The Statin Guidelines: Looking at the Whole Cardiovascular Spectrum

Latest thoughts from Doc Gumshoe on the new Statin Guidelines and cardiovascular health

By Michael Jorrin, "Doc Gumshoe", December 11, 2013

[ed. note: We feature the writings of Doc Gumshoe, our favorite medical scribe, every few weeks here at Stock Gumshoe. He is not a doctor, but we value his insight, research, contrariness and skepticism … and, most importantly, his ability to explain complex health issues for our readers. You can see all of Michael’s previous commentaries here.]

By now nearly everyone has heard about these controversial new statin guidelines, announced on Tuesday, November 12, by the American Heart Association and the American College of Cardiology. In the event that you have been paying attention to far more important matters, such as whether Alex Rodriguez will ever play baseball again, I will briefly summarize the main points. And, to give you an advance peek at where I stand: no, I don’t go with the narrative that holds that this is a conspiracy by the AHA and the ACC to throw more business to Big Pharma. But, also, no, I emphatically don’t believe this is the best way to address the huge issue of interlinked cardiovascular diseases.

Here are the essentials of what these AHA/ACC guidelines do:

  • They attempt to quantify total cardiovascular risk by arriving at a percentage figure for a ten-year risk of cardiovascular events (heart attack or stroke). Individuals aged 40 – 75 whose ten-year risk is 7.5% or higher are recommended to take statins.
  • They recommend that persons whose LDL-cholesterol levels are 190 mg/dL or higher should take statins.
  • The also recommend that persons with existing heart disease or Type 2 diabetes should take statins.
  • But specific LDL-cholesterol goals are not part of the new guidelines.
  • And regular monitoring of blood cholesterol levels is not necessary. The effects of treatment should not be based on how much cholesterol-lowering takes place.

There’s more, but those are the essentials.

As soon as AHA/ACC announced the guidelines, the fur began to fly. Many of the most eminent cardiologists in the country registered vigorous exceptions. One in particular, Dr Paul Ridker, of the Harvard Medical School, examined the algorithm used to calculate the CV event risk, and came to the conclusion that it tended to overestimate risks by a very large percentage, from about 75% to 150%. This would mean that some people would erroneously be placed in the category deemed to need statins when they probably did not need statins at all.

Another critic is Dr Steven Nissen, of the Cleveland Clinic. Dr Nissen did a couple of calculations in men who would be considered healthy by any usual standard – normal blood pressure, normal total cholesterol and HDL-cholesterol, not diabetics or smokers – and the algorithm in both cases (one African American, one white, both age 60) put their risk factors as 7.5%, therefore recommending statins for both men.

A specific criticism leveled at the risk calculator is that it is excessively quantitative – for example, it gives equal weight to a 30 point difference in systolic blood pressure, whether it’s between 100 and 130 mm Hg or 150 and 180 mm Hg. The risk calculator just factors in the number and spits out the answer.

And how about not monitoring cholesterol once the patient is started on the statin? Is the patient supposed to take it on blind faith that the statin is good for him or her? The AHA/ACC folks essentially say “yes – don’t just go by the numbers” (having put the patient on the statin by the numbers in the first place.) But if you’re the patient, what do you go by? In the opinion of many top cardiologists, this would result in low patient compliance, i.e., patients would just not take their pills. And, cardiologists will realize that and not follow the guidelines.

By the way, as these guidelines were being developed, the National Heart, Lung, and Blood Institute – the body that includes the National Cholesterol Education Program (NCEP) – took itself out of the picture. That should tell us something! NCEP has in the past issued treatment guidelines including guideline for statin therapy, and these guidelines have included risk assessment algorithms, i.e., the Framingham Risk Calculator. But those guidelines were much, much more conservative with regard to recommending statin treatment.

What I can say about the new guidelines is that they constitute an attempt to address the entire spectrum of cardiovascular disease (CVD). That’s one thing that I strongly agree needs to be done. Let’s take a look at the whole CVD spectrum.

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Cardiovascular disease and homeostasis

Diseases, illnesses, maladies, disorders, conditions … whatever we call them, have origins that can be grouped under different headings. There are infections caused by invaders such as microbes, bacteria, viruses. There are the maladies caused by nothing more complex than wear and tear, such as osteoarthritis. There are many highly complex diseases of genetic origin. There are the conditions caused by malfunctions in our immune system, such as allergies and autoimmune disorders. Among the diseases and disorders that arise out of disregulation of our own homeostatic mechanisms, cardiovascular disease stands out.

Homeostasis encompasses all the mechanisms of the organism to keep operating in an optimal range. If you build up too much carbon dioxide in your bloodstream, sensors take notice and send a message to your lungs to take a really deep breath. If you get too hot, you sweat, and the evaporation of the perspiration from your skin cools you off very effectively. Those are only two of the multitude of homeostatic mechanisms that are constantly operating in our bodies.

So, let’s look at three homeostatic mechanisms that keep critical body functions operating on an even keel: those that maintain levels of glucose and lipids in the blood and also blood pressure itself at optimal levels. All of these mechanisms are complex and several employ highly sensitive negative feedback processes that keep the physiologic functions that they might be said to supervise within fairly narrow bounds.

It would be natural to suppose that disregulation of these homeostatic mechanisms would occur one at a time. In other words, if the regulation of glucose levels in your blood goes off the track, you tend to develop diabetes, and the effects on your health are limited to that particular disease. Unfortunately, it isn’t that easy. When any one of those three homeostatic mechanisms is not operating as it’s supposed to, the others are affected also, with the result that there is a great deal of overlap among the conditions that these mechanisms are supposed to prevent.

What are these homeostatic mechanisms and how do they work?

Blood pressure

It may help to think of our circulatory system as a kind of irrigation machine for our bodies. The heart is the pump, the blood is the fluid in the system, and the arteries and veins are the hoses that carry this fluid to where it’s needed – i.e., everywhere in our bodies. The pressure in the system depends on how much fluid the pump is pushing into the system, but also on the total quantity of fluid in the system, and on how much flexibility, or resistance, the hoses exert on the fluid. If the pump is pushing too hard, if the amount of fluid in the system is too great, or if the hoses have no flexibility, – if any of those three is happening, the result is an increase in the pressure within the system.

The pumping action of the heart and the pressure in our circulatory system is mostly controlled by the autonomic nervous system. It goes up when we’re more active, or under stress. It goes down as we relax.

The quantity of blood in our circulatory system largely depends on the salt concentration in the blood. This is being monitored constantly and exquisitely, so that if the concentration is too high, we’re thirsty and take in more water to bring it to optimal levels. Then, when the salt concentration is back to normal levels, we get rid of the excess fluid in the usual way.

All of these mechanisms are interlinked, and a number of physiologic agents play a part. One of the most important is called angiotensin II, which is converted from renin, a substance that we make in a gland near our kidneys. Angiotensin II triggers increases in blood pressure by raising cardiac output and also tightens the muscles in our circulatory system.

Cholesterol and blood lipids

Let me say it right off the bat: there’s no such thing as “bad” versus “good” cholesterol. Those are terms adopted by the simplifiers who thought that describing the reality would be beyond the great majority of the public, and what they wanted people to latch onto was those two easy adjectives, “bad” vs. “good.”

Cholesterol is a fairly simple molecule, solid at body temperature, and not soluble in water. Therefore, in order to be transported in our bloodstream, it has to hitch a ride with substances that can be carried around in blood. These are lipoproteins – little particles containing both proteins and lipids, not in any fixed chemical combination, but bundles of varying sizes. Cholesterol attaches to the lipid part of these bundles, and the protein part permits them to be transported in blood.

These particles range in size and density. The low-density, loosely packed bundles, called low-density lipoprotein cholesterol, or LDL-cholesterol, are the ones nicknamed “bad” cholesterol, because they are the ones that are apt to shed the cholesterol molecules themselves, which can attach to the walls of the arteries. But, we have to remember, the LDL-C is absolutely essential to our lives, because those particles are the ones that convey cholesterol to where it’s needed, which is pretty nearly everywhere in our bodies.

The smaller, denser bundles, called high-density lipoprotein cholesterol, or HDL-cholesterol, carries cholesterol back to the liver, where it is taken up by the bile and carried in the bile duct to the colon for excretion in the feces. Therefore, HDL-C is dubbed “good cholesterol.”

It’s worth just mentioning that only about 15% to 20% of the total cholesterol in our bodies enters our digestive systems as cholesterol. The rest we make ourselves. Some of the foods we eat are more easily transformed into cholesterol, such as solid fats, especially partially hydrogenated fats (transfats). But no matter what we eat or don’t eat, we’ll go on making cholesterol, because we need it.

In the case of cholesterol, the homeostatic mechanism is exactly that balance between LDL-C and HDL-C. Those two types of particles have properties beyond their role as cholesterol delivery systems. LDL-C appears to be highly susceptible to oxidative damage, and may also inhibit the synthesis of nitric oxide, which is thought to be one of the body’s natural mechanisms to combat atherosclerosis. And HDL-C has the opposite effect. Its principal lipoprotein, apo A-1, plays a part in preventing particles involved in atherosclerosis from adhering to arterial walls.

So, not only do LDL-C and HDL-C play different roles in cholesterol transport, they do the same with regard to arterial damage. We could say that the nicknames “bad” and “good” cholesterol are fully justified.

Blood glucose

Any sugar we eat, as well as starches, and parts of other foods, is converted to glucose. The more complex the food is, the more work the body has to do to convert it to glucose, but glucose is where a lot of our food intake winds up, because it’s our chief source of energy. The conversion from sugar to glucose is easy as pie and happens very, very quickly. When we eat that piece of pie, a lot of the sugar in it goes into our bloodstream as glucose in minutes. When we drink soda pop, it’s even faster.

But that glucose by itself is useless to our bodies. It has to be metabolized to be converted to energy, and this metabolism can’t take place unless there is insulin present in our system to activate insulin receptors in our cells and trigger the metabolic process.

Insulin is produced in beta cells in the pancreas, partly in response to the presence of food in our stomachs, but also at a fairly constant background rate. The insulin response is the homeostatic mechanism that keeps blood glucose within optimal levels – enough for an energy reserve, but not so much that it can harm our bodies.

And glucose in our bloodstream can indeed harm our bodies, mostly by damaging our smaller blood vessels. Excess glucose in the bloodstream, as in diabetes, is a major cause of organ failure, especially kidney failure, of damage to the retina sometimes causing blindness and also of gangrenous infections leading to amputation.

The progression of diabetes is gradual and, unfortunately, insidious. The disease might be oversimplified as exhaustion of the entire glucose metabolism process. As a person consumes foods that contain or can be converted to glucose, the pancreatic beta cells respond by producing insulin. But the glucose in the circulation can overwhelm the capacity of the system. Insulin receptors throughout the body don’t respond the way they’re supposed to – they are, in effect, worn out. The person develops a condition termed insulin resistance and then hyperinsulinemia – too much insulin in the circulation, which in itself can have bad consequences. In the meantime, glucose levels keep rising.

The reason I said the disease is insidious is that most people who are going through these stages have no idea what’s going on. They mostly feel just fine. In fact, many people who have passed the line defining frank type 2 diabetes – a fasting plasma glucose level of at least 126 milligrams per deciliter – aren’t aware of symptoms severe enough to seek treatment. Thus, although about 14 million adults in the US have received a diagnosis of diabetes, it’s thought that about 6 million more have diabetes but are undiagnosed.

Clustering of risk factors associated with cardiovascular disease

A rational assumption would be that risk factors for cardiovascular disease (CVD) would be additive – that is, that having two risk factors would double one’s risk, having three would triple it, and so forth. Unfortunately, the increased risk is more than additive. And, on top of that, the evidence is fairly strong that these risk factors don’t come along singly. If you have one, you’re more than likely to have at least two, and quite possibly three or four. Here’s some statistics, gathered by the Framingham Study, which has been tracking CVD statistics on several hundred thousand subjects for more than three decades. The risk factors tracked by the Framingham investigators are hypertension (HTN), high levels of triglycerides or LDL-cholesterol, low levels of HDL-cholesterol, impaired glucose tolerance, hyperinsulinemia, obesity, and left ventricular hypertrophy. For persons with HTN, here are the percentages of persons with additional risk factors:

Men Women
No additional risk factors 19% 17%
One additional risk factor 26% 27%
Two additional risk factors 25% 24%
Three additional risk factors 22% 20%
Four or more additional risk factors 8% 12%

So the majority of both men and women with HTN have at least two additional risk factors for CVD, and fewer than 20% have HTN with no additional risk factors.

When we look at the combination of HTN and elevated cholesterol, what we find is that having both conditions increases mortality from coronary heart disease exponentially. These data come from a study called MRFIT, which followed more than 300,000 white men for 12 years. The blood pressure and total cholesterol values for these subjects were divided into quintiles, and the mortality risk was assessed.

As we might suppose, when the mortality risks for HTN and elevated cholesterol alone were calculated, persons in the higher quintiles had higher risks. But in the unfortunate group that was in the highest quintile for both HTN and elevated cholesterol, the mortality risk was 11 times higher – 33.7 per 10,000 patient-years –than in the lucky persons in the lowest quintiles, whose mortality risk was about 3.1 per 10,000 patient years.

Let’s look at diabetes as a risk factor for heart disease and stroke. These data are from the Centers for Disease Control, and they echo the evidence cited above. Persons with diabetes are 3.2 times more likely to have coronary heart disease, 2.9 times more likely to have a stroke, and 1.9 times more likely to experience another type of heart condition. About two-thirds of persons with diabetes die of heart disease or stroke.

Why do we need cut points for defining disease?

Cut points for defining disease are attempts to guide clinicians in the important decision-making process regarding when to initiate treatment.

A major reason why guidelines are out there is to publicize the need for treatment. And why does the need for treatment need to be publicized? Because, in contrast with diseases/conditions/disorders that produce symptoms, most people with hypertension, dyslipidemia, or diabetes experience no symptoms until the disease has progressed to the point of causing real, irreversible damage. Or, sometimes, death.

So, there have to be guidelines, and the public has to be made aware of them. The underlying question is, how closely should they be followed?

Returning to the AHA/ACC guidelines, they seem to me to have one major virtue: they call attention to the clustering of cardiovascular risk factors – not just total cholesterol or LDL-C levels, but the whole spectrum of risk factors, including smoking, nutrition, obesity, gender, age, and race. It’s good for all of us to know this.

But it’s not good for a treatment plan to be calculated by a one-size-fits-all algorithm. An algorithm, or a set of guidelines, should not be a substitute for the clinical acumen, experience, and judgment of a physician who has closely examined and interacted with a patient.

So, what’s to be done?

I suggest that all this brouhaha about the AHA/ACC guidelines may turn out to be a good thing – not that the guidelines themselves are a good thing, but that the discussion may bring more attention to the clustering of risk factors. In other words, individual patients with any of those risk factors may become more aware of the total risks that they run.

That certainly doesn’t mean that doctors should go along with the one-size-fits-all AHA/ACC guidelines, or that great numbers of people should demand prescriptions for statins based on the publicity. Many people clearly have benefited from taking statins; the evidence is the large decrease in the rate of cardiovascular events. A huge decrease in cardiovascular mortality happened in the years from 1963 to 1999, largely due to better treatment for high blood pressure and also to people taking prophylactic aspirin for stroke prevention. And there has been a continuation of this decrease since the introduction of statins in the mid 1990s, so statins are clearly good for lots of people. But that doesn’t mean they’re good for all the people that would be swept under the AHA/ACC guidelines.

A risk factor that I suspect the new AHA/ACC algorithm overweighs is age. (This was also true of the Framingham risk calculator.) Thus, even if you have no other risk factors at all, age by itself could put you over that 7.5% cut point and recommend you for statin treatment.

Doc Gumshoe doesn’t buy that.

* * * * * * *

Many thanks for all your comments. I’ll try to save up questions and answer them in a future piece. Right now, I’m trying to collect some more cheerful tidbits so I can send along some good news before the holidays. Best to all, Michael Jorrin (aka Doc Gumshoe)


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Cleveland
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👍6007

The real enemy is inflammation……. That is what needs to be the focus. “Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before. Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year. Simply stated, without inflammation being present in the body, there is no… Read more »

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Mike Gaynes
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Mike Gaynes

Please… a link to a ten-year-old article in a defunct magazine, courtesy of a website called bargainfishoil.com?

DrKSSMDPhD
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karma swim swami

Mike: My sentiments. Another huckster website. 2013 was the year that good placebo-controlled randomized trials disclosed fish oil to be snake oil.

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takeprofits
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What are you saying, that cold water fish are not healthy? That poisonous chemicals are somehow superior, please do explain.

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DrKSSMDPhD
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karma swim swami

The GISSI trials Myron. “Poisonous chemicals”? You do love drama.

John Mattingly
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John Mattingly

I have CVD, 7 stints in the LAD and other coronary arteries.
I have always had very health cholesterol numbers: HDL 70, LDL 80, TriGs 90 .
There is another test, that measures molecule size that my doc always orders.

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Peyman
Member
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Peyman

Excellent point made. why dont people ever refer to articles in New England Journal of Medicine, or the Lancet or Journal of American Medical Association for articles worthy of discussion?
Such “.com” sponsored articles are completely worthless in the eye of the scientific world. Reader’s Digest articles dont count either.

jrg345
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jrg345

Statins often cause muscle atrophy. What is the heart? A muscle.
There are a whole host of side effects from statin use.
Your health is bigger than any investment you can make. Do your own research!

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DrKSSMDPhD
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karma swim swami

The heart is not skeletal muscle. Statins do not cause cardiac atrophy.

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takeprofits
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Thats not what he said, he stated accurately, “There are a whole host of side effects from statin use.” In fact they are one of the post dangerous drugs on the market, a FACT you choose not to address.

DrKSSMDPhD
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karma swim swami

“Post (sic) dangerous drugs on the market,” a “FACT”? Show me some data Myron. They are among the most extensively prescribed drugs, near the very top of the most 100 heavily prescribed medications in the US. We do not see patients being admitted to hospital for statin complications. That they may in occasional cases cause myopathy, intensify dementia or aggravate insulin resistance is accepted. It does do those things in a minority of cases. That statins cause liver damage is a complete myth that has been richly debunked. Spare us the hyperbole and going all emo, Myron. Dispassionate facts you… Read more »

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DrKSSMDPhD
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karma swim swami

Doc Gumshoe: Not a bad summary for a non-MD. I might finetune some of your comments about diabetes, but you are accurate by and large. As I see things, evolution and natural selection really do not care what happens to you as long as your make it long enough to reproduce. If you are living on the savannahs of Africa at risk for incurring a serious wound from a lion, you have a survival advantage if you have a great deal of LDL to traffick lipid to the site of a wound for healing. That it is bad for us… Read more »

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Cleveland
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👍6007

” what’s the safest, most effective way to eliminate or decrease inflammation?”
Answer: Nutracuetical supplement Anatabloc at GNC
Well I have personal proof as my C Reactive Protein (CRP body inflammation marker) went from over 5 to 1.23 in 12 months.

Dr. Ryan Lanier “Scientifically proven to manage excessive inflammation”

http://www.youtube.com/watch?v=N3XwkBX1WN0&feature=youtu.be

http://www.youtube.com/watch?v=IaEg0SorD3A

Read the testimonials at http://www.gnc.com Anatabloc

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DrKSSMDPhD
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karma swim swami

Personal anecdote does not rise to the level of data. Two data points do not establish anything. Anatabloc is just vitamin A, vitamin D, plus a dash of anatibine. There is no theoretical reason that a homeopathic tincture of anatibine should do anything, and no data that it does anything at all, especially in trace amounts. This is stone soup.

Cleveland
Member
👍6007

Please do some basic research. Please see clinical trials below and scientific presentations. There have also been four peer-reviewed articles published on anatabine. Please research. Clinical Trials Study Title and Status Effect of Anatabine on Elevated Blood Levels of C-reactive Protein Completed Condition: Inflammation Intervention: Dietary Supplement: Anatabine A Study to Evaluate the Safety, Tolerability, and Effects of Anatabloc® Crème in Rosacea Active, not recruiting Condition: Rosacea Interventions: Other: Anatabloc Cream; Other: Placebo Cream Evaluating the Dietary Supplement Anatabloc in Thyroid Health-ASAP (Antabloc Supplementation Autoimmune Prevention) Completed Condition: Thyroiditis, Autoimmune Interventions: Dietary Supplement: Anatabloc Supplement; Dietary Supplement: Placebo Study to… Read more »

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DrKSSMDPhD
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karma swim swami

I am aware of all these “findings.” Anatabine for rosacea? How is that relevant for cardiovascular disease? CRP, a global, nonspecific, crude marker of inflammation at an organismal level, has nothing whatsoever to do with cellular NF-kappaB activity. One study using an animal model for Alzheimer disease? What does this have to do with anything? You disappoint me. What data exist are even weaker than I thought. “Support for the immune system” is typical warm-glow lingo for supplements that haven’t been shown to do anything. You disappoint me. The “Roskamp Institute”? Please.

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wade3
Irregular
👍114

So given the above, Dr. Lundell,” what’s the safest, most effective way to eliminate or decrease inflammation? (saw report RE Lipitor)

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Cleveland
Member
👍6007

You asked ” what’s the safest, most effective way to eliminate or decrease inflammation?”
Answer: IMHO Nutracuetical supplement Anatabloc at GNC
Well I have personal proof as my C Reactive Protein (CRP body inflammation marker) went from over 5 to 1.23 in 12 months.

Dr. Ryan Lanier “Scientifically proven to manage excessive inflammation”

http://www.youtube.com/watch?v=N3XwkBX1WN0&feature=youtu.be

http://www.youtube.com/watch?v=IaEg0SorD3A

Read the testimonials at http://www.gnc.com Anatabloc

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jrg345
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jrg345

Following an internal meeting between the FDA’s Office of Surveillance and Epidemiology and Office of New Drugs, the Agency announced it would be requiring additional warning labels for statin drugs. Among them are warnings that statins may increase the risk of: Liver damage Memory loss and confusion Type 2 diabetes Muscle weakness (for certain statins) According to Dr. Amy Egan, the FDA’s deputy director of safety in the division of metabolism drug products, the new warnings, particularly the one for memory loss, came as the result of anecdotal reports compiled over the past year. In short, with well over 30… Read more »

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DrKSSMDPhD
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karma swim swami

In order to keep discussion lively here and to keep people abreast about events, please note that ABC (A as in Australian) recently broadcast a documentary questioning the whole cholesterol/heart disease hypothesis. I do not agree with its conclusions; while it offers nothing new, it does present an interesting, if lopsided, take on what we are discussing.
You can view it here:
http://www.youtube.com/watch?v=rDVf-00w5gk&list=PL7YKya_R1ROugkN4_FSFU1a9ZhAXZQElW

DrKSSMDPhD
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karma swim swami

John Griffiths: You are definitely correct about those risks, all of them. Not to be crude, but if you boiled down a brain to its component susbstances, cholesterol is a major ingredient, and it is necessary/indispensible for normal myelin sheath function in nerves. When you lower serum cholesterol aggressively with statins, you do “suck out” cholesterol from the brain, and dementia in cause-effect fashion can result. The diabetes issue from statins appears to be more relevant in women. As far as statins causing liver damage, they do not. In fact, they may be the most liver-safe drugs there are! (I… Read more »

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P. S. Maropis
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P. S. Maropis

Only one of the above comments mentions inflammation as a causative factor in CVD, yet many health professionals now acknowledge and accept that as fact. And, unfortunately, elimination of inflammation at this point in time is an unrealistic goal; periodontal disease and CVD have been linked in several studies. As a retired periodontist, I still recall one particular professor’s comment on that subject: Inflammation is present in periodontal pockets (an active disease state) as well as in an apparently healthy gingival sulcus (the space between the gum and the tooth). More studies are indicated, obviously, but I agreed with my… Read more »

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Scott Hall
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Scott Hall

I agree with you that inflammation is the primary causative factor. Statins work to reduce CVD they have a potent anti-inflammatory effect. Unfortunately, for brain health and probably general longevity, they have the side effect of lowering serum LDL levels. I have often wondered about the periodontitis links to CVD being correlative, rather than causative. The same conditions, mostly diet, that promote gum disease also independently cause inflammation issues in the body. High sugar intake is a link to both problems. Inflammation in the body (and the mouth) can absolutely be reduced by to normal levels with lifestyle. This can… Read more »

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rubber
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rubber

35 years ago when a routine blood test first time showed my LDL level to be 270 and HDL 45, my doctor put me on cholesterol lowering drug. After 6 months my levels were 245 and 38, both went down, hence my ratio was worst. I decided to give up medication also because of some side effects. I am 72 now, had I been taking statins, I would be probably dead from side effects. My blood pressure is 122/75 and am on borderline with type 2 diabetes. Sixty percent of people who have hart attack do not have high cholesterol… Read more »

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edski
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edski

Gosh sakes, does anyone else feel that they should just live their life and die when it’s time anymore? That’s what my grandparents did, and everyone before them. Helped to keep the worlds population in check, also. You can test and study drugs all you want, but I fear that all the GMO feeds and food, antibiotic laden meats and poultry and additives we have ingested for years, eventually takes it’s toll anyway. I’m not trying to start an argument, and I believe in common sense. Keep taking the pills if you want to. I’m just asking if anyone else… Read more »

Bob's yer uncle
Guest
Bob's yer uncle

Absolutely agree. I also suspect our highly engineered foods impact our health in ways as yet unknown. No one dies suddenly anymore. They fight maladies for 10 years, feel awful, burden loved ones, bleed the HC system, and eventually die horrible deaths. Statins are a 40 billion industry with built on foundations on data questionably interpreted.

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Sally G
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Sally G

For the most part, yes! We seem to want a magic pill for everything. Sorry, I am not convinced, and will refuse outright any drug less than 10 or 15 years old. I will do my best to avoid being a lab rat. Buy organic when I can, but still have ingested too much of the GMO/antibiotic-ridden processed stuff. Ugh.

andrea
Guest
andrea

never believe what you read on the internet , IF you really want good info , listen to your body , and if you’re worried , go se a naturalist bfore you get a life sentence from your doctor. and it will be all down hill from then on.
Andrea ( med tech).

Mel
Guest
Mel

Thank you for the info and comments. I’ve had high cholesterol and triglycerides for about 30 years, but no hypertension or diabetes. I’ve been on statins off and on during that time when my triglycerides get too high. I agree that statins cause more problems for most people that use them. My doctor just put me on Lipitor, but I stopped because of articles like yours and also getting some side effects in the past. I really appreciate your article and the comments.

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jblynch
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👍12

I’ve been on 10 mg lipitor and now generic for about a decade…sometimes on and off. As I’d had to change GPs recently, I’d obtained records and did a spreadsheet of readings over the years-all over the map. The very first read by the new GP appeared really low on the one measure at 166. He’d said I could consider cutting the pills in half with this read. I discounted that and have not done so. That said, trying to measure into a constantly-downward moving target makes one wonder where they really are and where they should be. My Father… Read more »

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Gazza
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Gazza

What about people who produce excess chol from their liver.

Angela Neese
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Angela Neese

I, too, stopped taking my statins when I finally had enough of waking with calf cramps every stinkin’ night! When I pinned my doc down and asked what the numbers said, he admitted the statistics gave me only a 2% elevated chance for heart disease without the meds. That settled it for me. thanks for the great article and have a Merry Christmas!

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frankw17
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Doc Gumshoe and karma swim swami, thanks for the info. and the analysis. It seems to me that much of the “new” recommendations are made for the benefit of “big Pharma”. What I’m referring to are the current limits for;blood pressure,glucose,cholesterol,etc… have all been lowered, but we don’t seem to be making much headway in lowering the incidences of the associated diseases. That is to say, normal blood pressure used to be 140/100, now it’s 120/80. Cholesterol used to be 240, now it’s down to 200. Glucose used to be 140, now it’s 100. Considering we are less healthy today… Read more »

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Rusty Brown in Canada
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Rusty Brown in Canada

My experience exactly. My MD told me years ago that my cholesterol was not down to where it “should” be, and that “they” were about to announce even lower targets. I asked him who “they” were and he said “the pharmaceutical industry”.
I was not about to let big pharma decide such matters for me and stopped taking the medication altogether and glad I did.

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Ed
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Ed

After an initial myocardial infarc where the left ventricle was totally occluded, I was put on the highest dose of statin, 80mg/daily. Within three months I stopped taking them, not because of any side effects, but just reading of the possible side effects caused me to switch to Linus Pauling’s plan of 4-6 grams of Vit C and 4-6 grams of L-lysine. Presto, my gums tightened up and any bleeding stopped. Several years back sitting in the periodontist’s office waiting for treatment, I picked up a trade magazine wherein the periodontists were wondering if Vit C would help in that… Read more »

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Rusty Brown in Canada
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Rusty Brown in Canada

Happened to me, too. I quit statins and started 3 to 4 grams vitamin C daily with meals after reading Dr. Pauling. Three things happened: my gums stopped bleeding when I brushed; my varicose veins disappeared entirely (I was early 50s); my cholesterol numbers improved. Turns out vitamin C is a major component of collagen, which is a fibrous protein that strengthens blood vessels and skin so that your ankle veins become strong enough that they no longer bulge out under the weight of all that blood pressing down, and the tiny capillaries in your gums no longer tear open… Read more »

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DrKSSMDPhD
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karma swim swami

Linus Pauling won a Nobel Prize, and then proceeded to feel he could do no wrong scientifically. He utterly lost his moorings in reality, and every claim he made as regards vitamin C, that it helps with everything from colds to cancer to psychiatric illness, has been resoundingly disproven. Vitamin C does one thing in vivo: it is a cofactor for collagen synthase. It does not lower lipids, If anything, however, in vascular disease, it may help potentiate the fibrosis in atherosclerotic plaque and thus worsen disease.

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takeprofits
Member
👍416

Come on guys and gals, what a dozen or so at least apparently dreaming in technicolor. Don’t you know by now that your personal experiences are merely “anecdotal” and don’t count? Just ask the “SWAMI” they mean nothing. Linus Pauling and any other doctor that disagrees with medical orthodoxy are all frauds and you can’t believe a word they say, and your personal experiences are just a “placebo effect” because you were dumb enough to believe that somebody outside the orthodox medical profession might actually have something worthwhile to contribute? Don’t you know that headaches are caused by a lack… Read more »

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frankw17
Member
👍1251

Myron, satire, indeed! Excellent summary of views that are somewhat controversial to
those espoused by the medical and big pharma institutions. God forbid any of us should use our own grey matter when it pertains to our health!
Thank you!
Frank

tanglewood
Irregular
👍438

Ed; I was on the diuretic hydrochlorothiazide for about a year. Then a blood test showed that my pottasium (K) level was 3.0. It is supposed to be between 3.4 and 4.8. Hydrochlorothiazide depletes potassium so you might want to check your level the next time you get a blood test.

Ed
Guest
Ed

Thanks for pointing that out. I regularly have my electrolytes checked and make sure I eat some potassium rich food, such as bananas. My recent K score was 3.8, where 3.0 -5.0 is considered within range by my lab.
This topic sure has brought out some interesting links! Thank you everyone!

DrKSSMDPhD
Guest
karma swim swami

Gazza: But it is always, in all patients, a liver issue as regards source of the cholesterol. 85-90% of your serum cholesterol is liver-made, and independent of diet. This is why I personally view therapy with ezetemibe, which only works by blocking gut cholesterol absorption, as an expensive fool’s errand. Vytorin is ezetemibe/simvastatin.

Frank: I sympathize with what point you are making., that it sometimes seems that medicine moves the goalposts in order to subjugate and medicate patients. Those revised parameters about blood pressure and cholesterol are very much data-driven, based on studies,

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frankw17
Member
👍1251

karma swim swami, I could appreciate the need “to move the goalposts” if we did indeed
see improvements,i.e., a reduction on a percentage basis of incurrence of these diseases.
Frank

dr john the night tripper
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dr john the night tripper

It is true that many physicians do not do CRP’s. As a physician, I think there are two possible reasons for this. First, like a lot of the gene testing and other data, we are now able to gather about our bodies, it can help us understand our risk factors, but , as the periodontist above noted, what do you do about it?? I have arthritis, old teeth, and a two pieces of titanium in my right hip, all of which produce inflammation, but taking Omega3 and anti inflammatories will help only in a limited, and poorly defined way if… Read more »

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takeprofits
Member
👍416

The good doctor makes my point, education while sorely needed is neglected in the pursuit of profit. I understand very well the time pressure doctors are under as well as the peer pressure to conform, rather than thinking for themselves. Fortunately there are a few at least, (proportionately) who DO think for themselves, are open to new ideas and impartial in their assessment of studies outside the controlled atmosphere of medical orthodoxy. While I have known about well known actress Suzzane Sommers fight with cancer for many years and was aware she had written a book about her experiences with… Read more »

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John
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John

Cholesterol drugs are the biggest pharmaceutical rip off in the past 20 years.. Cholesterol is not the leading factor in heart disease and heart attacks.. Actually your CRP levels tell more of the story about the inflamation of your blood vessels . Most people don’t even know what a CRP test is and unless you ask for it they don’t do it. It is C-reactive Protein and it measures the amount of protein in your blood. There are at least 4 factors that determine heart disease and heart attacks. Blood pressure, CRP, Cholesterol, hypertension,diabetes etc etc.. If you don’t educate… Read more »

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