Cholesterol madness

[eytonxav]

Clearly there are cases where you would be a fool to not take a statin. Part of the problem is that they keep lowering the standards for when you need medications. They are doing that with BP medications too. I remember reading that ideally you shouldn’t be on more than 4-5 medication. I have to take 6 st the present time and don’t intend to add any unless I absolutely have to.

At what point does one become a clear case of having sufficient risk factors (HBP, diabetes, high LDL, family history of heat disease, etc) to warrant prescribing a statin or are there no real standards? Is it one risk factor, two,........

 

[RAE]

I don't remember "the medical establishment" (including our family doc and health class in high school back in the 60's) pushing "Sugary yogurt, margarine with trans-fats, highly processed cereals and other foods" as being healthy for our hearts. Even the old fashioned food pyramid featured whole grains, fresh veggies and produce, lean meat, etc.

Were you suckered into believing commercials and that sort of thing?

All of those unhealthy things were most definitely recommended by USDA, AHA, and many other government-backed nutritional organizations for years, going back at least to the 50s/60s. Even today, plenty of bad advice is still being given out. For example, quite a few highly processed cereals have the AHA "healthy heart" seal of approval on the box. And USDA still recommends (as part of their "MyPlate" guideline, which replaced the USDA Food Pyramid) low-fat milk and low-fat cheese, when the evidence is pretty overwhelming now that full-fat dairy is much healthier. I could go on, but this type of advice was and is still being given out.........it is not just from commercials.

 

[Teacher Terry]

DFW, there have been a few examples on this thread where it’s been livesaving. For me as a woman never because none of the studies were done on women.

 

[youbet]

The advice I mentioned came from dieticians, nutritionists and other medical professionals.

I can't say I ever had a dietician, nutritionist or other medical professional give advise pushing "Sugary yogurt, margarine with trans-fats, highly processed cereals and other foods." I guess things were different in your neck of the woods.

IIRC, the original food pyramid never mentioned sugar.

Yep. Not mentioned equaled not recommended as part of your diet as I recall. But darn, processed white sugar with a little cinnamon is really good on a tart apple!

 

[audreyh1]

My recall in this area is very different than yours. I suppose we all have selective memory that supports our beliefs.......

I don't remember "the medical establishment" (including our family doc and health class in high school back in the 60's) pushing "Sugary yogurt, margarine with trans-fats, highly processed cereals and other foods" as being healthy for our hearts. Even the old fashioned food pyramid featured whole grains, fresh veggies and produce, lean meat, etc.

Were you suckered into believing commercials and that sort of thing?

Excuse me. People were told not to eat butter, and eat margarine instead. This was very common, standard advice. Probably lasted two decades.

 

[Teacher Terry]

Audrey, I definitely remember that.

 

[audreyh1]

I completely agree that YOU considered "anything that was low-fat or fat-free for about 30 years to be 'healthy,' no matter how much sugar was in it." But the health education I was exposed to (health class at school, family doc, etc.) pointed otherwise. I can't remember anytime when I didn't understand that fresh produce and veggies, lean unprocessed meat and whole grains were the nutritional target and the highly advertised processed foods were commercial ventures with corresponding advertising.

I can't say that I didn't fall victim to the sales pitches from time to time (especially sweets and processed carbs. Yuuum!) But I never ate a slice of pizza where I didn't understand that eating a appropriately sized portion of protein, fat and carb at mom's kitchen table would have been a better nutritional choice.

Did you really fall for that crap? As you say, "I mean, come on!"

You are saying that products stamped as heart healthy that have an AMA or AHA approval logo, somehow don’t count as advice from the medical community?

 

[RAE]

DFW, there have been a few examples on this thread where it’s been livesaving. For me as a woman never because none of the studies were done on women.

Here is a paper that reviewed 13 previous studies dealing with the effect of lipid-lowering medications on CVD and all-cause mortality, and pulled out the data on women from those studies. So, there is some information out there on the effectiveness of lipid-lowering meds (like statins) on women. Here is the link to the paper, and below that is the conclusion they reached.

https://jamanetwork.com/journals/jama/fullarticle/198731

Conclusions For women without cardiovascular disease, lipid lowering does not affect total or CHD mortality. Lipid lowering may reduce CHD events, but current evidence is insufficient to determine this conclusively. For women with known cardiovascular disease, treatment of hyperlipidemia is effective in reducing CHD events, CHD mortality, nonfatal myocardial infarction, and revascularization, but it does not affect total mortality.

 

[youbet]

All of those unhealthy things were most definitely recommended by USDA, AHA, and many other government-backed nutritional organizations for years, going back at least to the 50s/60s.

Looks like it's time to agree to disagree! I'm not saying that public or private health agencies never recommended foods we today (at least for now) consider less healthy alternatives. But, I think there was plenty of good information out there to point people towards eating fresh produce and veggies, unprocessed whole grain carbs and lean protein. I just don't recall eating "crap" without the understanding there were better alternatives. Admittedly, I am quite prone to taking responsibility for my own decisions and actions and perhaps that plays into it.

Even today, plenty of bad advice is still being given out. For example, quite a few highly processed cereals have the AHA "healthy heart" seal of approval on the box.

Can you give an example of that? I just opened a cabinet and note that our box of Cheerios has the red heart, but I'm pretty sure Cheerios (and oatmeal) are generally considered a heart-healthy food in moderation.

I could go on, but this type of advice was and is still being given out.........it is not just from commercials.

To what extent did you fall victim to all this "bad nutritional advise?" I've eaten tons and tons and tons of "bad stuff" over the years and I'm an ex-smoker too. But I don't remember being bilked by bad information nearly as much as knowing better and making bad choices.

Maybe I'm just more of a sceptic than you and haven't fallen for the crap?

 

[youbet]

You are saying that products stamped as heart healthy that have an AMA or AHA approval logo, somehow don’t count as advice from the medical community?

Nope. I did not say that.

 

[Chuckanut]

Looks like it's time to agree to disagree!

+1

Actually, I suspect if most of us sat down over a cup of our favorite beverages and talked face to face we would find ourselves in overall agreement. The internet often tends to magnify differences, and obscures the more subtle parts of a give-and-take discussion.

 

[flintnational]

I keep hoping the AHA was right about Coco Puffs being heart healthy. I really like coco puffs! I also wish we would go back to the food pyramid. I liked bread being on the bottom. Now we are left in a world where veggies have taken the place of AHA endorsed Coco Puffs and Government recommended bread consumption. Where is the fun in veggies? Blah! Coco Puffs and bread forever!

 

[youbet]

Excuse me. People were told not to eat butter, and eat margarine instead. This was very common, standard advice. Probably lasted two decades.

Since I generally don't use butter or margarine, and never have, perhaps the margarine folks did get pushy in their sales pitch for their product and it went unnoticed by me. But I am curious, who, apart from commercial interests which I'm always very wary of, gave this advise? I'll Google around and see what I can find, but it sounds more commercial orientated than anything else. And, in the USA, if you're dumb enough to listen to commercial promoters of products without your own due diligence, you deserve what you get.

 

[Dawg52]

The topic of statins is almost as hot as politics and religion. Ha. My take is don't necessarily gulp down everything a doctor prescribes but have a good reason not to do so. I've been on Lovastatin for 12-14 years. Never had an adverse side effect. I remember going on it right before applying for an individual health plan with BCBS. I was afraid it might be a big negative in getting my plan approved. But when they called for a phone interview they praised my cholesterol and triglyceride numbers and told me to keep on doing whatever I was doing. And my numbers have stayed in good shape.

Every dr I have been to all suggest staying on it. Perhaps they are dumb as hell but I know I'm dumber than them so I will take their advice.

 

[googily]

Since I generally don't use butter or margarine, and never have, perhaps the margarine folks did get pushy in their sales pitch for their product and it went unnoticed by me. But I am curious, who, apart from commercial interests which I'm always very wary of, gave this advise? I'll Google around and see what I can find, but it sounds more commercial orientated than anything else. And, in the USA, if you're dumb enough to listen to commercial promoters of products without your own due diligence, you deserve what you get.

Well, bless your heart.

 

[flintnational]

........And, in the USA, if you're dumb enough to listen to commercial promoters of products without your own due diligence, you deserve what you get.

I completely agree. And, that is one of the reasons some of us doubt (but in my case not sure) of the cholesterol/statin story. The trials were funded by commercial organizations and statins have historically been one of the the most profitable drugs. And they were deceptively marketed, relative risk vs. absolute risk. I would love it if they were a wonder drug and maybe they are. But, for the reasons you mention, I look at the source of the information with great skepticism. I truly am a believer in science. But when the government and or commercial interests are involved in science, there is the possibility good science gets pushed aside.

 

[youbet]

I keep hoping the AHA was right about Coco Puffs being heart healthy. I really like coco puffs! I also wish we would go back to the food pyramid. I liked bread being on the bottom. Now we are left in a world where veggies have taken the place of AHA endorsed Coco Puffs and Government recommended bread consumption. Where is the fun in veggies? Blah! Coco Puffs and bread forever!

Well, ya got me there flintnational! I don't know anything about those cereals and can't figure out how to blow up the pic so I can read the nutritional labels. Off hand, those brands wouldn't be something you'd find in our pantry because the names and cartoon characters scream "watch out!" (We have Cheerios, oatmeal and sometimes Special K Protein in the cabinet at the moment.) I went to the AHA site and their general dietary recommendations look pretty non-controversial. But I couldn't find any info (in a very brief search) regarding how they award their heart-thingy stamp of approval and the criteria. "Coco Puffs" just sounds bad! And there are handy alternatives, like plain oatmeal, readily available. But I'll have to see a nutritional label to know just how bad Coco Puffs are for heart health if consumed in moderation.

 

[flintnational]

If I am not mistaken, the AHA has pulled their "Heart Healthy" endorsements. Hopefully it was obvious that I was kidding. We never followed their recs and knew at the time high sugar was not good. But, in the 80's and early 90's we did follow the food pyramid somewhat. We ate a lot of pasta, upped carbs, reduced meat consumption and even added some vegan meals. My weight continued to climb as my health deteriorated. We now eat a low carb whole food diet with lots of veggies and meat, fish and olive oil. Problems solved.

Well, ya got me there flintnational! I don't know anything about those cereals and can't figure out how to blow up the pic so I can read the nutritional labels. Off hand, those brands wouldn't be something you'd find in our pantry because the names and cartoon characters scream "watch out!" (We have Cheerios, oatmeal and sometimes Special K Protein in the cabinet at the moment.) I went to the AHA site and their general dietary recommendations look pretty non-controversial. But I couldn't find any info (in a very brief search) regarding how they award their heart-thingy stamp of approval and the criteria. "Coco Puffs" just sounds bad! And there are handy alternatives, like plain oatmeal, readily available. But I'll have to see a nutritional label to know just how bad Coco Puffs are for heart health if consumed in moderation.

 

[Scratchy]

Two characteristics describe our membership. We all know to do our own due diligence, and we’re respectful of fellow forum members. In other words, we know how to disagree without being disagreeable.

MichaelB, I like this forum and greatly appreciate the excellent work and generous character of the moderaters here especially including yourself. But on the topic of statin use, I think this forum has gone astray.

I am a physician and posted once before in a thread not different from this one that I believed it was not advisable to allow medical advice to be given on an open forum. I did not make any statement on statin use itself. There followed in response attacks on me personally and the medical profession in general. So, it is not true that "we know how to disagree without being disagreeable".

Much of what is written about statin use on this forum makes me cringe-complete untruths, invalid application of statistics, citation of dubious sources, anecdotal evidence, conspiracy theories, et al. I believe the internet can and should be used by people to learn about medical issues. But that comes with the danger of getting erroneous information due to the nature of the internet and I think open forums are particularly prone to this. I wish there was an easy way to identify what sites are reliable for getting good medical information but there is a lot of grey.

Guidelines for the use of statins for the primary prevention of cardiovascular disease have been issued by the American College of Cardiology and American Heart Association. They will be modified as new evidence and therapies become available. But in my opinion they are the best Guidelines available now in terms of the rigorousness of how they were developed and the evidence on which they are based.

Here is a link to a user friendly "Guidelines Made Simple" version:

http://www.onlinejacc.org/sites/def...delines/Prevention-Guidelines-Made-Simple.pdf

There is a large volume of posts here which contain stunning misinformation and advocate deviating from these Guidelines. On the other side, I have seen only one person (though there may be more) who identifies him/herself as a medical professional who has undertaken to respond. I'd surmise this is because many medical professionals recognize disagreement would subject themselves to personal attacks, and there is little to be gained from the exercise. On the other side, there is no restraint to repeating over and over the same opinion or even an untruth. For some reason a cadre of very passionate statin skeptics have accumulated here and the result is something akin to a crusade against statins which may lead people who might benefit from them to not take them.

I am not expecting to change the minds of the avowed statin skeptics here, and conversely my opinion that the ACC/AHA Guidelines should be followed will not be changed by anything here. And if you have decided not to take statins, I respect and encourage your right to make your own decision-go forth in peace. The purpose of my post is to note my perception of the tenor of the discussion of statins here, and to recommend to those seeking information on cardiovascular disease prevention the ACC/AHA Guidelines and your doctor as resources above anything written on this forum.

 

[Alan]

I also appreciated the UK based info Alan provided at my request. Thanks Alan!

The fact that the bulk of LDL reduction benefits occur at low doses of Atorvastatin is the primary reason I choose to remain on the drug. My numbers look good and I have no indications of side-effects.

Everyone needs to evaluate their own decision. Note that in the UK "instructions-to-docs paper" Alan shared with us, there are several mentions of patient discretion and choice given in the decision making process flow. This was a pleasant surprise as I thought their sometimes regimented system might not have pointed to giving the patient's desires and inputs consideration.

For sure the physicians discuss medication and other options with their patients. Over the last couple of years I have had discussions on drugs to control my afib which I declined and then the option of Ablation which I agreed to. Similar discussions on the taking of blood thinners, where my Chads2 score is explained and the increased risks of stroke with and without. At the end of the consultations it is the patient’s choice of options that takes precedence.

About 15 years ago a very good friend here needed a heart valve replacement and the cardiologist told him he had the option of a mechanical valve or a pig’s valve. He then said that he was off to the USA to a conference so have a study of the pros and cons on the internet and he would discuss options on his return. My friend was really conflicted on which option to choose but when he saw the doc again he told him that on his conference he had seen lots of evidence of great success with hybrid valves, so this is what they went with. It lasted 13 years and in 2016 needed replacing again. My friend was given the option of a valve within the valve done via catheter surgery, or open heart to replace the whole valve which gives much better blood flow and he was fit enough to recover well from open heart surgery. At 74 my friend chose open heart again and he is doing just great 3 years on.

Sorry for the long post, just wanted to point out with personal examples of the amount of patient doctor consultation that goes on here.

 

[RAE]

To what extent did you fall victim to all this "bad nutritional advise?" I've eaten tons and tons and tons of "bad stuff" over the years and I'm an ex-smoker too. But I don't remember being bilked by bad information nearly as much as knowing better and making bad choices.

Maybe I'm just more of a sceptic than you and haven't fallen for the crap?

I think we are talking about two different things here. It can't really be argued that the govt. and govt-backed organizations like AHA gave out bad dietary advice for many years, as you can look it up and confirm that. I THINK we agree on that. You say, though, that you were not fooled by such bad information, and instead made better choices, most of the time. That's great! But many, many people DID trust that advice as sound (since it was coming from sources they trusted), and I would argue that many of those people experienced (and/or are still experiencing) negative health consequences from eating the way the govt. recommended.

 

[RAE]

If I am not mistaken, the AHA has pulled their "Heart Healthy" endorsements.

Nope, they still do it. See link below:


https://www.heart.org/en/healthy-li...ry-store/certified-foods-in-the-grocery-store

 

[Teacher Terry]

I don’t think anyone is going to change their minds because of what they read on a open forum. I don’t believe it hurts anyone.

 

[Scratchy]

I don’t think anyone is going to change their minds because of what they read on a open forum.

If you don't, why have you written so many posts which would discourage people from taking them?

I don’t believe it hurts anyone.

It could, if someone did not take a medicine which may help them because of something they read online that was bad advice.

 

[youbet]

If I am not mistaken, the AHA has pulled their "Heart Healthy" endorsements. Hopefully it was obvious that I was kidding. We never followed their recs and knew at the time high sugar was not good. But, in the 80's and early 90's we did follow the food pyramid somewhat. We ate a lot of pasta, upped carbs, reduced meat consumption and even added some vegan meals. My weight continued to climb as my health deteriorated. We now eat a low carb whole food diet with lots of veggies and meat, fish and olive oil. Problems solved.

How old are those cereal box pics you found? Our recently purchased box of Cheerios, upon inspection, does have the AHA heart-thingy. I hadn't noticed until our discussion.

The dietician who helped me though slowly losing 70 lbs was a great believer in "whatever works for you - within reason." I think she had so many folks fail in their quest to achieve permanent weight loss, better lipid stats and sustainable dietary habits that she was ready to grant some leeway (within reason) if things were working for you. She refused to go with any of the popular, so-called "fad" diets.

I did it with an approximately 48% carb, 28% protein and 24% fat (long term averages) over two years. About 1700 calories per day, but with a lot of day-to-day variation depending on vacation schedules and that sort of thing.

Both my doc (a DO, not an MD) and the dietician are believers in counting calories within a "basically healthy" (the meaning of that seems quite controversial!) diet and increasing exercise. I tend to be a "responsible for my own actions and outcomes" kind of person, so cutting portions wasn't too bad a challenge and continues to go OK. But the exercise part of the equation has been tougher. I started at about 70 years old and with some aches and pains related to geezerhood so finding excuses to do nothing beyond taking long, gentle walks has been easy. Nobody's fault but mine.......

I haven't wanted to try low carb because I enjoy salads, veggies and fresh fruits and what I'm doing seems to be working. Otherwise, my diet doesn't sound very different from yours. Grilled salmon, asparagus, a bit of wild rice and a salad last night. Skinless chicken thighs, half a small sweet potato and grilled broccoli and a salad the night before. Walleye pizza tonight (substitute walleye fillets for the bread crust and add low-fat mozzarella, sauce, toppings, etc.) Lots of salads with deep greens, reds and yellows. Lots of colorful veggies. No-fat Greek yogurt. Small amounts of whole grains. I've known this was the right way to eat (more or less) all my life but admit to falling victim to my own lust for carbs, sugar and booze. Oh yeah..... I still have a beer or two or maybe a glass of wine most days.

The years I was stuffing my piehole with "bad stuff," I was making those decisions and wasn't sold on doing so by others. We all have to dig for information and make decision and I made a lot of mistakes.

I've been on a low dose of Atorvastatin for maybe 15 years so the following numbers reflect my lipid status on a low dose statin. It seems to be the weight loss and increase in exercise that have helped recently.

The first number is from July of 2017, early in the dietary change period. The second number is from March, 2019.

Cholesterol - 115 to 136

HDL - 56 to 89

Calc LDL - 47 to 40

Trig - 58 to 34

A1C - 5.0 to 5.0