ModeratedUser150120149

What do y'all think of the new statin guidelines? From what was on ABC News approximately 1/3 of all US adults will now be prescribed statin drugs.

Benefit outweigh the risks? Nothing in the news blurb about that.

hamster

I haven't researched this in detail, but I looked into statins some time back and was satisfied that, at the very least, their benefits outweigh risks if you have high cholesterol. They definitely lower cholesterol, it's less certain that they reduce CVD, but it appears that they do. It's still only a partial fix (diet and exercise will do more for your cholesterol than prescription chemicals) but it's better than nothing. We should have better data once more people get on statins.

Lipitor just went generic last year, and it's so cheap that anyone can afford it.

Fat Boy

I disagree. It's a money grab, pure an simple. For most people that have 'elevated' cholesterol, statins have no effect on 'all cause' mortality. They do lower cholesterol, but lowering cholesterol in and of itself is fairly meaningless. Cholesterol is not the boogieman it's been made out to be and the infatuation with reducing it has not done the health of the country any good.

If my cholesterol were 300 or 400 (it's not), I still wouldn't be on a statin.

eja_ bottecchia

I come to BF for info about bikes and bike riding.

I go to a qualified health professional for advise on health matters.

So far, it has worked out just fine for me.

YMMV

Chaco

I was on statins for 15 years, and 5 years ago quit cold turkey. In the last year of statins, my cramping was so severe that I couldn't sleep at night. My muscles were constantly sore. I was losing the will to exercise.

Since I quit them, 85% of the cramping is gone. My overall cholesterol and LDL are high, but my HDL and triglyceride numbers are way, way better than average. I still get charlie horses after long strenuous rides, but nothing like I used to.

I realize not everyone has side effects from statins, but I sure did. And it seems a LOT of people do. Statins are a multi-billion dollar business. It wouldn't be the first time big pharma has promoted drugs that end up being less than beneficial.

I'm not suggesting anyone make up their minds from what they read on the internet. But it sure doesn't hurt to get ideas to discuss with your doctor. And I would be very cautious about working with a doctor who just pushes statins on you without ever discussing the potential side effects.

Fat Boy

A question was asked and I gave my opinion. By all means, do your own research.

Fat Boy

Much more important that cholesterol numbers is the LDL particle size and the triglyceride number. If your LDL particles are mostly of the large, bouyant variety and your triglycerides are low (<75 or so), then I think you're in a much better place than if your cholesterol number is below some arbitrary line in the sand. The Framingham study, which is what too much of the present dogma is based on, even admits that higher cholesterol numbers are correlated to better cognition and less dementia/Alzheimer's in the elderly. Beyond that, they can't really draw an association between cholesterol number and cardiac deaths. It's not there. The graphs that they do come up with (which reference 'cardiac events') are highly cooked.

Statins are not without effects. Cramping and muscle issues are one issue. For a lot of people they completely mess up their cognitive abilities. I think we'll find one day that they have caused many, many more problems than they've helped.

hamster

Two points.

1. It's not a money grab because, like I said, Lipitor went generic, it's made in India and it costs $15/month. If you put 10 million people on Lipitor, that's $1.8 billion/year, which is, as far as big pharma is concerned, negligible. (Pfizer's annual revenues are $60 billion/year.)

2.
https://content.onlinejacc.org/articl...icleid=1188015
(For those unfamiliar with this kind of language - reporting "RR 0.89" for cardiovascular deaths means average reduction of 11%, and p-values below 0.05 indicate that it's unlikely to be a random fluke.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714690/

noglider 

Lipitor gave my father in law his life back. He was given six months to live in 1978. He died a year ago this month (34 years later). Lipitor wasn't his only treatment, but it was an important part of his overall plan.

likebike23

My dad liked to brag about his low cholesterol and blood pressure numbers. He still had a heart attack and triple bypass. At the time of his heart attack, he was smoking cigarettes and hadn't had his teeth cleaned in 30 years. The smoking part everybody knows about. Not having your teeth cleaned? Well, when you have periodontal disease and the associated inflammation that goes with it, it contributes to atherosclerosis. So to say that preventing heart disease is all about lowering one's cholesterol levels is oversimplifying it.

bmontgomery87

It's my understanding that inflammation is actually the problem, correct?

likebike23

Inflammation is a big factor. One of the biggest sources of inflammation is from the teeth and gums. I'm a dental hygienist, and I can't even tell you how many people ignore our recommendations to treat their periodontal disease. Most of it is fear, then comes cost. Periodontal disease is generally speaking painless. I think if it was more painful, people would treat it immediately. When someone has an abscessed tooth, fear be damned, they are getting a root canal as soon as possible.

Fat Boy

noglider, I have no knowledge of your FIL. If statins helped him, then that's great. I never tried to convey the message that they have _absolutely_ no place in medicine. In fact, your quote of me reads, 'For most people...'.

Putting 1/3 of the nation on statins is absolute madness. Yes, it's only $15/month (using a generic)....times 100 million people (you were missing a '0', hamster). We're talking about $1.5B per month and $18B yearly. Are you telling me that this is inconsequential? Sorry, I'm not buying that.

The sad part is that this is primarily diet related, and it's made worse by following the guidelines from the govt., AHA, ADA, etc. 5-11 servings of grains plus fruits & vegetables is _way_ too high of a carbohydrate load for the vast majority of people and this creates the hyperinsulinemia/type 2 epidemic we are seeing. Statins make this problem worse, not better. Maybe it would be nice to pop a pill and then be able to eat Twinkies and Ring-Dings all day long, but that's not reality. Eat real food and eat it in a reasonable quantity. Why is that such a difficult proposition?

Ultimately, this is all a personal choice. My choice is an obvious one, but if you haven't done much reading on the matter, I encourage you to do so. Don't just shove pills down your throat because your doctor says so. Ask questions, research answers and make an informed decision.

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[h=3]Benefits in Percentage[/h]

• 98% saw no benefit
• 0% were helped by being saved from death
• 1.6% were helped by preventing a heart attack
• 0.4% were helped by preventing a stroke

[h=3]Harms in Percentage[/h]

• 1.5% were harmed by developing diabetes**
• 10% were harmed by muscle damage

https://www.thennt.com/nnt/statins-fo...heart-disease/

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Conclusion This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.
Statins are now one of the most widely used drugs for the treatment and prevention of cardiovascular disease (CVD) both among individuals with established disease and among high-risk healthy individuals who are at an elevated risk of incident CVD.[SUP]1[/SUP]There is little debate that, compared with placebo, statin therapy among individuals with established coronary heart disease (CHD) not only prevents complications related to atherosclerosis but also reduces all-cause mortality.[SUP]2[/SUP][SUP]- 4[/SUP] The benefits of statins on fatal and nonfatal CVD have provided reassurance for the majority of clinicians for use of these agents in high-risk primary prevention settings.[SUP]1[/SUP] However, the absence of prior convincing data for all-cause mortality has led some researchers[SUP]5[/SUP][SUP],6[/SUP] to question the benefits of statins among individuals without a history of CHD, including Abramson et al[SUP]5[/SUP] who stated that “in some subgroups statins cause serious unrecognized harm, which negates the beneficial effects if the benefit is small—ie, most primary prevention settings.”



https://archinte.jamanetwork.com/article.aspx?articleid=416105

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[h=4]CONCLUSIONS:[/h]Statin therapy is an effective intervention in the secondary prevention of cardiovascular events in both sexes, but there is no benefit on stroke and all-cause mortality in women.



https://www.ncbi.nlm.nih.gov/pubmed/22732744

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[h=3]Key points[/h]

• One-third of the 75–84-year-old Swedes are treated with statins.
  
• The lowest cholesterol levels are associated with higher all-cause mortality among 80+-year olds.
  
• No evidence of an effect of lipid-lowering treatment on all-cause mortality among 80+-year olds was found.
  
• The data were not sufficient to make any recommendation regarding 80+-year olds and lipid-lowering treatment.
  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956535/

hamster

I'm not sure where 100 million came from. CNN says "these new guidelines will effectively double the number of Americans eligible for statin therapy, bringing the total to about 72 million." That's 36 million additional patients. And they go even lower than my $15/month. "except for Crestor, they're virtually all generic -- you can get a three-month supply for $10" https://www.cnn.com/2013/11/12/health...ol-guidelines/

No! They had RR 0.92 [95% CI, 0.76-1.13] for all-cause mortality and RR 0.92 [95% CI, 0.76-1.10] for stroke, which, in plain English, means: "incidence of stroke and all-cause mortality were reduced 8% with statins, but this effect did not reach statistical significance threshold, that is, the number of test subjects was too small to be sure that it wasn't a random fluctuation."

That's why you need meta-analysis studies. A single study like the one you quote may not reach statistical significance; a meta-analysis study that pools the results of 20 studies is likely to have less noise and more predictive power.

8% reduction in all-cause mortality is in line with the two meta-analysis studies I quoted above (those arrived at 7% and 12% reductions.)

Now, *if* there is a 1.5% risk of developing diabetes and a 10% risk of permanent muscle damage due to going on statins, that's a significant counter-argument. But the link you provided does not quite rise to the level of the same authority as all others. I need to look into this.

hamster

OK. Yes, it looks like there's a 10% or so risk of muscle pain (not permanent damage) due to statins. And these guys https://juku-pt.umin.jp/pharmacother/lancet2010.pdf estimate one additional case of diabetes per 255 patients per 4 years, vs. estimated 5.4 prevented "major coronary events (coronary heart disease death and non-fatal myocardial infarction)" in the same group over the same period of time.

I think it makes sense for high risk individuals to try statins and see if they cause muscle pain / fatigue issues for them personally. Even if 10% or more drop out due to side effect, there seems to be no permanent harm, and there's benefit for the remaining 90%.

Re: diabetes, it's not clear to me that it isn't simply human/lifestyle factor. Some percentage of all test subjects changes diet, takes up exercise or stops smoking during the study. The ones seeing 50% reduction in LDL due to statins are less likely to do either of those lifestyle changes than the ones taking placebo.

pdlamb

W.r.t. statins, I think I'll wait another 10-15 years for the Institute of Medicine's forthcoming recommendation to discontinue statins for all patients unless there's a specific reason for the prescription.

Slightly more seriously, statins do appear to reduce the risk of CV disease. They also have the minor side effects of muscle pains and accumulative liver damage. That's why I suspect somebody like IOM will eventually look at the whole situation and decide, as they have for PSA and mammograms, that the population-wide costs of the side effects appear to outweigh the benefits. It'll take 10-15 years to get it out of the hands of the cardiologists.

Even more seriously: I exercise regularly. I watch what I eat, and I'm trying to reduce that to lose weight. I suspect, therefore, I'll be in the "harmed more than benefitted by statin" camp.

(But I'm not THAT kind of doctor!)

Fat Boy

Quick math. The OP said 1/3 of the US population which is roughly 300 million people.

ModeratedUser150120149

And I was quoting the ABC News story.

Interesting discussion. I knew y'all would give a quicker perspective than anywhere else.

One of the interesting items in the story was what I call the longevity factor. Apparently one of the numbers cranked in to the decision is how long yet a person is expected to live. I'm trying to remember; but I think they said if a person only has about 7 years of expected life that puts them in candidacy for statin therapy. That fits with the overall theme of the story which was that the drug should be prescribed based on population norms as well as individual signs and symptoms. So, a person with no other health issues than age can expect to be a candidate for drug therapy? doesn't seem right somehow.

travelerman

I thank whatever gods may be that my cholesterol levels have always been ideal - the good is high and the bad is low. A diverse and reasonable diet helps, as does high level of activity and a median BMI.

wolfchild

We living in a generation of pill poopers. People will mess up their health through bad lifestyle choices, bad diet and lack of exercise or too much exercise, and then they want to find a magic pill to cure all their problems.

Fat Boy

Well said.

Machka 

I recently went for blood work. My Dr tells me that if I had gone for blood work a month ago, my cholesterol levels would have been normal. However, "they" have changed the limits, and now my cholesterol is high. My triglycerides are also high.

She told me I have two choices: 1) Statins, or 2) Lifestyle Change. She highly recommended I avoid the Statins, and go with the Lifestyle Change.

The Lifestyle Change choice includes four main parts: 1) Stop Smoking, 2) Stop Drinking Alcohol, 3) Get more exercise, 4) Eat a healthy diet.

In my case, I've got the first 3 parts covered already ... I just need to make a few adjustments to my diet.

It's nice going to a Dr who recommends healthy options rather than drugs.

Sixty Fiver

Unless you have a family history of heart disease you are probably going to live to 150...

What is so wrong with your diet save for that addiction to diet soda ?

I agree that this lowering of the safe cholesterol level and push for increased use of statins is just a huge cash grab as pretty soon those bad theories on cholesterol and dietary fat are going to be proven as being incorrect.

The enemy is in the excessive carbs most westerners consume, this causes inflammation and damage to arteries.

Cholesterol is an essential for good health and there is also growing evidence that higher cholesterol is essential for older people as it maintains higher mental function.

Sixty Fiver

People should have their c reactine protein checked as this is a marker for inflammation, if this is good then one should not be too worried and carry on what they were doing.

Sixty Fiver

Nothing has made big pharma as much money as the sale of statins and during this time the number of heart attacks has not decreased and diabetes rates continue to climb.

How much longer will people try and insist that the excessive carbs in most people's diets isn't the problem.