Preventive cardiac care >65 years of age: statins?

[Amethyst]

I'm shocked that it ignores family cardiac and diabetes history.

OP here. Some excellent responses and web sites to check out. A couple of people asked about a real risk assessment for cardiac problems. This web site was referenced in the doc's talk:

ACC/AHA ASCVD Risk Calculator

It's supposed to assess cardiovascular risk based on American Heart Association/American College of Cardiology guidelines. I did the assessment using my actual data and it said I had a 10 year 23% risk for heart disease or stroke. (I am 71 now.) It also said there was insufficient evidence that starting a low-dose aspirin would help but recommended a moderate to high intensity statin.

I was a little bothered by the high percentage since I consider myself to be in pretty good shape for an old guy. I then played around with the variables that I can presumably control (like cholesterol) and found very small decreases (like from 23% to 21%) in my risk if I get my cholesterol down to ideal levels. So I concluded that at my age the benefit would be modest indeed if I were to start a statin AND if it were to have the desired effect. My biggest risk factors are apparently my sex and age which I can't do much about.

I also noted that the calculator didn't ask anything about physical/aerobic exercise (which I do a lot of) although I suppose that could indirectly be factored into the blood pressure number. Nor did it ask about weight/BMI.

I've had several primary care docs over the past 25 years and have always had cholesterol on the high side. Since none of them have recommended a statin I guess I should trust their collective judgment more than an on-line calculator or a speaker's breakfast talk.

 

[6miths]

I'm shocked that it ignores family cardiac and diabetes history.

Yes, this can be one of the strengths of these calculators. It can get right at what the risk factors have been shown to be. It asks if you have diabetes which on a 10 year time horizon is likely the important question. It also turns out that smoking, risky lipid profiles, high blood pressure and race run in families and these are the independent risk factors that have been identified so far as having the greatest contribution to the overall risk. The good news is that you can alter some of these things, most powerfully with non-pharmacological measures.

Friar1610 was surprised that weight/BMI wasn't included but again the high BP, diabetes and risky lipid profiles that frequently go along obesity are the more predictive factors. (And BMI is not individually an always reliable indicator of obesity.)

 

[braumeister]

A significant point that has been posted here several times is that of those admitted to a hospital with a heart attack, half have high (above the "desired" level) cholesterol and half do not. A fairly large percentage have levels well below the standard "normal" level.

To me, that says your cholesterol levels are not really important in assessing your cardiac risk.

 

[CountryGal]

I am convinced most doctors do not do any risk analysis at all. For most things, it is all dictated by "standard of care". If you have x, then they do y. If they don't, the insurance company and AMA will come down on them. If they don't write you an RX for statin under certain circumstances, they are dinged on their review.

 

[Rustic23]

https://www.amazon.com/New-Low-Carb...70969316&sr=1-1&keywords=low+carb+the+new+way

This book is a "Diet Book", well really more medical than diet. Dr. Thompson is a "Preventive Cardiologist" (relative to my DW). This is one of the few diet books worth reading.

If you want to know about cholesterol and how it effects the heart. Read this book. He is also a big believer in statins. Exercise (walking), daily statin, cut down potatoes, rice, bread and sugared drinks. I don't think he addresses aspirin.

I'm sure he would prefer you buy the book, but if you look at the Amazon preview you can read a good part of the book.

 

[harley]

According to this article Drafter of U.S. Dietary Goals Was Bribed by Big Sugar to Demonize Fat - Hit & Run : Reason.com, newly released historical documents show the Sugar Research Foundation paid scientists to blame fat and cholesterol, not sugar, for coronary heart disease. I'm not trying to make any particular political point here, but it really does show that gov't and even medical recommendations for diet just can't be trusted. There's too much influence by interested parties to know if we're getting the whole story on any topic. I have my ideas about diet, but they're only for me. Everyone else needs to make up their own minds. It's just a shame so much policy like school lunches and all is influenced by faux science. My DGD isn't allowed to bring a cookie or a candy in her school lunch, but she can bring a blueberry muffin. And schools are supposed to teach logic and critical thinking!

 

[Teacher Terry]

Bottom line is that high cholesterol does not cause hart attacks or stroke, etc but it sure is a good con for the drug companies who are making a fortune from it. I am a believer in drugs when needed such as I take HBP meds because they are proven to be a life saver.

 

[Sunset]

Bottom line is that high cholesterol does not cause hart attacks or stroke, etc but it sure is a good con for the drug companies who are making a fortune from it. I am a believer in drugs when needed such as I take HBP meds because they are proven to be a life saver.

+1
Always amusing to read the very tiny print flashed on the tv ads for cholesterol drugs, because if you read the fine print, you wouldn't buy the drug.

 

[Ian S]

Bottom line is that high cholesterol does not cause hart attacks or stroke, etc but it sure is a good con for the drug companies who are making a fortune from it. I am a believer in drugs when needed such as I take HBP meds because they are proven to be a life saver.

The drug companies can't be making much off my generic atorvastatin: under my barebones Medicare Part D drug plan, I pay nothing for a three month mail order supply. (I just turned 65.)

I've been on atorvatatin for a couple of years now after my cholesterol was averaging between 210 and 220 even with regular daily exercise. My doctor suggested I try it however, at the lowest 10 mg dose, I experienced a noticeable increase in the level of my normal aches and pains even though my cholesterol dropped dramatically. We decided to stop the statin and the aches and pains returned to normal. Months later I tried a half a tablet a day and didn't notice an increase in the aches and pains but the effect on my cholesterol was still significant bringing it down to 151. I also take a baby aspirin each day. Heart disease runs in my family - my father died at 65 from his second heart attack and my mother had one in her eighties but survived. My brother just had a heart valve repaired. I've had no problem with bleeding taking the aspirin.

There's another wrinkle in the use of aspirin: its potential to reduce the incidence of certain cancers including esophageal, colon, rectal and prostate. See https://www.mdanderson.org/publicat...-2014/low-dose-aspirin-cancer-prevention.html for a discussion. I'm on a three year colonoscopy regime because I typically have multiple polyps to be removed. I also have Barrett's esophagus that increases my risk for esophageal cancer. I've known people who have died from both cancers and they are horrible ways to go. So I'll continue to take my chances with a daily aspirin as I think the benefits outweigh the risks.

 

[Helen]

After over 30 years of high Cholesterol (no statins), I was surprisingly able to drop it 70 points with a clean mostly plant based diet. I don't believe I have a statin deficiency and when they did further testing (at my insistence) my LDLs were actually the large kind (good) and not the small dense kind that cause issues.

I switched from a pescatarian diet to a mostly whole food, plant based diet and within six weeks my LDL had dropped by 22%!

I used to be a heavy smoker and at one point my total cholesterol was 312. When I was talking to my neurosurgeon about the results of my angiogram (for a brain aneurysm), he said my arteries looked better than 95% of his patients. Meanwhile, my primary care doctor kept trying to get me to take statins.

Unless I have a heart attack or develop heart disease I am not going on statins (and I don't think I would tolerate them according to my 23andme results.)

 

[Dash man]

Well, I was recently put in 40mg of the Lipitor generic and have no additional aches or pains. My LDL cholesterol dropped to 38. I also dropped all processed foods, all wheat products and most sugar from my diet. I did cheat a little on vacation. I don't have any symptoms but have been diagnosed with Coronary Artery Disease and Carotid Artery Disease from a Coronary Calcium Score, a nuclear stress test and a carotid ultra sound.


Enjoying life!

 

[harley]

The drug companies can't be making much off my generic atorvastatin: under my barebones Medicare Part D drug plan, I pay nothing for a three month mail order supply. (I just turned 65.)

This is a common logic fallacy. Just because you aren't paying anything to the drug company doesn't mean they aren't collecting. The gov't or your pharmacy plan is paying, possibly through the nose. Probably not for generic atorvastatin, but you don't really know because the cost is hidden from you.

Go order it from a pharmacy without using any insurance and see how incredibly cheap it is(n't).

 

[meierlde]

This is a common logic fallacy. Just because you aren't paying anything to the drug company doesn't mean they aren't collecting. The gov't or your pharmacy plan is paying, possibly through the nose. Probably not for generic atorvastatin, but you don't really know because the cost is hidden from you.

Go order it from a pharmacy without using any insurance and see how incredibly cheap it is(n't).

If you check the $10 lists at Walmart or go to Costco and they provide prices for name brands and generic alternatives and the like you can see which drugs are inexpensive. Avorstatin comes in at $20 full price for 30 tablets for example at Costco. The Lipitor equivalent comes in at $350 a month.

Of course there is another good reason for prefering generics over branded meds, Consider all the adds about drug problems, if a drug is going to present problems it is likley to do to so before becoming generic as the population taking the drug expands from the drug trials to full use and more folks are exposed to drug side effects.

 

[Ian S]

This is a common logic fallacy. Just because you aren't paying anything to the drug company doesn't mean they aren't collecting. The gov't or your pharmacy plan is paying, possibly through the nose. Probably not for generic atorvastatin, but you don't really know because the cost is hidden from you.

Go order it from a pharmacy without using any insurance and see how incredibly cheap it is(n't).

It's still cheap: about $10 for a month's supply through a bricks and mortar pharmacy. I also am on another drug: pantoprazole for my GERD. Lo and behold, a three month's supply via mail order is also free to me with my Part D drug plan. The drug plan that costs me less than $19 per month (no government subsidy). So no, these generics are cheap and so the margins for the drug companies have to be razor thin.

 

[Chuckanut]

A recent podcast from the People's Pharmacy reported that an Italian study found that a Mediterranean Diet is just as protective of health as taking a statin. Look up show 1048.

So, more fish, veggies, fruit, nuts, and olive oil. Less processed foods, sugar, and factory meats.

 

[harley]

Everyone seems to be missing my point, which is that you can't trust any of these studies without knowing who is performing them, who is paying them to perform them, and how much of that and future payments are based on the results reflecting the desires of the sponsors. And even if the scientists (or whoever) aren't being influenced by money, how many statistics and facts are they ignoring or mangling to make the results fit within their own predefined desired outcomes? I know in a perfect world none of this would happen, but this is not that world. So definitely look beyond the headlines (which the news people usually get wrong anyway), and make your best guess as to what will work best for you. Good luck!

 

[razztazz]

A recent podcast from the People's Pharmacy reported that an Italian study found that a Mediterranean Diet is just as protective of health as taking a statin. Look up show 1048.

So, more fish, veggies, fruit, nuts, and olive oil. Less processed foods, sugar, and factory meats.

Not sure of this most recent study you cite but others have, the Med diet improves health , lowers heart attacks, without regard to lowering cholesterol.

And in real life REAL Mediterraneans eat huge amounts of cheese, highly slated cured fatty meats, eggs, huge amounts of processed refined starches, and very little in the way of whole grains. (And if you read the label whole grains are the same as refined grains. Not a dime's worth of difference) What Mediterraneans do these people study? But I suppose they can call their diet whatever they want.

And if I eat fruit my triglycerides go over 600 so that is a heart attack, obesity, diabetes causing recommendation.

 

[braumeister]

you can't trust any of these studies

I'd be very skeptical of that conclusion.

 

[braumeister]

What Mediterraneans do these people study?

It has long been known that there is no generally accepted definition of "Mediterranean diet" since the term was first used.

 

[CountryGal]

Any study needs to be viewed critically. You need to determine how the study was done to determine if it is "valid" or not. Maybe people forgot what they were eating and didn't report accurately. Maybe the folks looking at the data reached the wrong conclusion. Maybe it is just the fact that people aren't eating junk or red meat. I have heard the Med diet studies have over emphasized olive oil to help fuel their industry and under emphasized vegetables because there is little profit for big business in it.

 

[template]

If you check the $10 lists at Walmart or go to Costco and they provide prices for name brands and generic alternatives and the like you can see which drugs are inexpensive. Avorstatin comes in at $20 full price for 30 tablets for example at Costco. ...

A 30-day supply of Atorvastatin is free at Meijer stores (located in the Great Lakes states and Kentucky).