Statin Wars?

[stephenson]

This has probably been discussed before ...

Buddy of mine who has a stated mistrust of doctors sent it to me after i accused him of not trusting doctors ��

I had shared that I aged into statins by turning 65 and having slight elevated BP ...

Looking for thoughtful input wrt this topic ...

 

[RAE]

Yeah, we've had many lengthy discussions here about statins, the diet/cholesterol hypothesis, the wisdom of eating red meat, and related matters. If you do a search using some of those key words, you will likely find them. I am not a doctor, but my opinion, after doing a whole lot of reading on the topics of diet, cardiovascular disease, and statins, is that statins are probably only really appropriate in a small minority of cases. They may reduce cholesterol, but since cholesterol is not the cause of heart disease, a reduction in cholesterol is probably not something to strive for (in fact, people over age 60 with somewhat high cholesterol tend to live longer than those with lower cholesterol). Statins are big business, and a huge money-maker for the big pharmaceutical companies. They tend to get prescribed a lot by physicians because the old hypothesis was that cholesterol caused heart disease, and that anything that reduced cholesterol was a good thing. In the last 20 years or so, that hypothesis has been largely refuted, but things change slowly, so a lot of physicians still cling to the old theory of heart disease. If you want to get an idea what your risk of having cardiovascular disease is, there are other things (blood test numbers) you can look at that have a much higher predictive value than cholesterol. Among them are things like your triglyceride/HDL ratio, your hBA1C number, and your fasting insulin number. Since heart disease is probably an inflammatory disease, your C-Reactive Protein blood test result is another one to look at (CRP is an indicator of the amount of inflammation going on in your body).

I will stop there for now. There is a lot more that could be said, but I'm guessing folks like Audrey (who is very knowledgeable on these topics) will add to this discussion, among others.

With regard to the video you posted - I did not watch all of it, but I'm familiar with Nina Teicholz and her writings, and I generally agree with most of it. She is not a scientist or a doctor, but she is someone who has researched these topics extensively. If you would rather get the opinion of MD's or researchers, there is a ton of published literature on statins, red meat, etc., from the last 20 years or so that I could cite to support what she is saying. Links to some of those published papers are in the other threads on these topics that I mentioned above.

 

[Chuckanut]

This has probably been discussed before ...

Buddy of mine who has a stated mistrust of doctors sent it to me after i accused him of not trusting doctors ��

I had shared that I aged into statins by turning 65 and having slight elevated BP ...

Looking for thoughtful input wrt this topic ...

A quick summary of the main points of the video would be nice.

 

[stephenson]

Thats what I told my buddy ...

 

[samclem]

This has probably been discussed before ...

Here was a very long recent thread on this very subject. Maybe there's more to say, but I kinda doubt it. . .
http://www.early-retirement.org/forums/f38/statin-wars-british-style-96618.html?highlight=statin

 

[RAE]

I watched most of the video. It is worth watching if you want to hear an opposing opinion on the value of statins for treating/preventing heart disease (as opposed to what many physicians and the drug companies will tell you). Basically, she makes a case that drug companies have conducted a scare campaign to frighten patients into taking statins, when they don't need them. She also feels that the potential adverse side effects from taking statins have been minimized/downplayed by drug companies and physicians, and that a significant percentage of people taking patients will experience adverse side effects. She also mentioned that a high percentage of published studies that found statins to be beneficial were sponsored/funded by drug companies, so the results from those studies are suspect.

There is more in the video, but that's the gist of it. For what it's worth, I basically agree with everything she said.

But, don't take my word for it. Spend a little time and do your own research online, then decide what you want to believe. The alternative is to just trust your doctor (and the drug companies) and do whatever they think is best for you. It's your choice, and your health.

 

[Teacher Terry]

Rae, I totally agree with you and you couldn’t pay me to take them.

 

[Amethyst]

"Aging into" statins at 65?

So far, my slightly elevated cholesterol and bad family cardiac history have not triggered Dr's offering statins. Other numbers are more favorable.

But I'm not 65 yet, either. Does the age, itself, trigger the statin "protocol" with the medical community?

 

[H2ODude]

Not sure about an age trigger. But. Same time I turned 65 my PCP retired. Went to new one for usual annual. Took the blood, and next thing I know pharmacy calls and says my (something or other) is ready for pickup (a statin). Really liked my former PCP, more of a meh, you're just fine kinda doc. This set me on a bad start with new as he prescribed this with no discussion. My LDL had actually been falling three years in row from 140 to 120 (diet efforts; always exercised). Having a good friend who had severe leg muscle issues with a statin it will take a lot of solid data to convince me to go on them. I guess if inflammation is the deal, I need to help myself to the Duralactin the vet said to give my Bassett Hound.

 

[stephenson]

Just getting into this, so pardon if reposting, restating, reasking.

I have mild hypertension (easily controlled with irbesartan), bit overweight (10 lbs - always been - 6’1”), no other issues.

As I understand some of the math, given a couple of factors one ages in at 65 ... I questioned doc and he was in strong agreement with the test to age in process, given my factors.

Now, I usually question everything ... i did early review, and decided, given my factors, that I fit the profile for statin inclusion. It made s huge difference in my LDL, then at 113.

Here’s the AHA statement from December 2018.

https://www.ahajournals.org/doi/10.1161/ATV.0000000000000073

 

[dirtbiker]

As a family doctor, some of the absolute worst advice I've seen and had patients tell me about come from internet forums where anyone with a keyboard can post anything, and that can be taken as gospel. I'm not saying everything medical on forums is bad, because it's not, but please keep that in mind.

I use the latest guidelines when I prescribe statins. The research shows that statins save lives. Not everybody should be on them, but a large number of people stand to benefit from using them. Depending upon the age, comorbidities, and cholesterol numbers (some clearly do not need them and some clearly do), I run their ASCVD risk using this readily available online calculator:

https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/

and prescribe based on this algorithm:

Not every case is this simple, so there is some variation, but this covers most patients most of the time. We're trying to save lives, not poison you. I treat myself and my family the exact same way I treat my patients. I try to do what the current research shows is most beneficial.

 

[Chuckanut]

But I'm not 65 yet, either. Does the age, itself, trigger the statin "protocol" with the medical community?

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.

 

[razztazz]

I did the same with a couple calculators. Used insane numbers like HDL 100 and "0" for LDL. Both unlikely or even impossible numbers. In every case my heart attack chances moved at best fractionally but always no matter what when UP with age. By age 60 there were no safe levels of cholesterol including ZERO LDL. I believe they were the Framigham and NCEP calculators.

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.

 

[Blueskies123]

Rae, I totally agree with you and you couldn’t pay me to take them.

I am curious why you are so strongly against statins that "they could not pay you to take them". Medical studies have conclusively shown there is a high correlation between high (bad) cholesterol with low good cholesterol and heart disease.
Do you have heart disease in your family? Have you seen someone linger after a massive heart attack? Stroke? What happens to the spouse and kids after a massive heart attack?



How do you feel about measles, pneumonia, and shingles immunizations?

 

[audreyh1]

"Aging into" statins at 65?

So far, my slightly elevated cholesterol and bad family cardiac history have not triggered Dr's offering statins. Other numbers are more favorable.

But I'm not 65 yet, either. Does the age, itself, trigger the statin "protocol" with the medical community?

First, the "medical community" is not unanimous on this topic.

For some risk calculators it seems to - at least for men.

But there is also evidence that higher cholesterol mean lower mortality for those over 60 or 65.

Some statins list that age 70 or older is a contraindication.

 

[audreyh1]

I am curious why you are so strongly against statins that "they could not pay you to take them". Medical studies have conclusively shown there is a high correlation between high (bad) cholesterol with low good cholesterol and heart disease.
Do you have heart disease in your family? Have you seen someone linger after a massive heart attack? Stroke? What happens to the spouse and kids after a massive heart attack?

How do you feel about measles, pneumonia, and shingles immunizations?

I think your "conclusively shown" statement is way out of date. It's not that simple. There are tons of studies that show no correlation, and some that show an inverse correlation for those over 60.

Scaremongering much? Decisions have to be made with your doctor looking at your individual risks, the life extension and risk lowering that might occur given a particular treatment against the potential side effect risks.

Immunizations have nothing at all to do with this topic.

 

[Amethyst]

To my horror, I input my recent numbers into the calculator, but edged my age up to 65. Sure enough - it now says "Statin recommended."

Since I have strong reactions to almost any Rx, I can see where this is going.

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.

 

[razztazz]

I think your "conclusively shown" statement is way out of date. It's not that simple. There are tons of studies that show no correlation, and some that show an inverse correlation for those over 60.

Scaremongering much? Decisions have to be made with your doctor looking at your individual risks, the life extension and risk lowering that might occur given a particular treatment against the potential side effect risks.

Immunizations have nothing at all to do with this topic.

Oh, those studies do conclusively show the correlation. But... ehh... others do not. The lies... the damn lies... and the stats. Hey, ya know what they say: A half truth is better than none.

I have never ever anywhere met a doctor who cared about my individual risk factors. When i bring it up they get annoyed. "Yeah but STUDIES!!!OOH! OOH!" That's all they say. In my case I have heart disease and strokes in parents starting in early 40's. Sounds bad doesn't it? But see then you're supposed to ask questions and acquire knowledge so that you actually know something. THEN assess risk. But.... I suppose that takes too long. The "study says" it all.

In my case... much harm from statins. Lost work. Disabled for years. Can't sue anybody because "Everybody does it." It's standard protocol. Still waiting after all these years for that heart attack. It's a good thing I had money and good government medical insurance or I'd have been broke and dead long ago.

 

[RAE]

I use the latest guidelines when I prescribe statins. The research shows that statins save lives. Not everybody should be on them, but a large number of people stand to benefit from using them.

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.

 

[RAE]

I am curious why you are so strongly against statins that "they could not pay you to take them". Medical studies have conclusively shown there is a high correlation between high (bad) cholesterol with low good cholesterol and heart disease.

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.

 

[samclem]

[Mod comment] The efficacy of statins, the protocals for prescribing them, and adherence to these protocals in common medical practice, are a subject of great interest and importance to many members here. In the past, these threads have sometimes become acrimonious and their utility has decreased due to the tenor of the posts. To prevent a repeat, please avoid questioning the motives, intelligence, or competence of other members and instead stick to constructive criticism/appraisal of the information presented. Thanks. [Mod hat off]

 

[bmcgonig]

As a family doctor, some of the absolute worst advice I've seen and had patients tell me about come from internet forums where anyone with a keyboard can post anything, and that can be taken as gospel. I'm not saying everything medical on forums is bad, because it's not, but please keep that in mind.

I use the latest guidelines when I prescribe statins. The research shows that statins save lives. Not everybody should be on them, but a large number of people stand to benefit from using them. Depending upon the age, comorbidities, and cholesterol numbers (some clearly do not need them and some clearly do), I run their ASCVD risk using this readily available online calculator:

https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/

and prescribe based on this algorithm:

Not every case is this simple, so there is some variation, but this covers most patients most of the time. We're trying to save lives, not poison you. I treat myself and my family the exact same way I treat my patients. I try to do what the current research shows is most beneficial.

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.

 

[HenryD]

I run their ASCVD risk using this readily available online calculator:

https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/

Current 10-Year ASCVD Risk: 1.8%

 

[bmcgonig]

Current 10-Year ASCVD Risk: 1.8%

Change your age to 65 and see what it does

 

[Teacher Terry]

Blue, because of the increase in diabetes, memory loss and muscle pain. The studies especially in women show more harm than good. I worked with people with disabilities so have seen it all. My dad had a massive stroke at 59 due to COPD and I helped my mom care for him for 14 years.