Statin Wars?

[Amethyst]

What kind of evidence would you need? Surely not an actual heart attack?

Quote:

Originally Posted by HenryD I'm in the "not going on statins unless I see some evidence of actual ASCVD happening" camp.

[ExFlyBoy5]

Quote:

Originally Posted by Amethyst I tried the statin calculator. Sure enough, at 65, with the exact same numbers, I went from "low cardiac risk" to "borderline risk" and a statin was recommended. Still doesn't explain why Mr. A., who turned 65 a long time ago, never gets told to take statins. True, his blood work is better than mine, but as we've been saying, the numbers themselves don't seem to matter when it's a question of age.

Re: Age 65. I think this is because

Quote:

The risk for heart disease increases as we age and almost everyone’s risk for ASCVD is greater than 7.5 percent by age 65.

https://utswmed.org/medblog/statins-debate/

I think debate is good. While not conclusive in any real way...both my Mom and Dad suffered from high cholesterol and were on statins for 20+ years. Mom died at 81, Dad at 90. Neither had a stroke or significant heart issues. Both died of COPD, probably for 2+ packs a day smoking for 20+ years.

Unlike the rest of my family, I don't have high cholesterol and am not on a statin. If I reach 65 years old and the good doc thinks it might be a good idea, then I will take them.

[bmcgonig]

Quote:

Originally Posted by Amethyst What kind of evidence would you need? Surely not an actual heart attack?

You can do a CAC scan. The calculator I referenced above uses that as an input.

https://www.mesa-nhlbi.org/MESACHDRi...RiskScore.aspx

I guess you could also do a CT Angiogram?

[bmcgonig]

Quote:

Originally Posted by ExFlyBoy5 Re: Age 65. I think this is because https://utswmed.org/medblog/statins-debate/ I think debate is good. While not conclusive in any real way...both my Mom and Dad suffered from high cholesterol and were on statins for 20+ years. Mom died at 81, Dad at 90. Neither had a stroke or significant heart issues. Both died of COPD, probably for 2+ packs a day smoking for 20+ years. Unlike the rest of my family, I don't have high cholesterol and am not on a statin. If I reach 65 years old and the good doc thinks it might be a good idea, then I will take them.

I can't imagine that *every* man in the world over 65 should automatically be on a statin. That's the implication.

[RAE]

Quote:

Originally Posted by dirtbiker You shouldn't be bothered that doctors follow the mainstream medical advice. This is the practice supported by the best evidence that we have at the time. Sometimes it is a little out of date (not by 30 years), but it's evidence-based. Would you rather your physician go against current evidence? Or cherry-pick studies and use that as a guideline for how he/she practices medicine? Should he/she treat based on personal experience as opposed to the pooled experience/research of many thousands? Unless you're dying of cancer and looking for the latest emerging drug as part of a study in order to have a chance at saving your life, you're generally going to be much better off with a doctor following standard of care medicine. I mean, I'd much rather my own doctor treat me and my family based on evidence rather than "his best advice," which could be based on anything.

Thanks, but I will have to respectfully disagree with you on this. There is no question in my mind that, in quite a few cases (like statin use), the mainstream medical advice is either way out-of-date, and/or was largely formulated through studies funded by major pharmaceutical companies (with profit as a clear motive, not providing the best possible health care). As a PCP, you must be quite familiar with Big Pharma and the influence they have on medical care in this country. My wife worked at a hospital for 20+ years, and the drug reps would drop by all the time, bearing loads of gifts for everyone (all sorts of stuff, and they'd buy lunch for the whole staff as well). This went on weekly, all through the year. They are not doing this stuff to be nice people - statins are a trillion-dollar business, and of course new drugs are coming out all the time that the reps want the docs to push on their patients. If you could speak to this, as a physician, and whether you have any concerns about it, I would be interested in your thoughts.

If I had a medical condition that I was seeking treatment for, I would like my PCP to give me both the "mainstream medical advice", and also his/her honest opinion on whether that advice was still sound........or whether there are other, perhaps newer/safer, approaches that should be considered. I also would like to have an honest opinion from my PCP as to whether he/she thinks anything in my blood tests (or other tests) need to be addressed, and specifically why. I don't want them to just plug my results into a calculator, that may or may not reflect the latest thinking (and evidence) from the medical community.

I will give you one example where I think my PCP failed me recently, due to simply following "mainstream medical advice". I was having symptoms that alarmed me, and went in for an exam and diagnosis. After lots of blood testing and other stuff, my PCP informed me that he could not find the cause of the symptoms.......no clue. He said my blood test results were all fine. So, I took the blood test results home and went over them myself, in detail. I found that my ferritin level (as well as serum iron) were way up there.......not outside of the "reference range" the lab used, but at the very high end. My ferritin level was over 400 ng/mL, and the reference range was 25-500, as I recall (which seemed like an absurdly large range to me). I did my own research and found out that other countries throughout the world used a reference range for ferritin topping out around 200 ng/mL, and that an optimum ferritin level for men my age was around 60-80 or so (based on published medical papers, not something I read in a magazine). Then I found several papers that talked about the serious problems that could occur from free iron in the blood, at the level mine was at. So I called my PCP back and told him what I had found, and asked him (nicely) whether he thought perhaps my high serum ferritin could be causing my issues. The response was both firm and condescending: the reference ranges we use are based on thousands of patients, and your ferritin is NOT too high, and could not possibly be causing your problems - and don't talk to me about something you read on the internet, I'm not interested. But of course, he still had no idea what might be causing my symptoms. So, I decided to donate blood to get my ferritin level down and see if that helped any (after going to a different doctor, who also had no clue what was causing my symptoms). Result: after a couple of blood donations, the symptoms improved markedly. After about the 3rd or 4th donation, they disappeared completely, and have been gone since.

So I hope that provides some background to my skepticism of "mainstream medical advice", and doctors that simply follow it, period. I also have a strong dislike of doctors (or any professional, really) that treat their patients/customers like small children who know little or nothing about what is best for them, and who should never question their advice. I know you probably are not that way, based on your earlier post, so please don't take this as a blanket criticism of all PCP's.

[ExFlyBoy5]

Quote:

Originally Posted by bmcgonig I can't imagine that *every* man in the world over 65 should automatically be on a statin. That's the implication.

I don't see it as an implication: "almost everyone’s risk for ASCVD is greater than 7.5 percent by age 65." I didn't (nor did the article) imply that EVERY man over 65 should be on a statin.

I look at it the same as "almost everyone's risk of death within 50 years of turning 65 years old" isn't an implication, it's a fact.

[dirtbiker]

Quote:

Originally Posted by RAE Thanks, but I will have to respectfully disagree with you on this. There is no question in my mind that, in quite a few cases (like statin use), the mainstream medical advice is either way out-of-date, and/or was largely formulated through studies funded by major pharmaceutical companies (with profit as a clear motive, not providing the best possible health care). As a PCP, you must be quite familiar with Big Pharma and the influence they have on medical care in this country. My wife worked at a hospital for 20+ years, and the drug reps would drop by all the time, bearing loads of gifts for everyone (all sorts of stuff, and they'd buy lunch for the whole staff as well). This went on weekly, all through the year. They are not doing this stuff to be nice people - statins are a trillion-dollar business, and of course new drugs are coming out all the time that the reps want the docs to push on their patients. If you could speak to this, as a physician, and whether you have any concerns about it, I would be interested in your thoughts. If I had a medical condition that I was seeking treatment for, I would like my PCP to give me both the "mainstream medical advice", and also his/her honest opinion on whether that advice was still sound........or whether there are other, perhaps newer/safer, approaches that should be considered. I also would like to have an honest opinion from my PCP as to whether he/she thinks anything in my blood tests (or other tests) need to be addressed, and specifically why. I don't want them to just plug my results into a calculator, that may or may not reflect the latest thinking (and evidence) from the medical community. I will give you one example where I think my PCP failed me recently, due to simply following "mainstream medical advice". I was having symptoms that alarmed me, and went in for an exam and diagnosis. After lots of blood testing and other stuff, my PCP informed me that he could not find the cause of the symptoms.......no clue. He said my blood test results were all fine. So, I took the blood test results home and went over them myself, in detail. I found that my ferritin level (as well as serum iron) were way up there.......not outside of the "reference range" the lab used, but at the very high end. My ferritin level was over 400 ng/mL, and the reference range was 25-500, as I recall (which seemed like an absurdly large range to me). I did my own research and found out that other countries throughout the world used a reference range for ferritin topping out around 200 ng/mL, and that an optimum ferritin level for men my age was around 60-80 or so (based on published medical papers, not something I read in a magazine). Then I found several papers that talked about the serious problems that could occur from free iron in the blood, at the level mine was at. So I called my PCP back and told him what I had found, and asked him (nicely) whether he thought perhaps my high serum ferritin could be causing my issues. The response was both firm and condescending: the reference ranges we use are based on thousands of patients, and your ferritin is NOT too high, and could not possibly be causing your problems - and don't talk to me about something you read on the internet, I'm not interested. But of course, he still had no idea what might be causing my symptoms. So, I decided to donate blood to get my ferritin level down and see if that helped any (after going to a different doctor, who also had no clue what was causing my symptoms). Result: after a couple of blood donations, the symptoms improved markedly. After about the 3rd or 4th donation, they disappeared completely, and have been gone since. So I hope that provides some background to my skepticism of "mainstream medical advice", and doctors that simply follow it, period. I also have a strong dislike of doctors (or any professional, really) that treat their patients/customers like small children who know little or nothing about what is best for them, and who should never question their advice. I know you probably are not that way, based on your earlier post, so please don't take this as a blanket criticism of all PCP's.

We don't blindly type in numbers and treat based on algorithms or whatever. That is an oversimplification of what physicians do. If it were, schooling would be a lot shorter.

In general, a ferritin level of 400 is indeed too high. However, all reference ranges are based on a particular lab's equipment/data, so they vary from lab to lab, and we take the lab's reference range when we interpret data. This being said, 500 on the high end does seem a bit bizarre.

Whether the ferritin played a role or not in your situation is inconclusive. You can't discount a sample size of 1, the placebo effect, or causation vs. correlation.

Have you had a bunch of other negative experiences with physicians?

[Amethyst]

Woman, too!

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Originally Posted by bmcgonig I can't imagine that *every* man in the world over 65 should automatically be on a statin. That's the implication.

[bmcgonig]

Quote:

Originally Posted by Amethyst Woman, too!

I purposely said man because women's risk is lower so they don't age in at 65, or so it seems.

[bmcgonig]

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Originally Posted by ExFlyBoy5 I don't see it as an implication: "almost everyone’s risk for ASCVD is greater than 7.5 percent by age 65." I didn't (nor did the article) imply that EVERY man over 65 should be on a statin. I look at it the same as "almost everyone's risk of death within 50 years of turning 65 years old" isn't an implication, it's a fact.

If you look at the flowchart that dirtbiker used earlier and the calculator linked to, once you're over 7.5% statins are recommended. Even with good lipid numbers etc. we all "age in" between 65 and 70 or thereabouts. Go play with the calculator and then look at the recommendations. They recommend everyone be on statins at approximately those ages.

[Amethyst]

I already posted that as soon as I plugged 65 into the calculator, it said "Statin."

Women lose their heart protection after menopause, sadly.

Quote:

Originally Posted by bmcgonig I purposely said man because women's risk is lower so they don't age in at 65, or so it seems.

[Amethyst]

Husband is well past 70 and has never been put on a statin. His cholesterol is ridiculously low anyway.

Quote:

Originally Posted by bmcgonig If you look at the flowchart that dirtbiker used earlier and the calculator linked to, once you're over 7.5% statins are recommended. Even with good lipid numbers etc. we all "age in" between 65 and 70 or thereabouts. Go play with the calculator and then look at the recommendations. They recommend everyone be on statins at approximately those ages.

[friar1610]

I've had relatively high cholesterol and triglyceride levels for years but aside from a mild caution to watch my diet, my doctors* have never done anything about them. I've apparently had good ratios which have lessened their concern. However, this year (at 74) I was advised to start a 20 mg Lipitor generic for the first time. Although my LDL has stayed about the same, my HDL had declined when my blood was checked at my most recent physical. My risk factor is now 26.1%. I've been on a mild BP med for years and the hypertension is well controlled. I've exercised regularly for many years and continue to do so. Not overweight.

I've accepted the recommendation and have been on the statin now for about 3 weeks. No signs of side effects to date. I go back at the 3-6 month point for another lipid panel. Guess I'll revisit the decision at that time.

* I said doctors because I've moved a few times in the last 20 years and have had several different docs. I interpreted the fact that, until now, none of them recommended a statin as a good sign that I didn't really need one in spite of the high numbers.

[audreyh1]

Quote:

Originally Posted by Blueskies123 https://www.ahajournals.org/doi/10.1...AHA.118.312782 There is now overwhelming evidence to support reducing LDL-c (low-density lipoprotein cholesterol) to reduce atherosclerotic cardiovascular disease (CVD).3 Statins are the most widely prescribed and evidence-based lipid-lowering drug in the world for lowering LDL-c and reducing cardiovascular morbidity and mortality, both in primary and secondary prevention.4 Recent statistics demonstrate increasing statin use in adults aged ≥40 years5 and in patients with elevated atherosclerotic CVD risk.6 Meta-analysis highlights the benefits of LDL-c reduction, with every 1 mmol/L (38.7 mg/dL) reduction associated with a significant 22% relative risk reduction in major vascular and coronary events.7 This is supported by the Cholesterol Treatment Trialists Collaboration. In men and women with a wide spectrum of clinical characteristics, there was a consistent relative risk reduction in major vascular events per change in LDL-c level with no observed adverse events, suggesting that lowering beyond current targets would further reduce CVD risk.8

The Cholesterol Treatment Trialists Collaboration CTTC holds a bunch of pharmaceutical statin clinical trials data under non-disclosure agreements and is heavily funded by big Pharma. They publish lots of papers praising statins, but no one else can independently verify their results or conclusions because not one else has access to the data. They claimed statin side effects were tiny. Well it turns out that test subjects are routinely screened for side effects and kicked out of the trials - especially during an initial run-in period. No wonder they way underreport side effects. The whole setup reeks.

The JUPITER controlled trial showed clearly that LDL was not the predictor of heart events. Lowering LDL did not have lowering effect on heart events. It was inflammation that predicted the heart events. It turned out the group on statins had lower inflammation and thus much fewer events than those on placebo. The trial was stopped early, and declared a success - but not because of lowering LDL.

There are lots of ways to reduce inflammation - statins are not the only option.

[Amethyst]

Audrey, I think you have written about this before...but what tests are useful to measure inflammation?

Quote:

Originally Posted by audreyh1 The Cholesterol Treatment Trialists Collaboration CTTC holds a bunch of pharmaceutical statin clinical trial data under non-disclosure agreement and is heavily funded by big Pharma. They publish lots of papers praising statins, but no one else can independently verify their results or conclusions. They claimed statin side effects were tiny. Well it turns out that test subjects are routinely screened for side effects and kicked out of the trials - especially during an initial run-in period. No wonder they way underreport side effects. The whole setup reeks. The JUPITER controlled trial showed clearly that LDL was not the predictor of heart events. Lowering LDL did not have lowering effect on heart events. It was inflammation that predicted the heart events. It turned out the group on statins had lower inflammation and thus much fewer events than those on placebo. The trial was stopped early, and declared a success - but not because of lowering LDL. There are lots of ways to reduce inflammation - statins are not the only option.

[audreyh1]

Quote:

Originally Posted by Amethyst Audrey, I think you have written about this before...but what tests are useful to measure inflammation?

In the JUPITER trial they were tracking CRP. There are multiple markers of inflammation, CRP is one of them.

In the JUPITER trial they found that men and women with low levels of LDL-cholesterol were at significantly increased vascular risk due to elevated levels of CRP.

[stephenson]

I don't think I'm following well - assuming dirtbiker is a qualified doctor, and has offered his learned opinion, and several others are not doctors, have not indicated medical training or education, but have their own opinions ... and, the some indication of belief the medical professionals know about the falseness of the information - hidden information, etc - what and who should one believe?

That is the question, right?

Hmmm ... after a lifetime of working in technical fields (non-medical), I have found those with specific training to be more qualified than those without ... while this is an interesting discussion, I think I'm going to monitor the topic, and continue taking generic Lipitor for now ... I could change my mind, but I haven't seen anything in the medical profession except caring, thoughtful people - doctors, assistant, nurses, equipment operators, etc. - that would make me believe I was smarter or better trained or educated in medicine than they are.

[RAE]

Quote:

Originally Posted by stephenson I don't think I'm following well - assuming dirtbiker is a qualified doctor, and has offered his learned opinion, and several others are not doctors, have not indicated medical training or education, but have their own opinions ... and, the some indication of belief the medical professionals know about the falseness of the information - hidden information, etc - what and who should one believe? That is the question, right? Hmmm ... after a lifetime of working in technical fields (non-medical), I have found those with specific training to be more qualified than those without ... while this is an interesting discussion, I think I'm going to monitor the topic, and continue taking generic Lipitor for now ... I could change my mind, but I haven't seen anything in the medical profession except caring, thoughtful people - doctors, assistant, nurses, equipment operators, etc. - that would make me believe I was smarter or better trained or educated in medicine than they are.

You are free to do whatever you want.........I don't think anyone is offering specific medical advice to anyone here, certainly not me. I would like to point out, though, that the opinions expressed by me and some other non-doctors that post here are not just random thoughts we came up with.......in my case, my beliefs are based largely on evidence I've read about in medical journals (papers written by MDs and medical researchers, mostly). And I did not form my opinion on statins and other things based on one or two papers I've read...........there are dozens, and more get published all the time. I don't disagree with you that most medical professionals are caring, thoughtful people. What I think you may be minimizing, though, is that the whole medical system in this country (and other places around the world) is heavily influenced by the drug companies and their relentless drive for profits. For example, a significant percentage of studies on things like statins were funded by the drug companies..........would you expect those studies to reach any conclusion other than statins are recommended for many people? Dirtbiker mentioned that his compensation is negatively affected if too many of his patients do not follow his mainstream medical advice. That's absurd, and it's just one example of how our current medical system is messed up in a major way. I still go to the doctor when I feel I need to, but I also take responsibility for my own health, and do my own research on whatever it is that I need to learn more about. Some other folks choose to just do whatever their doctor tells them to do, and that's okay too. It's your choice, and your health.

[RAE]

Quote:

Originally Posted by dirtbiker In general, a ferritin level of 400 is indeed too high. However, all reference ranges are based on a particular lab's equipment/data, so they vary from lab to lab, and we take the lab's reference range when we interpret data. This being said, 500 on the high end does seem a bit bizarre. Whether the ferritin played a role or not in your situation is inconclusive. You can't discount a sample size of 1, the placebo effect, or causation vs. correlation. Have you had a bunch of other negative experiences with physicians?

From what I understand, the reference ranges used by many labs are based on blood test results from lots of people who are judged to be generally healthy because they are not currently "symptomatic" for a particular condition. But just because someone is not symptomatic (at that particular moment) does not mean they are in optimum health, nor does it mean that they are not on the verge of having issues related to a particular blood test result. So.........someone could have a serum ferritin level of 400, and clearly be headed for problems down the road (maybe not far down the road?), but their result is lumped in with the other "normal" ferritin results to help calculate the desire reference range. Am I correct about that? If so, that means the desired reference ranges for things like ferritin are based on flawed data. That is probably why my ferritin result of 400 did not trigger a reaction from my PCP, when it clearly should have. Virtually all of the medical literature says that 400 is way too high, yet it was fine with my doctor, since it was within the reference range. It is insanity.......

I think it is highly unlikely that the resolution of my issues was not connected in any way to the reduction in serum ferritin I achieved through donating blood. Once I got my ferritin level down below 300, my symptoms improved markedly. Once I got it down below 200, they were basically gone. Obviously, it is a sample size of 1, but I am comfortable with concluding that my high ferritin level was the cause of my issues in this case.

DW and I have both had negative experiences with physicians, yes. I won't bore you with more long stories, but DW also had a lot of problems a few years back, and went to about 3 different doctors to try to figure out what was going on. Like my situation, none of them were able to help at all, so I started doing my own research to try to figure out what was going. After extensive reading, I concluded that she may have a Vitamin B12 deficiency, based on her symptoms. So, I suggested this to the 4th doctor she went to (only telling him I thought it might be a possibility, and asking if it would make sense to look further into it). Fortunately, that guy (a physician's assistant) took my comments seriously, did look into it, and concluded (after ruling out some other things) that she did indeed have a B12 deficiency, and also Pernicious Anemia. Now she takes B12 injections and is doing okay. So that was a positive experience in the end, but it seems like the bad experiences have outnumbered the good experiences lately, at least for us.

[ncbill]

Quote:

Originally Posted by Chuckanut A few years ago a statin 'calculator' was introduced. One input about 1/2 dozen factors relating to health and it came out with a recommendation regarding statins. In my case, I played a few games with it, setting the factors to those of an extremely healthy person - non smoker, very low cholesterol, high HDL, etc. Once the age hit 64, it ALWAYS recommended I take a statin no matter how good all the other factors were. Always. Cut my age down a few years and the recommendation went away, but hit 64 and it as statin heaven not matter how good the numbers and lifestyle. If the medical professionals wonder why people don't trust them, well.... here is a good reason. Edited to add: FWIW, I post this message as a person who has decided it is in my best interest to take a lowest dose statin. I made this decision after a lot of research in to heart disease, LDL, etc. Just because I take a low dose statin does not mean I wanted to be bamboozled into it.

And the calculator posted qualifies one as hypertensive with a systolic BP of 125...surely that needs to be medicated as well?

Or maybe not: https://athleticheartsf.com/your-bp-...this-too-high/