LDL Measurements and Statin Use Poll

[audreyh1]

Quote:

Originally Posted by ERhoosier Most everything I've read suggests these new guidelines with greatly INcrease the number of folks taking statins. According to Hopkins Director of Preventive Cardiology (Dr Roger Blumenthal), under these new guidelines statin treatment is recommended for 50-60% of men over 50, 30-50% of women over 60, and ALL men over 70!! New treatment guidelines could double number of Americans taking statins - Metro - The Boston Globe

Well that's disturbing.

I thought there really was no benefit for folks > 70.

[Lsbcal]

Quote:

Originally Posted by Chuckanut It certainly is more profitable to treat a risk factor rather than an actual disease. I would be far more comfortable with the recommendation if none of the people involved had a financial interest in the recommendation (The fact that they didn't vote is just putting lipstick on a pig.) And, I would also feel better if big pharma was not aggressively advertising their drugs on TV. My instincts tell me something is not right about this. And I have learned to trust my instincts.

I used to own drug stocks and found myself rooting for whatever would push up the stock prices. This stuff isn't evil but it does appear to go over the top at times. I'm glad I don't own individual stocks now so no need to root for anyone but the general interests of society at large (+ me).

I think your instincts are right on here. It's very easy for people to go with their biases, especially if they can convince themselves it's in others best interests.

[imoldernu]

Despite the number of scholarly works, authoritative pronouncements, long term testing and govenrment approvals, I believe we have a long way to go in determining effectiveness, side effects, and prescriptive selectivity.

Doubtless, treatment is effective but broad brush declarations about protecting against specific ills (ie. heart attacks) hmmm . read 10 studies, and read 10 different results.

Comments like this:

Quote:

Dr. Michael Johansen, a professor of family medicine at Ohio State University's Wexner Medical Center, said the new statin guidelines should gain acceptance from patients and physicians, despite 20 years of marketing and medical practice that fueled "the misconception that statins are for cholesterol reduction instead of a drug to prevent heart attacks and strokes." Johansen called the new guidelines "far simpler and more effective to implement" than the current approach, which calls on doctors to prescribe additional medications to patients with stubbornly high LDL. These include cholesterol absorption inhibitors, high doses of niacin, bile acid binders and triglyceride-lowering fibrates. As the new guidelines enter into broad use, Johansen said, both patients and physicians will be happy to scale back the use of costly non-statin cholesterol medications "that haven't been shown to make people live longer or happier lives."

leads to a "one size fits all " solution... probably good over the broad public, but not borne out by the testing that leads to the many warnings for individual drugs.

I worry that it lowers the bar for phyicians. Personal experience... after years of switching through six different statin type drugs, with very small effect, a change to Lipitor resulted in a large reduction in LDL, and was continued for five years. Dr. was pleased with results and with the onset of aches and pains, was happy to prescribe Celebrex for developing arthritis... two more years. Then after moving and forgetting the Lipitor, went a week without it, and amazingly the arthritis disappeared... (leg and arm aches).
After changing doctors my new (angel) lady doctor... tried me on fenofibrates (one of the drugs that the current articles seem to indicate aren't as effective as a statins...) and not only did the LDL drop, (still a little high, but not like the 325 of years ago) but my off the wall triglycerides, (at one time in the early 1990's over 1000 when the ratings went that high) dropped to near normal.
Currently, BP is 120/70, and last two physicals make me worry that I could live to 100... (can't afford that).

So yes, a boring personal health history, that is atypical and by itself meaningless, except to make me do more reading on the test results and the detailed information on the goverment websites.

I fear that the 3 minute TV news blips and the 500 word articles in the online and printed media, are stepping into the realm of the "magical cure" or "new discovery" area... while a concientious doctor will have to stand on the knowledge and state of the art medical journals.... which, from what I can see, varies.

No plans to change what we're doing.... and BTW... nice side effect to getting old... losing weight... back down to "large" from Xlarge, for the first time since retirement in '89.

[Mr. Paul]

When diagnosed as a type 2 diabetic 8 years ago, my doctor said I needed to go on statins. Did my own research and told the doc, no I don't need to go on statins. My mid 60's HDL level told me so.

After three years of appointments during which he continued to hammer away, I finally agreed. I developed muscle pain within one week to 10 days on Lipitor, then again on Simvistatin. To me that stuff is poison. My wife is a physical therapist and has treated patients who, with the help of their doctors, ignored the muscle pain symptoms for years and became disabled as a result.

[rockymountainhigh]

Here are some videos from ABC Catalyst in Australia about cholesterol.

Heart of the Matter Part 1 - Dietary Villains - YouTube

Part 2:

Heart of the Matter Part 2 - Cholesterol Drug War - YouTube

[donheff]

Quote:

Originally Posted by rockymountainhigh Here are some videos from ABC Catalyst in Australia about cholesterol. Heart of the Matter Part 1 - Dietary Villains - YouTube Part 2: Heart of the Matter Part 2 - Cholesterol Drug War - YouTube

I liked both of these documentaries but the blow-back from the Australian Heart Assoc has been intense. They accused the doctor who made the documentary of endangering viewers and called her sources fringe. She makes a spirited rebuttal here.

[rockymountainhigh]

My Doc ( Kaiser) wanted me to start treatment due to high numbers...I declined. Didn't test for atherosclerosis just wanted to start the drugs. I am not comfortable with having my liver messed with just because it is doing its job.

[Lsbcal]

I think we should be careful about dissing the newest studies. I'm not going on statins but I'm probably in the low heart risk category. My cursory look at the scoring on the new ideas from a downloadable Excel file was that I was somewhat high ... which surprises me. But I run >20 miles/week and am active in other ways.

It's not the same for all of us. Some of us here are sedentary. Some of us have genetically inherited issues. Some are overweight and don't see it in the mirror. Etc.

[donheff]

I'm in about your situation Lsbcal. I dropped the statins and have done great on a low carb diet. But, if a sensible approach now appears to me to have shifted 180 degrees who knows what will be wisdom in 10 years.

[meierlde]

Quote:

Originally Posted by donheff I'm in about your situation Lsbcal. I dropped the statins and have done great on a low carb diet. But, if a sensible approach now appears to me to have shifted 180 degrees who knows what will be wisdom in 10 years.

This is the whole problem, as another example when I was growing up in the 1950-1960 period margarine with is trans-fats was more healthy than butter, but things have changed, and the opposite is true today. Of course 150 years ago alcohol was good for whatever might have ailed you (take enough and at least for a while you fell better). I do tend to agree that the medical profession is one big conflict of interest in favor of more treatment today, but if you when to a payment per patient per year you might find the conflict the other way to do the least possible.
Of course thank goodness you have the right to say no to any treatment yet.

[harley]

Quote:

Originally Posted by audreyh1 Well that's disturbing. I thought there really was no benefit for folks > 70.

Well, it's important to have good numbers when you die.

[eytonxav]

I've been on a statins for probably 10+ years, but only in the past few years has my PCP insisted on getting my ldl <70 due to my type 2 diabetes (despite it being well controlled with a1c's of 5.5 or less). If I read the article correctly, perhaps they will ease up on that < 70 requirement. I've always believed your body needs a certain amount of cholestrol to function properly, and did not really agree with shooting for such low ldls.

[Chuckanut]

I actually read the information pamphlet that came with a statin. It talked about clinical trials where the statin did provide a small but statistically significant reduction in future heat attacks and death for people who had previously had a heart attack. I kept reading to see what trials showed it would prevent heart attacks and prolong life for people without heart disease. IIRC, I never found any mention of this.

Many times when I hear about how statins help us, the speaker refers to the first group who are helped (people who have had heart attacks), and then slides into discussing the second group (people with no diagnosed CVD) leaving the impression that the study results are the same.

[ERhoosier]

Quote:

Originally Posted by Chuckanut It certainly is more profitable to treat a risk factor rather than an actual disease.....

True, but sometimes people also benefit from the profit motive of Big Pharma. If (theoretical example), my personal/family history suggested a 25% risk of heart attack (or worse) in next decade and a drug could reduce that risk to <5% (inc all drug side-effects) at a cost of $4/month I would consider that a bargain. I would have no problem with part of that cost being Big Pharma profit. OTOH- A drug costing $2-300+/mo to reduce that 10yr risk from 25% to 23% ? IMHO- I could likely get better overall health benefits from spending half that drug cost on fitness membership/personal trainer/healthier foods,etc. It's all about balancing benefits & costs (both $$$ & risk of side-effects).

[Katsmeow]

For the new guidelines as I understand it statins for recommended for 4 groups of people:

1. People who already have atherosclerotic cardiovascular disease.

2. People with LDL levels of 190 or above

3. People who are diabetic between the ages of 40 and 75

4. People with none of the above, but ho have LDL between 70 and 189 and a 10 year risk of atherosclerotic cardiovascular disease.

http://www.medscape.com/viewarticle/814152

There is also not a requirement to try get people to a specific low LDL. What I understand from reading is that under the old guidelines they would try to get someone to a specific LDL target. If statins alone didn't achieve it then they would try to add other drugs or increase dosage to try to get there. Basically they now feel that piling on more drugs just to get to a specific LDL number doesn't achieve much. Part of this is because much of the benefits from statins apparently have nothing to do with the cholesterol reducing effects but from other things statins do such as reducing inflammation.

There are some people who would probably be prescribed under the old guidelines, but would not be prescribed under the new ones. I used to take statins (I am one of those relatively rare people who do get a dramatic reduction in cholesterol level from taking statins). It is clear that under the new guidelines I would not be part of the group recommended to take statins, unless there is some additional criteria used.

Basically people who were told to take statins just because their LDL was high wouldn't be told to take stains under this unless the LDL was at least 190 or the other criteria was met.

However, I read that under the old guidelines for people without high LDL, or existing heart disease, the criteria was a 10 year risk of over 20%. That has been lowerd to 7.5%. This is what brings in tons more people.

You can run the calculator for yourself. You have to download the CV risk calculator

Prevention Guidelines

This is an interesting calculator. Using my numbers from the last time I had cholesterol checked my 10 year risk percentage for ASCVD is about 3% (I am 59). Someone my age with optimal risk factors would have a 2.1% risk. Someone at 50 (that is the only age used on their for the lifetime risk part) with optimal risk factors would have a lifetime risk of 8%.

Using my actual numbers from the last check gave me a 3.1% 10 year risk and 39% lifetime risk. The higher lifetime risk is apparently mostly based upon 2 numbers. My overall cholesterol number and the fact I put in 120 as my systolic BP. In reality, when tested the BP number is usually from 118 to 120.

If I lower my overall cholesterol number from 205 to 180 with systolic BP of 120 my lifetime risk goes to 27%. Lowering my systolic BP to 119 does nothing. If I use 175 cholesterol and 120 systolic BP the lifetime risk is 27%. But then lower systolic BP to 119 and the risk goes down to 8%. So the calculator seems to have some very jarring changes.

The big thing is that some people will have a risk of over 7.5% even with optimal risk factor levels. For example, DH is 66. A 66 year old white male with optimal risk factors has 9.6% 10 year ASCVD risk. So this would say that DH should be prescribed statins basically because he is 66 years old and a male (the risk for a 66 year old white female is 4.5% for 10 years).

And, this is where the big increase in people recommended to take statins come from - all the people who due to age (anyone age 71 or older) or gender (white men who are 63 or older) have a greater than 7.5% risk even if all other risk factors calculated are optimal. Most of those people would be nowhere close to the old 20% level.

[Chuckanut]

Quote:

Originally Posted by ERhoosier True, but sometimes people also benefit from the profit motive of Big Pharma. If (theoretical example), my personal/family history suggested a 25% risk of heart attack (or worse) in next decade and a drug could reduce that risk to <5% (inc all drug side-effects) at a cost of $4/month I would consider that a bargain.

I agree. A 25% chance of a heat attack in the next 10 years would put one in a high risk group I would think. Mot of us are, I hope, comfortably under 10%.

[Chuckanut]

Quote:

Originally Posted by katsmeow and, this is where the big increase in people recommended to take statins come from - all the people who due to age (anyone age 71 or older) or gender (white men who are 63 or older) have a greater than 7.5% risk even if all other risk factors calculated are optimal. Most of those people would be nowhere close to the old 20% level.

bingo!

[Animorph]

Quote:

Originally Posted by Katsmeow The big thing is that some people will have a risk of over 7.5% even with optimal risk factor levels. For example, DH is 66. A 66 year old white male with optimal risk factors has 9.6% 10 year ASCVD risk. So this would say that DH should be prescribed statins basically because he is 66 years old and a male (the risk for a 66 year old white female is 4.5% for 10 years). And, this is where the big increase in people recommended to take statins come from - all the people who due to age (anyone age 71 or older) or gender (white men who are 63 or older) have a greater than 7.5% risk even if all other risk factors calculated are optimal. Most of those people would be nowhere close to the old 20% level.

Yeah, and that seems kind of weird. Theoretically, at age 70 you could have a total cholesterol of 130 and a BP of 110 and it would tell you use statins. What are the statins supposed to be doing for you at that point? Certainly not just lower you cholesterol, which would seem useless at that point.

[rbmrtn]

Since most statins are off patent now, sounds line they trying to make it up in volume.

[donheff]

Quote:

Originally Posted by rbmrtn Since most statins are off patent now, sounds line they trying to make it up in volume.

+1 fits the data.