Cholesterol madness

[sengsational]

I notice my doc included direct LDL in my next scheduled blood tests for the first time, without explanation. I have pretty good lipid numbers, so probably he has decided on this as standard procedure for all his patients now.

forza's post mentions some tests that shed light on risk. Some of them are pretty cheap. Calcium score goes on sale once a year here for $99. If you're, say, 55+ and come out with a zero, that's good (a younger person's zero is not meaningful since it takes a while for plaque to calcify). I don't know why someone would not have LP(a), ApoB, homocysteine, and LipoScience NMR, calcium score, and CIMT tests if you were concerned about CV health. You might as well have the whole picture as best the technology can produce if it doesn't cost too much. My PCP did some of these over the span of a few years, and I did some of my own blood tests. A knee jerk doctor might look at my calculated LDL-C and whip out the prescription pad, but with this other information it's obvious that I'm very low risk for CV and the side effects of a statin are nowhere near justified.

 

[youbet]

I'm surprised we haven't heard more from the ER Forum Canadian and Brit folks regarding this subject. Their medical systems seem to be held in great esteem here so I would think that their testing and use of the test data regarding the use of statins would be a good guideline.

Canadians and Brits, what are the guidelines regarding statins from your national medical systems? Are citizens generally compliant to whatever the guidelines are?

 

[RAE]

Needless to say, I immediately went on the highest dose of Crestor and Zetia to drive down the cholesterol and calm the inflammation. 4.5 years later, my cholesterol has dropped nearly 75%. My inflammation markers rapidly got better. My morning wood came back. My VO2Max has actually improved to almost an elite athlete level. I take 300mg of coq10 daily to ward off any chances for statin induced muscle aches especially at my high dosage. So far, I feel great and haven’t had any issues.

Later this year I will have another Coronary CT Angiogram to see if everything I have been doing has worked to halt the progression of my heart disease.

All signs are that my arteries have improved and that I may have caught this just in time to fix it, we’ll see.

Moral of the story is that we are all unique. Some people’s arterial network can handle high cholesterol and be fine. Others like me can’t.

Interesting story - thanks for sharing. I am curious about a couple things, though. You don't mention what your diet was like before you had the CT scan done and got the bad news.....would you mind sharing that? Also, were your triglycerides and HDL numbers good at that time also? You mentioned your cholesterol and LDL numbers, but not triglycerides and HDL (which, to me, are much better indicators of CVD disease risk).

 

[youbet]

I don't know why someone would not have LP(a), ApoB, homocysteine, and LipoScience NMR, calcium score, and CIMT tests if you were concerned about CV health. You might as well have the whole picture as best the technology can produce if it doesn't cost too much.

Might the results of these tests lead to actionable lifestyle changes if you're already leading a reasonably heart-healthy lifestyle and your routine annual physical tests look good? Or is it more of a matter of finding out you require a medical procedure or prescription meds that otherwise wouldn't be known?

 

[RAE]

These debates about statins and apparent bad side effects for many patients makes me wonder why CT scans are not more widely applied. At least if you believe my doc, the calcium score from such a test is a very good indicator of how much actual arterial disease one has developed. He says that it is particularly good for older folks (>60 y.o.) as by that point any deposits would have had time to have calcified.

Of course, the CT scan costs perhaps ~25 times the cost of a lipid panel blood test and involves some non-trivial radiation exposure. And perhaps, in the end, the calcium score is no more predictive of serious problems/mortality than just the blood test (I have no idea on any evidence in this regard)?

Anyways I would be curious if there is any experience/knowledge/wisdom on this subject folks here might share?

Yes, from what I have read, the arterial CT scan that you had done is a good test to consider having done if you are concerned about risk of CVD. I've thought about doing it, but haven't done it yet, since my other indicators (triglycerides, HDL, CRP-HS, HbA1C, etc) are all good, and I'd rather not have the radiation exposure if I don't need the test. But it is definitely something to consider. I would absolutely have this test done before I would ever take a statin drug.

 

[MichaelB]

That’s because your cardiologist is trained in medicine, unlike the quacks here in this thread that are spreading horrible advice.

Two characteristics describe our membership. We all know to do our own due diligence, and we’re respectful of fellow forum members. In other words, we know how to disagree without being disagreeable.

 

[Alan]

I'm surprised we haven't heard more from the ER Forum Canadian and Brit folks regarding this subject. Their medical systems seem to be held in great esteem here so I would think that their testing and use of the test data regarding the use of statins would be a good guideline.

Canadians and Brits, what are the guidelines regarding statins from your national medical systems? Are citizens generally compliant to whatever the guidelines are?

Fortunately I have no personal experience or knowledge of friends or relatives’ discussions with their doctors on statins. NHS doctors are required always to follow the guidelines from the National Institute of Clinical Excellence (NICE)

The advice on the use of statins can be found here

https://pathways.nice.org.uk/pathwa...apy-for-preventing-cardiovascular-disease.pdf

 

[Teacher Terry]

The thing is we all get to make our own decisions. No one is giving medical advice to others. People are merely stating what they are doing for themselves. Following doctor’s advice blindly has led to many injuries and deaths.

 

[youbet]

The thing is we all get to make our own decisions. No one is giving medical advice to others. People are merely stating what they are doing for themselves. Following doctor’s advice blindly has led to many injuries and deaths.

My feeling is that it is much more common for folks to blow off doc's advise and go on with sub-optimal lifestyle situations because "my situation is different."

For example, all the fat, sedentary, smoking, processed food eaters that always seem to have an excuse why they are OK continuing that pattern.

 

[googily]

My feeling is that it is much more common for folks to blow off doc's advise and go on with sub-optimal lifestyle situations because "my situation is different."



For example, all the fat, sedentary, smoking, processed food eaters that always seem to have an excuse why they are OK continuing that pattern.

Not many of those in this thread. Seems like it's mainly people who have chosen to get processed food out of their way of eating, either completely or radically scaled back.

 

[Teacher Terry]

I have always exercised, not smoked, ate decent, etc. Funny thing is my sister who smoked until 60 , doesn’t exercise, eats bad , is 10 years older is just as healthy as I am.

 

[brett]

Neither of us (in Canada) have had an issue with it.

Our respective physicians attribute our relatively good health and stats to our habits. We keep our weight in check, exercise (apparently that is good for our numbers), don't smoke, don't eat processed (especially sugars) or fried foods, olive oil only, lots of fresh fruit, salads with no greasy dressings etc, smaller portions or lean red meat, and of course fish. Plus red wine in reasonable amounts for me. DW has had other issues but they are not in any way connected.

We have doubled down on this since early retirement. We immediately felt the benefits when we started to cut out the junk foods, processed foods, and sugars. We really notice it when we travel. So much more comfortable when we are sitting on long flights or hiking. It is amazing how much excess weight can impact you and your feelings of good health.

Health care costs are increasing in our country. It is no wonder. One only has to go to a public area, shopping center or whatever, and notice the ever increasing number of overweight and obese people. Especially children. Then take a drive down a thoroughfare and see the number of fast food outlets or see amount of space dedicated to processed foods in our grocery stores.

Really, you can't eat and drink yourself into obesity, load up on junk food, live a sedentary life and then expect to reverse the effects by prescriptions drugs. The medical profession and drug companies may appreciate it but your body will not.

 

[Chuckanut]

IMHO, there are two reasons many Americans are suspicious of the drug companies and 'expert' advice.

One reason is the drug advertising we see on TV. On the advice of the couple who do the People's Pharmacy podcast, I tried closing my eyes and just listening to the drug ads on TV. Wow! The impression I got is so much less positive when the pictures of happy, healthy people playing with their grand-kids, skiing down mountain, sailing their boats, etc. etc. etc. are not seen. Just listen to what they actually tell you about the drug.

The Second reason is that the 'experts' got it so very wrong years ago with their over emphasis on reducing fat at any cost. Sugary yogurt, margarine with trans-fats, highly processed cereals and other foods were touted as being healthy for our hearts when they were perhaps more harmful than the natural foods they replaced. I distinctly remember being told to not eat nuts for a snack, instead pretzels (loaded with salt and highly processed white flour) were recommended as they have very little fat in them. ?!?!?! Another time, I was told to avoid avocado on my salad, and instead use a non-fat dressing that was loaded with sugar and calories. ?!?!?!?

Many cereal companies paid $$'s to get the healthy heart OK on their boxes of chocolate sugar bomb cereal. Yet we are supposed to trust the 'health' organizations who told us that sugar bombs were good for our heart. Really?

Statins are a medical tool. They are not the devil, nor should they be put in the water supply. They should be used appropriately in combination with good diet and other healthy lifestyles habits.

 

[MichaelB]

My feeling is that it is much more common for folks to blow off doc's advise and go on with sub-optimal lifestyle situations because "my situation is different."

I agree. It’s also quite easy nowadays to find internet support for any view that is well organized and gives the appearance of reasoned thinking.

It is nonetheless very challenging to pursue health options that run against the health care “status quo”.

 

[youbet]

Not many of those in this thread. Seems like it's mainly people who have chosen to get processed food out of their way of eating, either completely or radically scaled back.

Clearly, my comment to TT referred to people in general and not just folks participating in this thread. And I believe that TT's statement that "Following doctor’s advice blindly has led to many injuries and deaths" referred to people in general and not just people participating in this thread.

 

[forza]

Answering a couple of questions - diet in my 40’s was the standard Mediterranean diet of fish 10+x per week, a few servings of pasta, some wine, mindful of saturated fat intake, etc. my HbA1c results were excellent...no pre-diabetic issues whatsoever. As my cardio said, there’s nothing else you can do dietwise, that’s not your problem. I have deficient cholesterol receptors and clearance in my liver. My HDL was always over 70, my trigs were always under 70.

Sengsational’s test menu is a perfect start for someone around 50 who wants to understand their CV risk before deciding on statins, etc. My homocysteine levels were off the charts high because of a MTHFR genetic defect which inhibited my ability to turn homocysteine into methionine. This directly caused the high homocysteine which can injure the arteries. The fix was easy, i take methylated B2, B6, B12 and methylfolate. Homocysteine numbers are now lower end of normal. I downloaded my raw 23 and Me data and ran it through Promothease to get exact my CV genetic data. It included my APOE status which unfortunately shows an increased risk of heart disease and 3x risk of alzheimers. Also showed that I would respond to statins. Interesting info and important to have to guide decision-making.

My dad needed a stent in his LAD at 53 due to a blockage. He’s been on statins since and has never needed an additional stent, bypass, etc, and he’s now 76. I was following in his footsteps.

This discussion is important to me. If one person avoids an out of the blue CV event because of getting the testing and information mentioned here, that makes me feel helpful on this issue.

 

[youbet]

It is nonetheless very challenging to pursue health options that run against the health care “status quo”.

Defining "status quo" seems challenging. While a number of anecdotal examples of "docs in the pocket of the MegaPharms" forcing steroids on unwilling patients have been given in this thread, that hasn't been my personal experience. My cardiologist, long ago, gave me sales pitch for taking a low dose statin, my PCP countered with a pro vs con discussion and we've been monitoring and discussing ever since. In the end, we all agreed the choice was mine as there was no overwhelming evidence (in my case) one way or the other.

In terms of who is listening to who, my own experience is that I'm aware of more acquaintances finding excuses why doc's suggestions for lifestyle improvements (stop smoking, lose weight, less alcohol, more exercise, etc.) don't apply to them than of situations where a doc is pushing statins in an ongoing, heavy-handed manner. But I do believe and appreciate the anecdotal examples being given by posters.

 

[Chuckanut]

Fortunately I have no personal experience or knowledge of friends or relatives’ discussions with their doctors on statins. NHS doctors are required always to follow the guidelines from the National Institute of Clinical Excellence (NICE)

The advice on the use of statins can be found here

https://pathways.nice.org.uk/pathwa...apy-for-preventing-cardiovascular-disease.pdf

Very interesting. Thanks for posting that link.

The table on page 4 indicates that the majority of the LDL decrease occurs at the lowest dose. After than, the amount of the decrease fall off quite a bit.

For example, Atorvastatin has an initial 37% decrease in LDL at the lowest 10 mg dose. After that each additional 10 mg buys the patient about another 6 percentage point decrease. IOW, doubling the dose only decrease LDL another 6 percentage points. The law of diminishing returns strikes again.

 

[youbet]

Sugary yogurt, margarine with trans-fats, highly processed cereals and other foods were touted as being healthy for our hearts when they were perhaps more harmful than the natural foods they replaced.

My recall in this area is very different than yours. I suppose we all have selective memory that supports our beliefs.......

I don't remember "the medical establishment" (including our family doc and health class in high school back in the 60's) pushing "Sugary yogurt, margarine with trans-fats, highly processed cereals and other foods" as being healthy for our hearts. Even the old fashioned food pyramid featured whole grains, fresh veggies and produce, lean meat, etc.

Were you suckered into believing commercials and that sort of thing?

 

[Chuckanut]

Were you suckered into believing commercials and that sort of thing?

The advice I mentioned came from dieticians, nutritionists and other medical professionals.

IIRC, the original food pyramid never mentioned sugar.

 

[googily]

Anything that was low-fat or fat-free was considered for about 30 years to be "healthy," no matter how much sugar was in it. You can still see "Heart Healthy" labels on cereal, and low-fat and fat-free yogurt was a massive industry.

I mean, come on.

 

[youbet]

Very interesting. Thanks for posting that link.

The table on page 4 indicates that the majority of the LDL decrease occurs at the lowest dose. After than, the amount of the decrease fall off quite a bit.

For example, Atorvastatin has an initial 37% decrease in LDL at the lowest 10 mg dose. After that each additional 10 mg buys the patient about another 6 percentage point decrease. IOW, doubling the dose only decrease LDL another 6 percentage points. The law of diminishing returns strikes again.

I also appreciated the UK based info Alan provided at my request. Thanks Alan!

The fact that the bulk of LDL reduction benefits occur at low doses of Atorvastatin is the primary reason I choose to remain on the drug. My numbers look good and I have no indications of side-effects.

Everyone needs to evaluate their own decision. Note that in the UK "instructions-to-docs paper" Alan shared with us, there are several mentions of patient discretion and choice given in the decision making process flow. This was a pleasant surprise as I thought their sometimes regimented system might not have pointed to giving the patient's desires and inputs consideration.

 

[RAE]

Answering a couple of questions - diet in my 40’s was the standard Mediterranean diet of fish 10+x per week, a few servings of pasta, some wine, mindful of saturated fat intake, etc. my HbA1c results were excellent...no pre-diabetic issues whatsoever. As my cardio said, there’s nothing else you can do dietwise, that’s not your problem. I have deficient cholesterol receptors and clearance in my liver. My HDL was always over 70, my trigs were always under 70.

Sengsational’s test menu is a perfect start for someone around 50 who wants to understand their CV risk before deciding on statins, etc. My homocysteine levels were off the charts high because of a MTHFR genetic defect which inhibited my ability to turn homocysteine into methionine. This directly caused the high homocysteine which can injure the arteries. The fix was easy, i take methylated B2, B6, B12 and methylfolate. Homocysteine numbers are now lower end of normal. I downloaded my raw 23 and Me data and ran it through Promothease to get exact my CV genetic data. It included my APOE status which unfortunately shows an increased risk of heart disease and 3x risk of alzheimers. Also showed that I would respond to statins. Interesting info and important to have to guide decision-making.

My dad needed a stent in his LAD at 53 due to a blockage. He’s been on statins since and has never needed an additional stent, bypass, etc, and he’s now 76. I was following in his footsteps.

This discussion is important to me. If one person avoids an out of the blue CV event because of getting the testing and information mentioned here, that makes me feel helpful on this issue.

Thanks, I appreciate the follow-up. It sounds like you are one of a small minority of people who are genetically prone to CVD, regardless of diet/lifestyle. I know that high homocysteine is associated with high inflammation, including inflammation within the arteries. Having that arterial CT scan done was the smartest decision you could have ever made.

 

[Teacher Terry]

Clearly there are cases where you would be a fool to not take a statin. Part of the problem is that they keep lowering the standards for when you need medications. They are doing that with BP medications too. I remember reading that ideally you shouldn’t be on more than 4-5 medication. I have to take 6 st the present time and don’t intend to add any unless I absolutely have to.

 

[youbet]

Anything that was low-fat or fat-free was considered for about 30 years to be "healthy," no matter how much sugar was in it. You can still see "Heart Healthy" labels on cereal, and low-fat and fat-free yogurt was a massive industry.

I mean, come on.

I completely agree that YOU considered "anything that was low-fat or fat-free for about 30 years to be 'healthy,' no matter how much sugar was in it." But the health education I was exposed to (health class at school, family doc, etc.) pointed otherwise. I can't remember anytime when I didn't understand that fresh produce and veggies, lean unprocessed meat and whole grains were the nutritional target and the highly advertised processed foods were commercial ventures with corresponding advertising.

I can't say that I didn't fall victim to the sales pitches from time to time (especially sweets and processed carbs. Yuuum!) But I never ate a slice of pizza where I didn't understand that eating a appropriately sized portion of protein, fat and carb at mom's kitchen table would have been a better nutritional choice.

Did you really fall for that crap? As you say, "I mean, come on!"