*Not* taking statins

[samm]

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Originally Posted by BoodaGazelle ............... I was wondering if anyone else has made a similar decision

Yes. But... after 6 months my cholesterol spiked...so I went back to the meds.

[sengsational]

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Originally Posted by Archman If you can't take statins, or need to supplement statins, consider taking NEXLETOL (bempedoic acid) ...

They talked about bempedoic acid in the Attia podcast, but I'd never heard of it before. This is a newly approved (2020) drug, no generic available, and it's $350 for 30 (in the US), according to GoodRx. Doesn't appear on "Canadian" drug seller web sites. Not sure how to see the price of it in the EU, Australia, India, etc, but I'm sure it's cheaper.

https://en.wikipedia.org/wiki/Bempedoic_acid

[6miths]

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Originally Posted by sengsational One should know the NNT for a person like yourself before taking any drug that has a significant risk profile. For an X year old M with no history of heart disease, you'd need to treat Y people to avoid one cardiac event. You can get more specific than age, gender, and cardiac history. If you get an NNT from the doctor, ask which study, and make sure the population was like you.

Quote:

Originally Posted by braumeister A very good point. For an more detailed explanation, this is a good source: https://www.thennt.com

+1

I was just about to post on the same topic. NNT (and NNH - number needed to harm) are relatively easy to understand concepts that can help in decision making. The NNT site (along with the Cochrane Collaboration) is often recommended to learners and has a nice breakdown of 'things that work', 'things that don't work', and 'things we need to study more'. The use of statins in people with no heart disease or at low risk of cardiovascular disease is not recommended. One of the reviews is here - https://www.thennt.com/nnt/statins-p...cular-disease/

Drug companies are famous for trying to push drugs that do work for something (e.g. statins in people who have had a heart attack) into use for all sorts of other conditions or for primary prevention because it 'makes sense'. It may make good business sense but the history of medicine is littered with practices and treatments that 'made sense' at the time but led to much suffering and death in retrospect. Why all medical learners should have to take a 'History of Medicine' course and be constantly fed servings of humble pie. Sadly, a second thing that drug companies have done (with the aid of those who believe in minimal government regulation and oversight) is attempt to hijack Evidence-Based Medicine by taking over and controlling a great many of the drug/treatment trials that are being done.

[braumeister]

Quote:

Originally Posted by 6miths the history of medicine is littered with practices and treatments that 'made sense' at the time but led to much suffering and death in retrospect. Why all medical learners should have to take a 'History of Medicine' course and be constantly fed servings of humble pie.

A short history of medicine.

"I have an earache"

2000 BC Here, eat this root.

1000 AD That root is heathen. Here, say this prayer.

1850 AD That prayer is superstition. Here, drink this potion.

1940 AD That potion is snake oil. Here, swallow this pill.

1980 AD That pill is ineffective. Here, take this antibiotic.

2000 AD That antibiotic is artificial. Here, eat this root.

[6miths]

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Originally Posted by braumeister A short history of medicine. "I have an earache" 2000 BC Here, eat this root. 1000 AD That root is heathen. Here, say this prayer. 1850 AD That prayer is superstition. Here, drink this potion. 1940 AD That potion is snake oil. Here, swallow this pill. 1980 AD That pill is ineffective. Here, take this antibiotic. 2000 AD That antibiotic is artificial. Here, eat this root.

I would posit that this is more a history of trying to gain advantage/value from others complaints. Medicine has achieved some very impressive successes, unfortunately it has also had some pretty embarrassing setbacks. Thus the attempt to move towards more 'Evidence-Based' practices, with varying degrees of success due to the many forces that resist this move. Bear in mind as well that many, many medicines are derived from plants, fungi and bacteria. I would also add that most people are not aware of how recent a phenomenon 'modern medicine' is.

[Time2]

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Originally Posted by audreyh1 Really - equivalent to a mammogram? I find that surprising.

" A study from Kim KP, et al. has found significant variability in the radiation doses delivered at different sites performing CAC scoring with radiation doses ranging from 1 to even as high as 8–10 mSv [2]. Thus, the benefits of coronary artery calcium quantification should be weighted against the risks of exposure to ionizing radiation [1]. --ARRGH! 1mSv, great, 8, not so great.

https://link.springer.com/article/10...410-016-9373-1

[braumeister]

Quote:

Originally Posted by 6miths I would posit that this is more a history of trying to gain advantage/value from others complaints.

No, it was a joke.

[6miths]

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Originally Posted by braumeister No, it was a joke.

Oh yes I totally got that it was a joke. It has been posted before. I would still say it is a good commentary on the 'medicine as a business' model.

[RAE]

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Originally Posted by Time2 " A study from Kim KP, et al. has found significant variability in the radiation doses delivered at different sites performing CAC scoring with radiation doses ranging from 1 to even as high as 8–10 mSv [2]. Thus, the benefits of coronary artery calcium quantification should be weighted against the risks of exposure to ionizing radiation [1]. --ARRGH! 1mSv, great, 8, not so great. https://link.springer.com/article/10...410-016-9373-1

Yeah, I've been reluctant to get a CAC for this reason also. If I had other risk factors for heart disease, I would probably get the CAC, but since my trig/HDL ratio is fine, my HbAIC is good, and other blood test results are all good, I have decided not to get the CAC at this time. There will probably come a time when I want to have the CAC done, but not right now. YMMV.

[Buckeye]

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Originally Posted by 6miths I have never heard any doctor say this and the only thing comparable would perhaps be a single chest X-ray but even that would be almost a weeks worth. By my reckoning, the Calcium score would be about 2 months' worth of exposure. A CT would be about a year's worth.

Just heard this today at my new dentist with digital x-rays! The tech said the lead apron was technically not required but they used it anyway to make patients more comfortable since that's what they are used to. This dentist is doing my implant and I am switching to him as my primary dentist.

Does anyone know if it is true the dose from the latest digital dental x-rays don't require the patient to use the lead apron? This dentist has the latest equipment (including 3D imaging which was awesome for my implant) but it's not all about the tech with him. He is young (and GQ handsome) but very personable and shows great respect for his young techs who are smart as whips.

[DrBrisket]

For some reason, reading this thread triggered a recollection of a statistics paper I read some years ago. Finally managed to remember enough to find the paper that focused on the type of statistics used in cholesterol/lipid studies for risk assessment.

The models typically used in this type of research seem to overestimate the importance of high cholesterol and underestimate the importance of high triglycerides. But there's a lot more for those so inclined to pursue this more. Original paper. There is additional discussion of this paper in chapter 9 of DWScott's Mulitivariate Density Estimation, 2ed, 2015.

[6miths]

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Originally Posted by Buckeye Just heard this today at my new dentist with digital x-rays! The tech said the lead apron was technically not required but they used it anyway to make patients more comfortable since that's what they are used to. This dentist is doing my implant and I am switching to him as my primary dentist. Does anyone know if it is true the dose from the latest digital dental x-rays don't require the patient to use the lead apron? This dentist has the latest equipment (including 3D imaging which was awesome for my implant) but it's not all about the tech with him. He is young (and GQ handsome) but very personable and shows great respect for his young techs who are smart as whips.

Dental X-rays are very low dose. A panoramic dental X-ray is about 40 times less than a mammogram or 400 times less than a GI series and about a 1000 times less than a coronary CT. So very low but I'd still be wearing the collar to protect my thyroid. The problem is that it only takes one stray, albeit well placed, X-ray.

[Buckeye]

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Originally Posted by 6miths Dental X-rays are very low dose. A panoramic dental X-ray is about 40 times less than a mammogram or 400 times less than a GI series and about a 1000 times less than a coronary CT. So very low but I'd still be wearing the collar to protect my thyroid. The problem is that it only takes one stray, albeit well placed, X-ray.

Yes, I had the collar on. I always insist on it. Thanks for the comparisons. I can better picture the dose DH was exposed to for the coronary CT...and why they should only be done sparingly.

[Freedom56]

I had my annual physical yesterday morning and they took the usual five vials of blood for testing. I got an email notification that my results were available late last night. It normally takes three days but things are moving much faster during this pandemic. In any case I logged into my account and my total cholesterol was 172 with my LDL at 102 and the system flagged it as red since it was above the threshold of 100. This threshold used to be 140 for LDL. I have no desire to take medication nor is my doctor recommending that I do to lower it even further.

My doctor talked to me about a shingles vaccine and all the bad things that could happen if I got the shingles. I don't ever recall having chicken pox and requested a blood test for the varicella zoster virus before committing to a vaccine. I'm still waiting for those results.

[6miths]

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Originally Posted by Freedom56 My doctor talked to me about a shingles vaccine and all the bad things that could happen if I got the shingles. I don't ever recall having chicken pox and requested a blood test for the varicella zoster virus before committing to a vaccine. I'm still waiting for those results.

Wouldn't one want the vaccine either way - what would the rationale be for getting the antibody test. If you grew up in a temperate climate the chance that you haven't had VZ is very low. If you haven't had VZ you definitely want the vaccine so you don't get an initial infection now. If you have had VZ you are still at risk of shingles which is nasty.

[Freedom56]

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Originally Posted by 6miths Wouldn't one want the vaccine either way - what would the rationale be for getting the antibody test. If you grew up in a temperate climate the chance that you haven't had VZ is very low. If you haven't had VZ you definitely want the vaccine so you don't get an initial infection now. If you have had VZ you are still at risk of shingles which is nasty.

My mother and my brothers never got chicken pox. My brothers and my mother all tested negative for the VZV. The shingles vaccine is only for those who had chickenpox in the past. In rare cases the the shingles vaccine can cause a rash and even shingles. My rationale is why take a vaccine for something that I never had?

[sengsational]

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Originally Posted by Buckeye Yes, I had the collar on. I always insist on it. Thanks for the comparisons. I can better picture the dose DH was exposed to for the coronary CT...and why they should only be done sparingly.

You can get CIMT, where they measure the thickness of the intima-media. The plus side: no radiation, earlier to show disease (thickens before it calcifies), the minus side: really depends on the skill of the tech doing the scan. The machines are getting less dependent on the "operator variable".

[braumeister]

Quote:

Originally Posted by Freedom56 My rationale is why take a vaccine for something that I never had?

That's what I used to think. Never had chicken pox, nor did any of my childhood friends, AFAIK.

Then I got shingles. Agony.

My doc told me it wasn't at all uncommon to have chicken pox with absolutely no symptoms, so he wasn't surprised at all.

Since that experience I've been a strong vaccine advocate for everyone.

[Freedom56]

Quote:

Originally Posted by braumeister That's what I used to think. Never had chicken pox, nor did any of my childhood friends, AFAIK. Then I got shingles. Agony. My doc told me it wasn't at all uncommon to have chicken pox with absolutely no symptoms, so he wasn't surprised at all. Since that experience I've been a strong vaccine advocate for everyone.

This is why I wanted the blood test for VCV.

[youbet]

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Originally Posted by Old Microbiologist Actually, here the director of the National Cardiac Institute privately agrees with me that statins are only good for pharmaceutical companies.

Statements like this confuse me. Why would pharmaceutical companies push drugs that are cheap and generic? Without insurance, my annual cost to be on a statin (Atorvastatin) is about $24/yr.

Now my blood thinner, that's another story. Without insurance, I'd pay over $5k per year for Xarelto. Seems like that's where the push would be.......

BTW, Google fails to find a "National Cardiac Institute."