The Truth About Cholesterol

[chiang mai]

I've long suspected that the real benefits of Statins existed mostly in the share price of the drug companies. But now along comes this argument that suggests that whilst Statins may do the job they were designed to do, the job they were intended for has little to do with coronary heart disease! Some of the arguments are quite compelling and now with Statin side effects starting to come out from under the covers it may well be time to revisit the need to take Statins in the first place. Comments anyone?

http://www.alternet.org/healthwellness/78554/

[backflip]

The websites promoting "healthy-living" and "alternative therapies" are mostly trying to sell you unproven "herbal and natural" solutions, which frequently are as expensive as the medications they discredit. "Doctors" claim that they have been hounded by the regular medical establishment, and are the only people alive who have a secret remedy (based on natural, wholesome goodness) that can fix you up.

On another thread, a poster boasted "I don't like chemicals, and I take saw palmetto and lycopene..." Obviously, the poster doesn't realize that "saw palmetto" and "lycopene" are chemicals, as are water, salt, and statins. You don't like statins, and that's OK with us.

[BigSnake]

HDL

[FBN]

I've long suspected that the real benefits of Statins existed mostly in the share price of the drug companies. But now along comes this argument that suggests that whilst Statins may do the job they were designed to do, the job they were intended for has little to do with coronary heart disease! Some of the arguments are quite compelling and now with Statin side effects starting to come out from under the covers it may well be time to revisit the need to take Statins in the first place. Comments anyone?

http://www.alternet.org/healthwellness/78554/

The "wheel" of cholesterol may be turning yet again. In the 50's, it was the best thing since sliced bread, then LDL was discovered and the link to IHD (Ischemic Heart Disease) and it went to the opposite direction..

The $ element in drug sales and developent can not be discounted. Recent information on the antidepressants again highlights that as with several other "wonder drugs" over the past few years.

A balanced, holistic approach to health and lifestyle issues is important; going off at a tangent on every new trend has never shown any benefit on the long run.

On this particular drug; who wants to have constant debilitating joint pains, be sexually dysfunctional and no memory of why you had been given the drug in the first place?

The basic structure of cholesterol is a pre-cursor to a sex hormone, it can't be all that bad!!

Usual disclaimers apply!

[chiang mai]

The websites promoting "healthy-living" and "alternative therapies" are mostly trying to sell you unproven "herbal and natural" solutions, which frequently are as expensive as the medications they discredit. "Doctors" claim that they have been hounded by the regular medical establishment, and are the only people alive who have a secret remedy (based on natural, wholesome goodness) that can fix you up.

On another thread, a poster boasted "I don't like chemicals, and I take saw palmetto and lycopene..." Obviously, the poster doesn't realize that "saw palmetto" and "lycopene" are chemicals, as are water, salt, and statins. You don't like statins, and that's OK with us.

I would guess from what you wrote that you didn't read the article because the site is not trying to promote alternate therapies. What the article does do very well is pull together a fairly complete picture of IHD and Statins and leaves readers to form their own views. It's not about liking statins or not, it's about whether the general population and the medical profession is being misdirected or dare I say, misled.

I do have IHD and was prescribed Statins about eighteen months ago and can atest to the existence of unwanted side effects. I have subsequently found that I can achieve the same end result as taking statins by going to the gym three times a week, it's actually fun, cheaper, I feel better overall, I don't have to take uneeded drugs and there are no side effects.

[thaiclan]

I know very little about cholesterol and heart disease but this is just to share with you that recently I read a book "The China Study" by T. Colin Campbell PHD and the book is exremely revolutionary in regards to Heart Disease and cancer. Heart Disease being the biggest killer of US adults yet is completely reversible at EVERY stage (yes that includes late stage) by switching to a plant-based diet. Of course the drug companies dont want to hear that.

The book also points to some pretty amazing studies done in regards to eating animal protein and the growth of cancer.

[chiang mai]

I know very little about cholesterol and heart disease but this is just to share with you that recently I read a book "The China Study" by T. Colin Campbell PHD and the book is exremely revolutionary in regards to Heart Disease and cancer. Heart Disease being the biggest killer of US adults yet is completely reversible at EVERY stage (yes that includes late stage) by switching to a plant-based diet. Of course the drug companies dont want to hear that.

The book also points to some pretty amazing studies done in regards to eating animal protein and the growth of cancer.

That is the problem, very few people know or become concerned about heart disease until it effects them personally. In the meantime, you should take it with a large pinch of salt I'm afraid and then move to motives of the author.

Edited March 11, 2008 by chiang mai

[Sheryl]

I know very little about cholesterol and heart disease but this is just to share with you that recently I read a book "The China Study" by T. Colin Campbell PHD and the book is exremely revolutionary in regards to Heart Disease and cancer. Heart Disease being the biggest killer of US adults yet is completely reversible at EVERY stage (yes that includes late stage) by switching to a plant-based diet. Of course the drug companies dont want to hear that.

The book also points to some pretty amazing studies done in regards to eating animal protein and the growth of cancer.

Vegetarians, and even vegans get heart disease and cancer, too. Not as frequently as meat-eaters, but they still do.

ANd, as a nurse with many years of cardiac care experience, I assure you that no diet will reverse end stage heart disease. Or even next-to end stage. Plenty of desperate people try. They don't succeed.

Plant-based diets are indeed healthy, as long as long as they are balanced in amino acide content. I'm a vegetarian myself. But while beneficial to one's health, a vegetraian diet does not totally prevent any disease let alone such very common ones as heart and cancer.

[Sheryl]

I've long suspected that the real benefits of Statins existed mostly in the share price of the drug companies. But now along comes this argument that suggests that whilst Statins may do the job they were designed to do, the job they were intended for has little to do with coronary heart disease! Some of the arguments are quite compelling and now with Statin side effects starting to come out from under the covers it may well be time to revisit the need to take Statins in the first place. Comments anyone?

http://www.alternet.org/healthwellness/78554/

The article you refer to, and the study that it in turn quotes, is not about statins.

It is about a drug called Zetria, which combins a statin (Zocor) with another drug with a totally different mode of action.

Anyone out there taking Zetria should indeed check it out and see their doctor about a change, but those on statins alone need not be concerned based on the findings to date.

As for those who claim that the fuss about LDL is just a ruse of the drug companies, it pre-dates the various cholesterol lowering drugs. I'm old enough to well remember the days when all medicine had to offer people was dietary and exercise advice to lower their LDL, which even then was recognized as a health risk. When the statins came out, doctors eagerly embraced them because 1) Some genetic types of hypercholestremias do not respond to diet or exercise and 2) they weren't have a great deal of success in terms of patient compliance with diet and exercise. Sure, the pharm companies promoted the products, but those were the main selling points.

Of course, anyone who is able to get their LDL into normal range through diet and exercise should do so and not take cholesterol-lowering drugs. Same goes fopr anti-hypertensives, oral hypoglycemics etc. These medications are for people who are unabl;e to manage their conditions through life style chnages, either because of inherited factor or because they just can't (or won't) make the changes needed.

[Jingthing]

It is my understanding that the trend is exactly the opposite from what the OP suggests. The facts appear to show that statins reduce inflammation and inflammation is a killer. Statins are therefore being given to people who would have been considered borderline before, and also higher does to achieve better levels.

[cathyy]

Sheryl, I don't think I have EVER seen you make a misstatement on this forum. I apologize for correcting you.

Zetia contains no statin, it is ezetimibe only. You are thinking of Vytorin, which is the combo of ezetimibe and simvastatin. I take Zetia. I have familial hypercholesterolemia, for which Zetia is a good choice. Years of low-fat eating did nothing for my cholesterol level. Statins are out of the question with my elevated liver enzymes. Zetia is really my only choice.

[chiang mai]

I think the article is about the role LDL plays in heart attacks and consequently, the reasonability of using statins to lower LDL levels - the opening paragraph sums it all up nicely:

"The widespread belief that "bad Cholesterol" ( LDL cholesterol) is a major factor driving heart disease -- and that cholesterol-lowering drugs like Lipitor and Crestor can protect us against fatal heart attacks -- is turning out to be a theory filled with holes. These drugs, which are called "statins," are the most widely-prescribed pills in the history of human medicine. In 2007 world-wide sales totaled $33 billion. They are particularly popular in the U.S., where 18 million Americans take them".

The case against statins is stated as follows:

"there are no studies to show that these drugs will protect older patients over 65 -- or younger patients who are not already suffering from diabetes or established heart disease from having a fatal heart attack. Nevertheless, 8 or 9 million patients who fall into this category continue to take the drugs, which means that they are exposed to the risks that come with taking statins -- which can include severe muscle pain, memory loss, and sexual dysfunction."

I think that was is emerging here is a case that suggests reducing LDL by prescribing statins probably does no more than taking asprin and whilst the upside if statin usage is widely touted, the downside are rarely mentioned.

[Sheryl]

Sheryl, I don't think I have EVER seen you make a misstatement on this forum. I apologize for correcting you.

Zetia contains no statin, it is ezetimibe only. You are thinking of Vytorin, which is the combo of ezetimibe and simvastatin. I take Zetia. I have familial hypercholesterolemia, for which Zetia is a good choice. Years of low-fat eating did nothing for my cholesterol level. Statins are out of the question with my elevated liver enzymes. Zetia is really my only choice.

Thanks Cathhy, and it is I who should apologize!! You are absolutely correct. The study compared people taking Vytorin (combination of Zocor + Zetia) with people taking Zocor alone.

The results in the group taking the Zycor + Zetia (ezetimibe + simvastatin) combination were very poor. This definitely warrants reconsidering use of Vytorin.

Since both groups were ingesting simvastatin, and the statin-only group fared well, the results have also raised some doubts about the efficacy of Zetia (ezetimibe), a non-statin, altho the possibility also certainly exists that there was something in the interaction of the 2 drugs that caused the unfavorable outcomes observed.

Pending further investigation, the Cleveland Clinic is now recommedning vis-a-vis Zetria that it be taken only as a last resort when other cholesterol lowering drugs have failed or cannot be used. Sounds like you are in that group. You would probably do well, though, to keep close tabs on emrging studies now that some dioubt has arisen. Hopefully the problem will prove to have been in the chemical interaction of the 2 drugs, but it will need morre research to tell.

Glad to know that other health professionals are alert when I am half-asleep!

[Sheryl]

I think the article is about the role LDL plays in heart attacks and consequently, the reasonability of using statins to lower LDL levels - the opening paragraph sums it all up nicely:

"The widespread belief that "bad Cholesterol" ( LDL cholesterol) is a major factor driving heart disease -- and that cholesterol-lowering drugs like Lipitor and Crestor can protect us against fatal heart attacks -- is turning out to be a theory filled with holes. These drugs, which are called "statins," are the most widely-prescribed pills in the history of human medicine. In 2007 world-wide sales totaled $33 billion. They are particularly popular in the U.S., where 18 million Americans take them".

The case against statins is stated as follows:

"there are no studies to show that these drugs will protect older patients over 65 -- or younger patients who are not already suffering from diabetes or established heart disease from having a fatal heart attack. Nevertheless, 8 or 9 million patients who fall into this category continue to take the drugs, which means that they are exposed to the risks that come with taking statins -- which can include severe muscle pain, memory loss, and sexual dysfunction."

I think that was is emerging here is a case that suggests reducing LDL by prescribing statins probably does no more than taking asprin and whilst the upside if statin usage is widely touted, the downside are rarely mentioned.

The article you quote, written by a lay person, is based an another article, also written by a lay person ( in the NY Times) which in turn is based on a press release about a study. In otehr words, it is 2 degrees removed from its source.

The NY Times article describes the study findings fairly accurately and makes none of the sort of statements you mention. The article you are citing makes statements that are simply not backed up by the source it cites. If you click on the link and read the actual NY Times study, you will see that.

http://www.nytimes.com/2008/01/14/business...amp;oref=slogin

Whenever reading an article about a scientific study -- especially one appearing in either the lay press or a publication with a specific stance that might bias their interpretation and use of the data -- it is essential to go to the source cited.

I am constantly amazed at how often websites devoted to points of view contrary to established medical opion will blatantly misquote sources and even more amazed that they never seem to get called on it, even when the link to the original supposed source was posted. Apparently few readers actually check.

Going back to statins, the study results were favorable in the statin-only group, the problem was in the group taking a statin plus another, non-statin drug which, unlike the statins, had not been proven to lower tthe risk of cardiovascular disease.

It is not yet clear if the study results reflect negatively on that other, non-statin drug (altho this is what is feared) or if there is something in the combination of the 2 drugs that creates an adverse outcome.

It should also be noted that the study was confined to people with a special type of genetically based elevation in LDL cholesterol and is not representative of the general population of people with elevations in LDL.

[Sheryl]

P.S.

This study (ENHANCE) is generating much debate and discussion within the medical community (around the pros and cons of ezetimibe (Zetia), not about statins) and there is disagreement even among prominent cardiologists about the implications, other than a concensus on the need for more information. Much of the debate ciomes from the fact that the impact of the drug was assessed solely through carotid artery imaging and not any other outcomes.

Anyone interested can find a full discussion, with varying views expressed, at this link:

http://www.medscape.com/viewarticle/568987

[chiang mai]

I think the article is about the role LDL plays in heart attacks and consequently, the reasonability of using statins to lower LDL levels - the opening paragraph sums it all up nicely:

"The widespread belief that "bad Cholesterol" ( LDL cholesterol) is a major factor driving heart disease -- and that cholesterol-lowering drugs like Lipitor and Crestor can protect us against fatal heart attacks -- is turning out to be a theory filled with holes. These drugs, which are called "statins," are the most widely-prescribed pills in the history of human medicine. In 2007 world-wide sales totaled $33 billion. They are particularly popular in the U.S., where 18 million Americans take them".

The case against statins is stated as follows:

"there are no studies to show that these drugs will protect older patients over 65 -- or younger patients who are not already suffering from diabetes or established heart disease from having a fatal heart attack. Nevertheless, 8 or 9 million patients who fall into this category continue to take the drugs, which means that they are exposed to the risks that come with taking statins -- which can include severe muscle pain, memory loss, and sexual dysfunction."

I think that was is emerging here is a case that suggests reducing LDL by prescribing statins probably does no more than taking asprin and whilst the upside if statin usage is widely touted, the downside are rarely mentioned.

The article you quote, written by a lay person, is based an another article, also written by a lay person ( in the NY Times) which in turn is based on a press release about a study. In otehr words, it is 2 degrees removed from its source.

The NY Times article describes the study findings fairly accurately and makes none of the sort of statements you mention. The article you are citing makes statements that are simply not backed up by the source it cites. If you click on the link and read the actual NY Times study, you will see that.

http://www.nytimes.com/2008/01/14/business...amp;oref=slogin

Whenever reading an article about a scientific study -- especially one appearing in either the lay press or a publication with a specific stance that might bias their interpretation and use of the data -- it is essential to go to the source cited.

I am constantly amazed at how often websites devoted to points of view contrary to established medical opion will blatantly misquote sources and even more amazed that they never seem to get called on it, even when the link to the original supposed source was posted. Apparently few readers actually check.

Going back to statins, the study results were favorable in the statin-only group, the problem was in the group taking a statin plus another, non-statin drug which, unlike the statins, had not been proven to lower tthe risk of cardiovascular disease.

It is not yet clear if the study results reflect negatively on that other, non-statin drug (altho this is what is feared) or if there is something in the combination of the 2 drugs that creates an adverse outcome.

It should also be noted that the study was confined to people with a special type of genetically based elevation in LDL cholesterol and is not representative of the general population of people with elevations in LDL.

Your point about the reliability of third hand information is of course entirely valid - in the case of the article in question it seems as though the author has drawn his information from a number of sources although I remain skeptical that one of them may be the thin air!

I remain interested to understand whether there is conclusive medical evidence to support use of the Statins in my particular case or whether prescription of the Statins has become the automatic response of doctors in Thailand to any patient discovered to have IHD - I am particularly keen to understand this in light of unannounced side effects resulting from their use. So thank you for your input on all of this but I will continue to look for relevant "first hand" material to confirm the consensus medical view on this issue.

[geriatrickid]

I read the article and did not see any specific evidence in the way of experiments or clinical trials to substanitate the claim about that statins. Statins were never intended as a one pill wonder to prevent heart attacks. They were intended to be one of several tools, chief amongst which was diet, exercise and cessation of smoking to facilitate a return to normal blood levels of cholesterol.

[chiang mai]

I read the article and did not see any specific evidence in the way of experiments or clinical trials to substanitate the claim about that statins. Statins were never intended as a one pill wonder to prevent heart attacks. They were intended to be one of several tools, chief amongst which was diet, exercise and cessation of smoking to facilitate a return to normal blood levels of cholesterol.

The question is whether Cholesterol is the cause of the problem or merely a participant, dare I say even a mildly related observer.

[Sheryl]

I read the article and did not see any specific evidence in the way of experiments or clinical trials to substanitate the claim about that statins. Statins were never intended as a one pill wonder to prevent heart attacks. They were intended to be one of several tools, chief amongst which was diet, exercise and cessation of smoking to facilitate a return to normal blood levels of cholesterol.

That's becayuse the study the article was about wasn't about statins, it was about combining statins with another drug of a different type. The effectiveness of statins was been thoroughly established more than 10 years ago in multiple studies:

Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian simvastatin survival study (4S). Lancet 1994;344:1383-9.

Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996;335:1001-9.

Lipid Research Clinics Program. The lipid research clinics coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984;251:351-4.

Knatterud GL, Rosenberg Y, Campeua L, et al. Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Circulation 2000;102:157-65.

Pitt B, Waters D, Brown WV, et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med 1999;341:70-6.

Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes. JAMA 2001;285:1711-18.

There is no doubt that statins are effective in reducing LDL and the risk of heart disease (or recurrence). the problems are:

(1) Like all drugs, they have side effects. More so in some people than others.

(2) There are some genetic forms of hypercholesterolemia which do not respond to statins. This was the impetus for the development of Zetia and the study that initially started off this thread.

The fact that statins are effective for most people does not mean that most people should take them. Many people can achieve or maintain a satisfactory LDL level through proper diet and exercise alone, and that is always preferrable to taking medication where it is possible.

Some people have medical contraindications to statins or are otherwise unusually susceptible to adverse effects. In those cases it becomes a question of wieghing risks and potential benefits and no two people are exactly alike. Some people, by virtue of their prior medical history, family history or other medical problems are at much higher risk of heart disease than others. Some people, by virtue of these same types of factors are at higher than average risk of adverse effects from the drugs.

Personally, from what I have observed, statins are both under and overprescribed. That is to say, many people who should be on them, because of specific high risk factors, aren't, while at the same time it is indeed true that some doctors are too quick to reach for the prescription pad without first exploring lifestyle modification approaches with the patient.

In general I would say that Thai physicians as a group are more prone to the last than Western doctors, it seems to stem from 2 things: (1) a perception that people want and expect to be given a medication when they go to see the doctor (and the more medications, the better..I've actually seen doctors apologize for giving "only one" ! ); and (2) a widespread belief/attitude that patients can't be trusted/expected to follow instructions about things like diet and exercise (don't ask me why, if that's true, they would be any more reliable about how they take prescribed drugs!). That patient non-compliance might be at least in part related to the fauilure of doctors to take the time to explain things thoroughly and clealry doesn't seem to be widely appreciated. But these are generalizations and there are, of course, exceptions. Those exceptions are the docs you want to have taking care of you, and it's worth a little time and trouble to find them.

[cathyy]

Yes, there's no doubt that statins lower cholesterol levels. I think one of the questions people have now is whether high LDL cholesterol is the smoking gun of Coronary Artery Disease that it was once believed to be. My doc in the US was interested in my LDL cholesterol, which was high, but he was more interested in my homocysteine level, which is an inflammation indicator, and was normal.

The more recent info about transfats, and how very bad for you they are, intrigues me. What I'd like to see is a study on a transfat-free diet vs. a normal diet, vs. a low-fat diet. My own personal opinion, and this is only a personal opinion, is that the huge rise in heart disease in the US corresponds quite nicely to the massive increase in use in the US of hydrogenated fats/transfats. Prior to the introduction of products like Crisco, in 1911, people used lard or butter for a solid fat. The kids who grew up on cookies baked with Crisco instead of butter became the cardiac statistics of the 60s and 70s. The fast/packaged food industry uses transfats as they don't go rancid as soon. The current statistics are then the result of the fast food/packaged food industries since Mom probably isn't baking anymore, she's too tired from worki.

I have modified my diet in accordance with these beliefs, doing my best to eliminate transfats. The new formula for Crisco contains less than half a gram of transfats per serving, so they can advertise 0 grams. It isn't really transfat-free, but far far better than before they were forced to change it. I use butter now, or canola oil, or olive oil.