular Risk Assessment: Combining your cholesterol test results with other risk factors, you are at low risk. Risk factors include: age, smoking, diabetes, high blood pressure, cardiovascular disease (heart disease, angina/chest pain, prior heart attack or stroke), and family health history (hereditary cholesterol disorders, early death from heart attack or stroke). "

And then they included this link:

Fact or Fiction: What Do You Really Know About Cholesterol?
https://www.onemedical.com/blog/newsworthy/cholesterol-fact-or-fiction

 

[forza]

Always love a good cholesterol debate. My story: Back in 2014 at the age of 46 I was on top of the world. Successful career. Well trained athlete. 6’1”, 175. Top runner, 6x week workouts, non-smoker, no diabetes, no high blood pressure, pulse rate of 50. Yearly James Bond day-long physicals testing everything including stress echocardiograms, VO2Max, etc. No issues, but every year the doctor would say “your cholesterol is very high, you should go on a statin”. My LDL was around 190, total around 280. Trigs fine. Every year I knew better, as I had the same opinion as many in this discussion “BS, I dont need them, the theory is crap, doctors are all in big pharma pockets, etc”.

On a whim, right around xmas I decided to get a $299 calcium heart scan which was just about the only cardiovascular test not part of the yearly James Bond physical. The results were shocking. I had 8 coronary lesions in 3 arteries. My calcium score put me in the worst 5% of all 46 year olds. I had the arterial calcium score of a 75-80 year old man.

Massive anxiety ensued. How could this be? I was able to get the head of Cedars in LA as my cardiologist. We did some advanced cholesterol testing via NMR, including LPa, oxidized LDL, etc. Turns out that I had a lethal combination of very high LDL, LPa and Homocysteine (which can act like a dagger to your arteries). A similar cholesterol profile as Ben Harper from the Biggest Loser who recently had a heart attack just after 50.

We then did a more advanced Coronary CT Angiogram (non-invasive) which showed I had a 50-69% lesion in my LAD, along with multiple 25% lesions in the other arteries. You want to talk about fear? I had no obvious risk factors other than the excessive cholesterol and LPa, and I was rapidly heading toward a LAD widowmaker.

You better believe I researched all of the medical journals on this subject (I do alot of research for a living) and couldn’t believe all of the misinformation on both sides of the cholesterol debate.

Needless to say, I immediately went on the highest dose of Crestor and Zetia to drive down the cholesterol and calm the inflammation. 4.5 years later, my cholesterol has dropped nearly 75%. My inflammation markers rapidly got better. My morning wood came back. My VO2Max has actually improved to almost an elite athlete level. I take 300mg of coq10 daily to ward off any chances for statin induced muscle aches especially at my high dosage. So far, I feel great and haven’t had any issues.

Later this year I will have another Coronary CT Angiogram to see if everything I have been doing has worked to halt the progression of my heart disease.

All signs are that my arteries have improved and that I may have caught this just in time to fix it, we’ll see.

Moral of the story is that we are all unique. Some people’s arterial network can handle high cholesterol and be fine. Others like me can’t.

My opinion - get the very simple “no dye” calcium heart scan around the age of 50. If you get a 0, don’t worry about high cholesterol and retest a few years later. If you get a shocking result like I did showing that you have rapidly developing heart disease, then do everything possible (pharmaceuticals, diet, meditation, etc) to immediately fix the problem.

 

[Teacher Terry]

I have had the dye test with no blockage.

 

[forza]

That is excellent news!

 

[I was misinformed]

That is quite a remarkable story. Thank you for sharing and good luck going forward!

Always love a good cholesterol debate. My story: Back in 2014 at the age of 46 I was on top of the world. Successful career. Well trained athlete. 6’1”, 175. Top runner, 6x week workouts, non-smoker, no diabetes, no high blood pressure, pulse rate of 50. Yearly James Bond day-long physicals testing everything including stress echocardiograms, VO2Max, etc. No issues, but every year the doctor would say “your cholesterol is very high, you should go on a statin”. My LDL was around 190, total around 280. Trigs fine. Every year I knew better, as I had the same opinion as many in this discussion “BS, I dont need them, the theory is crap, doctors are all in big pharma pockets, etc”.

On a whim, right around xmas I decided to get a $299 calcium heart scan which was just about the only cardiovascular test not part of the yearly James Bond physical. The results were shocking. I had 8 coronary lesions in 3 arteries. My calcium score put me in the worst 5% of all 46 year olds. I had the arterial calcium score of a 75-80 year old man.

Massive anxiety ensued. How could this be? I was able to get the head of Cedars in LA as my cardiologist. We did some advanced cholesterol testing via NMR, including LPa, oxidized LDL, etc. Turns out that I had a lethal combination of very high LDL, LPa and Homocysteine (which can act like a dagger to your arteries). A similar cholesterol profile as Ben Harper from the Biggest Loser who recently had a heart attack just after 50.

We then did a more advanced Coronary CT Angiogram (non-invasive) which showed I had a 50-69% lesion in my LAD, along with multiple 25% lesions in the other arteries. You want to talk about fear? I had no obvious risk factors other than the excessive cholesterol and LPa, and I was rapidly heading toward a LAD widowmaker.

You better believe I researched all of the medical journals on this subject (I do alot of research for a living) and couldn’t believe all of the misinformation on both sides of the cholesterol debate.

Needless to say, I immediately went on the highest dose of Crestor and Zetia to drive down the cholesterol and calm the inflammation. 4.5 years later, my cholesterol has dropped nearly 75%. My inflammation markers rapidly got better. My morning wood came back. My VO2Max has actually improved to almost an elite athlete level. I take 300mg of coq10 daily to ward off any chances for statin induced muscle aches especially at my high dosage. So far, I feel great and haven’t had any issues.

Later this year I will have another Coronary CT Angiogram to see if everything I have been doing has worked to halt the progression of my heart disease.

All signs are that my arteries have improved and that I may have caught this just in time to fix it, we’ll see.

Moral of the story is that we are all unique. Some people’s arterial network can handle high cholesterol and be fine. Others like me can’t.

My opinion - get the very simple “no dye” calcium heart scan around the age of 50. If you get a 0, don’t worry about high cholesterol and retest a few years later. If you get a shocking result like I did showing that you have rapidly developing heart disease, then do everything possible (pharmaceuticals, diet, meditation, etc) to immediately fix the problem.

 

[Bir48die]

Good on some, borderline bad and have always had high triglycerides. I could change many of my habits to get to awesome levels. Maybe could lose ten pounds. Don't foresee being on any medications. I mainly deal with BP issues currently in a minor way

 

[JoeWras]

I'm OK with taking Atorvastatin in this very low dose. All my numbers are good and I have no discernable side effects. I've developed a "why rock the boat" attitude about it I guess. The only real pita is needing to use a pill cutter to half the 10mg pills to 5 mg since 10mg is as low dose as they come.

Talk with your doctor and consider going to 10mg every other day. It may be just as, or more, effective. It is more convenient. Just discuss with doc. That's what I'm doing.
https://www.acsh.org/news/2013/02/14/alternate-day-statin-dosing-may-be-as-effective-and-cheaper


I really didn't want to get on this thread. There are some very passionate people here that make the discussion very loud. It is not my style and I've become uncomfortable here on ER.org on the way some tones of threads (not just this one) are going.

 

[RetMD21]

Talk with your doctor and consider going to 10mg every other day. It may be just as, or more, effective. It is more convenient. Just discuss with doc. That's what I'm doing.
https://www.acsh.org/news/2013/02/14/alternate-day-statin-dosing-may-be-as-effective-and-cheaper


I really didn't want to get on this thread. There are some very passionate people here that make the discussion very loud. It is not my style and I've become uncomfortable here on ER.org on the way some tones of threads (not just this one) are going.

Well one thing that many agree on is that physicians know next to nothing about nutrition, cholesterol and statins. The people who agree on this don't seem to necessarily agree on the optimal diet.

 

[threegoofs]

That is what my cardiologist said. I wanted to come off statins, I have low LDL, and triglicerides and good HDL, good BMI, controling my blood sugar well through LCHF. But she said the anti inflammation properties are important for me, I had two ablation procedures. We compromised and I reduced the dose 50% but continue to take a statin. Have not had any negative side effects.

That’s because your cardiologist is trained in medicine, unlike the quacks here in this thread that are spreading horrible advice.