Why I declined a Statin.
 

I am 78 and I was recently dignosed with non clinical hypothyroidism. TSH levels are very slightly elevated. All other levels are normal. My cholesterol levels are rising and I was advised by a young doctor to begin taking a Statin. I declined and here's why:

The Framingham Study that set into motion the idea that cholesterol causes heart disease is flawed in many ways. After decades of statins people are dying of heart disease as fast as ever. Without going to into boring detail, I have concluded by my own research that damage to the artery walls is not caused by cholesterol HDL. The damage is caused by alcohol, tobacco, drugs, and fast food. When the artery wall breaks down cholesterol moves in to repair it. Then the cholesterol becomes a problem after it calcifies and causes blockage. But the artery walls are still damged by poor lifestyle so lowering cholesterol does not prolong life. In fact cholesterol is needed because it is important for cells. So, the connection of high cholesterol to heart disease is casual, not causal. Patients advised to take cholesterol are being fooled into believing they are preventing heart disease while they continue what really caused it in the first place. If you are taking a Statin I am not telling you not to take it. I am telling you why I am not taking it.

CrossFit | The Framingham Heart Study, Part 3: Framingham’s Presentational Flaws—Bias or Fraud?


Flawed Reasoning Allows the Persistence of Mainstream Atherothrombosis Theory - PMC

Regardless of what I think about your logic, at 78, I wonder if there is any clinical benefit to starting a statin.

Logic at 78? You mean mental decline?

I did my own research, too, but my conclusion was the opposite: statins help prevent cardiovascular disease in people without prior heart conditions (that's me).

Some studies of statins on people without prior heart conditions:

Taylor et al 2011: "All-cause mortality and fatal and non-fatal CVD events were reduced with the use of statins as was the need for revascularisation (the restoration of an adequate blood supply to the heart) by means of surgery (coronary artery bypass graft) or by angioplasty (PTCA). Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event."

Shepard et al 1995: "Treatment with pravastatin significantly reduced the incidence of myocardial infarction and death from cardiovascular causes without adversely affecting the risk of death from noncardiovascular causes in men with moderate hypercholesterolemia and no history of myocardial infarction."

Thavendiranathan et al 2006: "Trials where at least 80% of participants were not known to have cardiovascular disease (defined as coronary artery disease, cerebrovascular disease and peripheral vascular disease) were eligible for inclusion...There was a 29.2% reduction in the relative risk of a major coronary event with statin therapy compared with control... there was a 31.7% reduction in the relative risk of nonfatal myocardial infarction and a 33.8% reduction in the relative risk of having a revascularisation procedure with stain therapy compared with control."

No, statins have shown clinical benefits in people but most studies are done in younger populations to allow for time to events. There is more limited data regarding clinical benefit in older populations. I do believe that in those above 85, there is no benefit.

Hi Terry,
CVD is very much on the minds of many of us, especially those of us who have had an 'occurrence'.
And those of us who have had an incident have, likely, all been advised to use statins (prolly?).
The question becomes, what is the most effective way to reduce the probability of CVD... The 'Statisical' studies, many of which were focused on statins, don;t seem to take into account (not sure how they even could...) of 'Diet'... Is there a way to tied diet to CVD AND statin use? ... don;t know...
Have those who were able to reduce LDL also made adjustments to their diets ?
Maybe statins don;t have the effect they seem to show in these older studies.
One must say, that the modern dominant diets in many societies are very heavy in foods which give large amounts of LDL.
Here's an interesting article where social structure and related diet have produced a society of very low CVD.
"Why an Amazonian tribe has the lowest rate of heart disease of any global population"
So Diet may be the key element in reducing CVD ?
So if one is eating a diet high in LDL and also taking statins - is that a sensible approach?
...this brings up another current thread about 'Ketone intense diet, and Keto diet'... are many on Keto diets also having a large segment of the diet with High LDL foods ???
It was recommended I go on Statins after my event in '08. I declined. Deciding to further improve my overall diet content - which was already always in my attention.
However, when one burns a lot of calories, one can make the mistake that it's ok to eat most anything - "it'll all be burned"
Statins do work directly on the Liver, and the Liver like a few other organs are primary in the general health of the body, being the only one which cleans most of the body's waste products...
Anyway, it so complex and most ailments, like CVD can be tied to many important functions...
And so many things always point to the foundation of 'nutrition', good quality nutrition, provided in a way 'balanced' for overall body functions...
Here's another consideration for CVD...
synopsis provided by Google AI...
"Yes, general body pH can factor into cardiovascular disease, particularly in the context of acid-base imbalances. Changes in blood pH can affect heart function, and certain cardiovascular conditions can also impact blood pH. "
" Cardiovascular Conditions and pH:
Certain heart conditions, like heart failure, can lead to acid-base imbalances. For example, metabolic acidosis is a common complication in severe heart failure.
Other Factors:
Intense exercise, dehydration, certain medications, and some chronic conditions can also affect blood pH.
Research and Clinical Implications:
Studies have investigated the link between dietary acid load and cardiovascular disease risk, but results have been mixed, says the National Institutes of Health (NIH) (.gov). Some research suggests that maintaining a balanced acid-base status may be beneficial for overall health, as noted by www.revivalchiropractic.com. "
If these major considerations are given attention, will statins be the answer?
Ride On
Yuri

Clearly, diet and exercise play an important in cardiovascular health. You can have the most heart healthy diet known to science, and you can exercise obsessively, but you can still have high LDL.

And people with high LDL develop arterial plaque. And the higher the LDL level, the more plaque develops.

I had a go with statins on two occasions. Both times it was a disaster. I won't go into specifics but I just can't take them. Oh, I am about to be 79 in June. One of the things that comes to mind about longitudinal studies is this: if a study indicates that doing something over time indicates that, say, 75% end up with a certain result it also means 25% don't. Tests and studies are valuable but you also have to see the patient in front of you.

Perhaps the most heart healthy diet known to science is not the most heart healthy diet at all. Science is not a settled argument.

That is genetics. Most of the early statin studies were done on people with familial hypercholesterolemia and in those, you see the greatest benefit. Statins, on a population level, are associated with reduced levels of cardiovascular events (CE) in multiple populations.

There is also simple statistics that most people don't understand. Statins can reduce risk of a CE by 35-40%. What that means, most people don't understand.

And diet can play an important role in CEs. Those studies have been done and have shown that you can't out exercise a bad diet.

Nothing in biology is absolute. Nothing. Thousands of people survived massive radiation exposure and lived a full life. Many people lost 40-90% of their cranial matter and were completely normal.

Interesting discussion. I've started taking statins for three reasons:

1) I'm inclined to trust Peter Attia and he is bullish on statins to the extent that they are the only drug that he recommends everyone take prophylactically. He explains his take on the science for why that makes sense well in his book. Basically, it puts the brakes on a buildup process that is taking place in everyone, at all times, to varying degrees. Babies have cholesterol buildup.

2) Also according to Attia, if you tolerate the statins well, there so far do not seem to be compelling reasons not to take them.

3) I'm type 2 diabetic and always see things through that lens, for better or worse. At points in the past, I've had bad cholesterol so high that my "heart age" was 78 even though I was 47. My doctor told me, at that time, that it was the highest cholesterol of any of her patients that were not known to be raging alcoholics. Moreover, she told me that the amount of cholesterol vastly exceeded anything that could have come from dietary sources. The "source" was really my insulin resistance. It turns out that T2D's only focus on blood sugar because it's expedient to measure that. If T2D's measure blood lipid levels, those will be even more concerning. And those lipid levels promote cholesterol buildup.

Does any of this matter for folks who are not T2D? I suspect that it does. My understanding is that, if measured for insulin resistance directly, about 80% of the adult population of North America will exhibit some degree of insulin resistance. What many people infer as unclean living causing CVD may well be more accurately described as unclean living promoting insulin resistance and then insulin resistance promoting cholesterol buildup.

Perhaps we should ignore the current science and just eat whatever we want to. Since, you know, science is never settled.

:notamused:

True enough. An endeavor rather than a conclusive pursuit.

I managed to survive a 'mild' CE late March of 2006. Two stents in one coronary artery after I experienced what I believed could be the end of me on my way to work early one morning. Been on Crestor 20mg daily ever since along with blood pressure meds.

Lipids panels since about 2015 show steady decline in cholesterol:
https://cimg9.ibsrv.net/gimg/bikefor...482cc3cfff.jpg
- which I attribute mostly to increased physical activity over what had been typical prior to the event. Back in the early '00's my Dr told me 'keep doing what you're doing' despite total Cholesterol numbers just under 200.

My cardiologist (where I am now, the last 12 years) is on board with me halving the statin dosage since that last panel. We'll see what effect that has on numbers in another few months.

My diet hasn't changed significantly (other than I've pretty much eliminated HFCS from my diet as much as possible by now) but as I've made a happy return to road-biking since mid-'23, as well as made regular use of my Wahoo Kickr over the winter just past, I'm thinking the downward trend may be the result.

Just turned 76 about two weeks back.

My doctor finally convinced me that I should adopt his philosophy of "better living through chemistry." I started taking a statin and didn't even notice it. I'm probably getting a cardiac calcium scan in a week, hopefully it turns out I'm okay. I feel like since both parents had issues with heart disease, my insurance should pay for it, but they won't

Had a Ca scan in 2000, my Dr said 'no problem'.

Insurance (I was working full time at the time) didn't pay for it either but the $100 cost I felt worth it after having watched a co-worker die from a massive heart attack a few weeks prior. He had 'issues' entirely unlike what I thought I might have had stalking me.

My work-based coverage made that 2006 procedure 'affordable'. Then, when the company went south in 2009 making COBRA non-existent as a result, I had to resort to a high-risk state pool that had my statin taking about $1,000 out of my remaining 'retirement' savings every month until it lost it's patented status a few years later. Since 2014 it's about $18 for 90 days.

My wife's calcium score cost $180, and that was the cheapest in the area. Some of the geisinger hospitals charge almost $500 for it. I'm not sure I'm going to get it if it costs that much. They are supposed to call me back with a price. Probably should get it anyway, my mom died suddenly, probably from cardiac issues.

I take rosuvastatin, which pharmacies often label as Crestor. I used to like their ads. "Reduces harmful cholesterol levels by 52%, that's about half."

I went with them seem good to me

Just to put my previous comments in perspective......I was put on Atorvastatin by a cardiologist after an AFIB. I told him I couldn't take statins. He ignored me and put me on one at 80 mg. The next day I went to my GP who took one look, shook her head, and reduced it to 10 mg. I still had a problem. I went back to the Cardiologist office and saw an APRN. I explained my problems. I also asked why I was put on statins. She said it was because my cholesterol numbers were a bit high. I don't have the numbers at hand but my total cholesterol and LDL are a bit high. My HDL is about 60 and the Total/HDL ratio is perfect. My LDL has been dropping slightly over the past 5 years. My heart imaging shows no blockage or artery issues. I took a nuclear stress test and the RN administering the test said, "A guy your age can barely last 6 minutes. You did 10 minutes. How are you doing that?" I said, "Cycling." Back to the APRN. I said to her that if she had seen my cholesterol levels 50 years ago she would have seen the same numbers as today. So, why are we doing this? She listened and agreed. So, I am off statins and my chart now notes that I am allergic to them.

No, we should look at all information possible WITHOUT prejudice or arrogance in the knowledge we think we have.

But how do we rank the value of all the information about diets, so we can determine which information is decent and which is pure bunk?

I know of one way that has had pretty decent results: SCIENCE, and that's what I rely on exclusively when making health decisions. Some may call that arrogant, but I think it's just sensible.

You do the best you can Terry, but SCIENCE isn't a settled thing ever. There are always opposing views. You just have to be as objective as possible. That's not an easy thing because people get so polarized in their beliefs and opinions that they tend to look for things to prove themselves true rather than being objective. Good luck!

I know an elderly hippie couple who enthusiastically dismiss mainstream science with essentially that same argument. They did their research and are satisfied that the best practice is to be open to the use of any medication except those approved by the FDA.

There will always be differing opinions among scientists, because scientists are people, but there is a thing in science called consensus. And it's pretty reliable.

So when you're trying to decide which opinion is the best, choose consensus. That's what doctors do. That's what I do.

In my observation, stating that "science is never settled" is often a straw man fallacy, used to denigrate well-established consensus. There lies danger.

I’m on Simvistatin. Have really had no side effects from it. I did have a recent incident of severe chest pain at 4:30 in the morning, like a fool opted to not go to the ER, as the pain disappeared in 4 minutes. I did end up at the cardio doc, who sent me to the ER and a Angiogram the next day, the result was no HR and very minor blockages. That was a very useful bit of information. Had I immediately gone to HR they blood test for an HA would likely had been negative and they would not have done an angiogram, thus my stupidity resulted in knowledge not others wise gained and I can essentially not work too much of an HA due to blocked arteries. I’ll stay on the statins.