Statin Wars?

[stephenson]

Thank, dirtbiker.

Calculator was interesting to "game." Except this is serious stuff.

Looks like it does what is supposed to do ... seems like is moderately oriented towards statin use in those that have hypertension, taking hypertension meds (different groups perhaps), smokers, age factor, etc ... just like it shows.

I tend to be moderate in my approach to things like this - mainly because I know very few doctors who are NOT smarter than I am ... I can read and hope I understand, but I the end I will weigh all the evidence from those that are in the biz.

Thanks!

 

[ExFlyBoy5]

As someone mentioned, what is "accepted" by the medical profession can be a two edged sword. Although there seems to be a bunch of studies that indicate that a statin *might* not be worth it, the fact is that they are still the "go to" by most providers. Hence, when a provider decides to go against the grain in their recommendation, they now open themselves up to malpractice litigation since they are held to the "national practice standard"

 

[HenryD]

Change your age to 65 and see what it does

7.8%

 

[bmcgonig]

7.8%

You "aged in" to taking a statin according to that calculator. Cool, huh? [emoji16]

 

[razztazz]

7.8%

And what's with this notion that: If one has 'risk' therefore everything must be done to reduce or eliminate it? And everything they do to eliminate it has 'risk' but they never want to mention that. AND all that study data still doesn't tell you what your risk is. So what if I have a statistically discernible "risk"? The knee-jerk to "take statins / Deus ex Cholesterol" seems pretty non-sequitur given the bigger picture, including the much vaunted statsitcs.

 

[HenryD]

You "aged in" to taking a statin according to that calculator. Cool, huh? [emoji16]

Yeah, I'm under 7.5% until 65 Maybe the calculators will be radically different 15 years from now. I'm in the "not going on statins unless I see some evidence of actual ASCVD happening" camp.

 

[dirtbiker]

Thanks for your post. I'm curious, though, what evidence you have found that demonstrates that statins do save lives in people without pre-existing heart disease. I know you use the ASCVD risk calculator, but what I would like to see are any actual studies that demonstrate a benefit to patients who do not already have heart disease. As you may know, there are quite a few studies out there that show just the opposite........that statin use in people without existing heart disease not only does not reduce mortality, but often results in adverse side effects (muscle pain, and even diabetes and cancer).

Here is one such study:

Statins for Heart Disease Prevention (Without Prior Heart Disease) – TheNNTTheNNT

and here is a quote from the authors of the above study:

"These data examine the effect of statins for people who have never before had a heart attack or stroke (most of the people who currently take statins). The effectiveness of the statins appears to be reproducible across studies in this group—they do lower cholesterol in most people who took them. But very few people will avoid a heart attack or stroke by virtue of this change. It takes 5 years of daily statin therapy to achieve a 1.6% chance of avoiding a heart attack, and a 0.37% chance of avoiding a stroke. Most disappointing, statins seem unable to prevent death in this group. And most concerning, the drugs may increase diabetes, a serious and life-altering disease."

If you could comment on their findings, I would appreciate it. Thanks.

What you quoted and linked is not a study. Rather it is a synopsis of multiple studies aimed at explaining medical studies to a non-medical audience. Nothing wrong with this, but it is an important distinction, and can have far-reaching consequences, because they make no mention of how they chose to pool those studies. Did they cherry pick studies that only show no mortality benefit in the primary prevention group? Do they have financial incentives to show a certain result? Are they funded by a particular organization/company? What methodology do they use to pick their studies? I don't know because they don't say. But in an actual study, all of these questions and more are answered. Just something to keep in mind when looking at information online. This website and its members appear to be very legitimate, and most likely are, so don't think I'm tearing them down, I'm not. But, I had never heard of them before this, and just don't know.

There are also studies that show all-cause mortality benefits in patients taking statins for primary prevention.

For example:

Primary Prevention of Cardiovascular Mortality and Events With Statin Treatments | JACC: Journal of the American College of Cardiology

"Statins have a clear role in primary prevention of CVD mortality and major events."

There are many more out there, and the current recommendations, made by physicians and researchers in the field based on current evidence, are as I stated above.

If you are unconvinced and feel that not taking statins against the recommendation of your doctor who has over a decade of post secondary education and experience, then by all means don't take them. I don't force any of my patients to take medications they don't feel comfortable taking. I give them my reasoning and recommendations, but in the end, its up to the individual to make their own choices. I also recommend weight loss and smoking cessation, but most ignore this advice. If I had an overweight smoker, I'd recommend they lose weight, stop smoking, and start a statin (assuming they needed one). This being said, I'd much rather see them stop smoking and lose weight then start a statin. The evidence of these benefits is much clearer and less contested.

The more recent studies on cholesterol and LDL do not show that at all. A lot of people with higher LDL have mostly the larger, fluffy LDL particles which don't cause any heart problems. Most major heart attacks actually occur in people with normal cholesterol levels, but most doctors won't tell you that. Also, statins have been shown to be ineffective (and potentially harmful) when given to people who do not have pre-existing heart disease.

There are lots of recent published, peer-reviewed papers in the medical journals that support what I have said......I've posted links to some of them in the past.

LDL absolutely is in independent risk factor for heart disease. There have been some limited research to suggest otherwise, but the overwhelming majority of studies show otherwise. And if you are in doubt, look into homozygous familial hypercholesterolemia, where untreated the average life expectancy is under 20. Treatment with LDL lowering drugs significantly extends these lives. It's the high LDL. There is no question.

I don't have issue with people choosing their own life paths, even if it decrease their own life expectancy. It's our choice. I do have a problem with people convincing others to do the same. It's irresponsible.

 

[Blueskies123]

https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.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

 

[Teacher Terry]

I think some medications are much more clear cut such as if you have HBP or diabetes. Taking medications for these conditions is a no brainer. I also find it concerning that they keep lowering the level to be diagnosed with HBP or high cholesterol. I have been on a beta blocker for 15 years due to very HBP and a erratic too fast heartbeat with no identifiable reason. When I was diagnosed I was trim and walking 6-8 miles a day. Everyone in my mom’s side of the family develops HBP. Many as young as 31 despite doing everything right. I don’t mind a doctor suggesting a medication but wouldn’t go to one that tried to insist. If someone asks my opinion I give it but would never try to convince anyone to do the same. In the end we all have to live with our own decisions.

 

[dirtbiker]

I accept the above. But there's even controversy within that. There are other calculators besides the one you linked to such as

https://www.mesa-nhlbi.org/MESACHDRisk/MesaRiskScore/RiskScore.aspx

If you were my doctor you would probably prescribe statins to me as I'm about 9% using the calculator above. However if this cardiologist in the article below was my doctor he would not as I'm about 3% using the mesa calculator.

https://www.mdedge.com/cardiology/a...der-adopting-mesa-10-year-chd-risk-calculator

Now you could be right, and of course he could be right, but it's hard to avoid the evidence of the MESA calculator if you're a patient. And would your reaction be insistent on statins if I, as your patient, wanted to use the Mesa calculator?

Again, no judgment on you at all, but you can see the quandary patients are in.

Like I said above, I don't force any of my patients to do anything. I have plenty of patients that refuse colonoscopies, statins, mammograms, paps, etc. It's up to them how they live their lives.

UNFORTUNATELY my compensation is decreased due to "low quality measures" the government has been enforcing when enough of my patients refuse screenings and treatment. It doesn't matter if I document it, I'm held accountable and lose money out of my pocket. Many of my colleagues are dismissing patients from their practice who refuse treatment because it is affecting their bottomline. They then come to see me and my numbers look worse because I don't think it's ethical to dismiss a patient who refuses screenings, etc. On paper though, I look like a bad doctor. And it's only getting worse. Think this is good medicine? I don't think so. Wonder why I'm against socialized medicine? This is only the tip of the iceberg if that comes to pass. Be very afraid of socialized medicine. It's no good for anyone. Sorry, I'll get off my soapbox now.

/end rant.

Thank, dirtbiker.

Calculator was interesting to "game." Except this is serious stuff.

Looks like it does what is supposed to do ... seems like is moderately oriented towards statin use in those that have hypertension, taking hypertension meds (different groups perhaps), smokers, age factor, etc ... just like it shows.

I tend to be moderate in my approach to things like this - mainly because I know very few doctors who are NOT smarter than I am ... I can read and hope I understand, but I the end I will weigh all the evidence from those that are in the biz.

Thanks!

And personally I think this approach makes the most sense.

 

[RAE]

LDL absolutely is in independent risk factor for heart disease. There have been some limited research to suggest otherwise, but the overwhelming majority of studies show otherwise. And if you are in doubt, look into homozygous familial hypercholesterolemia, where untreated the average life expectancy is under 20. Treatment with LDL lowering drugs significantly extends these lives. It's the high LDL. There is no question.

I don't have issue with people choosing their own life paths, even if it decrease their own life expectancy. It's our choice. I do have a problem with people convincing others to do the same. It's irresponsible.

Well, you must be aware that there are a lot of opinions in the medical/research community that are contrary to this. Here is a comprehensive review (from 2018) of a bunch of studies on LDL and heart disease that concludes LDL does not cause heart disease.

https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391?scroll=top&needAccess=true

The authors are all MD's and/or medical researchers from around the world. I've posted this before in another thread, but here are their key findings from their review:


Key issues

• The hypothesis that high TC or LDL-C causes atherosclerosis and CVD has been shown to be false by numerous observations and experiments.
• The fact that high LDL-C is beneficial in terms of overall lifespan has been ignored by researchers who support the lipid hypothesis.
• The assertion that statin treatment is beneficial has been kept alive by individuals who have ignored the results from trials with negative outcomes and by using deceptive statistics.
• That statin treatment has many serious side effects has been minimized by individuals who have used a misleading trial design and have ignored reports from independent researchers.
• That high LDL-C is the cause of CVD in FH is questionable because LDL-C does not differ between untreated FH individuals with and without CVD.
• Millions of people all over the world, including many with no history of heart disease, are taking statins, and PCSK-9 inhibitors to lower LDL-C further are now being promoted, despite unproven benefits and serious side effects.
• We suggest that clinicians should abandon the use of statins and PCSK-9 inhibitors and instead identify and target the actual causes of CVD.

I think you can see there there is far from universal agreement that LDL-C is a causative factor for heart disease. And I hope you can see why many folks are uncertain whether to believe their doctors advice (and the statin calculators) when trying to figure out what the best course of action is to keep their cardiovascular system healthy.

One more question for you, if you don't mind: what do you think of using the Triglyceride/HDL ratio as an indicator of CVD risk? Many studies I've read single that out as perhaps the single best predictor of CVD risk (at least among the blood test results you should pay attention to).

With regard to non-doctors giving advice other people on forums such as this: I always try to make it clear that I am not a doctor (I am a retired biologist), but I do read a lot of medical journal papers on topics of interest to me (like heart disease and statins, etc). And I often link to those papers to support what I believe. The papers I am referring to are generally authored by MDs or medical researchers. So, I am not just reading stuff in a popular magazine and giving out information based on that. And I certainly do not expect anyone to blindly follow what I say either.......everyone needs to do their own research, and form their own opinions. I have read plenty of bad information online myself, as I'm sure we all have. So I'm pretty careful about providing support from a reputable source when I state my opinion/belief about serious topics like medical stuff. I am certainly not giving medical advice to anyone.

 

[RAE]

Like I said above, I don't force any of my patients to do anything. I have plenty of patients that refuse colonoscopies, statins, mammograms, paps, etc. It's up to them how they live their lives.

UNFORTUNATELY my compensation is decreased due to "low quality measures" the government has been enforcing when enough of my patients refuse screenings and treatment. It doesn't matter if I document it, I'm held accountable and lose money out of my pocket. Many of my colleagues are dismissing patients from their practice who refuse treatment because it is affecting their bottomline. They then come to see me and my numbers look worse because I don't think it's ethical to dismiss a patient who refuses screenings, etc. On paper though, I look like a bad doctor. And it's only getting worse. Think this is good medicine? I don't think so.

Thanks for the information - I was not aware of this. I knew that doctors were strongly encouraged to stick to the mainstream advice on things like statins, etc, when advising their patients (which bothers me in the first place, since I want my doctor to give me his best advice on these matters........not blindly follow some mainstream advice that may be 30 years out-of-date). I did not know that your income was negatively affected when patients refuse the recommended treatment. That is really sad to hear. No wonder medical care in this country is so messed up.....

 

[dirtbiker]

Well, you must be aware that there are a lot of opinions in the medical/research community that are contrary to this. Here is a comprehensive review (from 2018) of a bunch of studies on LDL and heart disease that concludes LDL does not cause heart disease.

https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391?scroll=top&needAccess=true

The authors are all MD's and/or medical researchers from around the world. I've posted this before in another thread, but here are their key findings from their review:


Key issues

• The hypothesis that high TC or LDL-C causes atherosclerosis and CVD has been shown to be false by numerous observations and experiments.
• The fact that high LDL-C is beneficial in terms of overall lifespan has been ignored by researchers who support the lipid hypothesis.
• The assertion that statin treatment is beneficial has been kept alive by individuals who have ignored the results from trials with negative outcomes and by using deceptive statistics.
• That statin treatment has many serious side effects has been minimized by individuals who have used a misleading trial design and have ignored reports from independent researchers.
• That high LDL-C is the cause of CVD in FH is questionable because LDL-C does not differ between untreated FH individuals with and without CVD.
• Millions of people all over the world, including many with no history of heart disease, are taking statins, and PCSK-9 inhibitors to lower LDL-C further are now being promoted, despite unproven benefits and serious side effects.
• We suggest that clinicians should abandon the use of statins and PCSK-9 inhibitors and instead identify and target the actual causes of CVD.

I think you can see there there is far from universal agreement that LDL-C is a causative factor for heart disease. And I hope you can see why many folks are uncertain whether to believe their doctors advice (and the statin calculators) when trying to figure out what the best course of action is to keep their cardiovascular system healthy.

One more question for you, if you don't mind: what do you think of using the Triglyceride/HDL ratio as an indicator of CVD risk? Many studies I've read single that out as perhaps the single best predictor of CVD risk (at least among the blood test results you should pay attention to).

With regard to non-doctors giving advice other people on forums such as this: I always try to make it clear that I am not a doctor (I am a retired biologist), but I do read a lot of medical journal papers on topics of interest to me (like heart disease and statins, etc). And I often link to those papers to support what I believe. The papers I am referring to are generally authored by MDs or medical researchers. So, I am not just reading stuff in a popular magazine and giving out information based on that. And I certainly do not expect anyone to blindly follow what I say either.......everyone needs to do their own research, and form their own opinions. I have read plenty of bad information online myself, as I'm sure we all have. So I'm pretty careful about providing support from a reputable source when I state my opinion/belief about serious topics like medical stuff. I am certainly not giving medical advice to anyone.

The 'study' you linked above was really more of an opinion piece using some literature that they hand-picked AND which was authored by individuals who are making money off of books dismissing standard of care medicine, and one who has a patent on a treatment protocol that would compete with statins. I'm far from convinced. Once the treatment recommendations are changed based on the sum of the evidence and expert opinion, I remain far from convinced.

I think the TG/HDL ratio has promise, but there are conflicting studies on its efficacy and benefits as well. Once the major physician-led groups make recommendations based on current evidence on how to actually apply it to my practice, then I'll gladly use it. Doing so early is cowboy medicine. I stick to standard of care medicine.

 

[dirtbiker]

Thanks for the information - I was not aware of this. I knew that doctors were strongly encouraged to stick to the mainstream advice on things like statins, etc, when advising their patients (which bothers me in the first place, since I want my doctor to give me his best advice on these matters........not blindly follow some mainstream advice that may be 30 years out-of-date). I did not know that your income was negatively affected when patients refuse the recommended treatment. That is really sad to hear. No wonder medical care in this country is so messed up.....

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.

 

[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.

 

[Amethyst]

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

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

 

[ExFlyBoy5]

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

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]

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/MESACHDRisk/MesaRiskScore/RiskScore.aspx

I guess you could also do a CT Angiogram?

 

[bmcgonig]

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]

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]

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]

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!

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

 

[bmcgonig]

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]

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.