Cholesterol Myth-Are Cardiologists Really Wrong?

[jrtmedic]

partington

I admire your stamina !

However ,I suspect your efforts are falling on infertile ground !

[Tolley]

You dont even have do to much clinical research to see that it is sugar and refined carbs that is doing most of the damage because sugar consumption has rocketed over the last few decades yet consumption of fat has remained stable.

On the subject of statins all the research indicates that only those with CAD benefit from statins but 70 percent of people who have been prescribed statins dont have CAD thus they are unecessarily taking a potentially harmful product.

Although you say that "all the research" indicates that only those with CAD ( coronary artery disease) benefit from statins, I have to tell you that you are mistaken in this statement.

In the Lancet last year ( http://www.ncbi.nlm.nih.gov/pubmed/22607822 ) a meta-analysis was published that analysed data from 27 separate clinical trials of statins, done at different sites and by different groups all over the world. It therefore represents the conclusions of the majority of the clinical trials of statins that have ever been done.

This was extensively covered in the popular press, and created a stir because its major conclusions were that:

1. People with low CAD risk who would not normally be prescribed statins showed a clear benefit in terms of prevention of future coronary events and

2. These benefits were independent of whether they had existing CAD or not, that is, statins reduced future heart disease in people who did not already have it.

As I have given you the reference so you can look up the paper, I hope you will stop repeating the statement that only those with CAD benefit from statins, as I have shown you it is not supported by the scientific literature.

Secondly the low fat recommendations of the last 50 years have not been a fiasco, and are not the wrong advice. In this period mortality from heart disease in the US has fallen 60-70%, whereas all-cause mortality has fallen only 40%. The change in diet has played an important contributory role in this success story.

I suppose what depresses me most is that it seems really difficult to get across the idea that atherosclerosis has more than one risk factor, and they are all important. It is not a competition where a winner has to eliminate all the others!

It seems to me that for some people an almost faith-based need to criticise statin use causes a denial of the importance of plasma cholesterol to become an end in itself.

Nevertheless: high blood cholesterol increases your risk for heart disease. Smoking increases your risk for heart disease. High fructose/sucrose consumption increases your risk for heart disease. High blood pressure increases your risk for heart disease. Obesity increases your risk for heart disease. Diabetes increases your risk for heart disease. Unknown factors yet to be identified increase your risk for heart disease.

In recent years it is quite true an increased incidence of diabetes, metabolic syndrome and obesity has begun to reverse the benefits derived from cholesterol lowering strategies, reduction in smoking etc, and the consumption of high fructose corn syrup and sucrose containing foods is probably the major contributory factor to this increase.

To say that scientists or clinicians are somehow responsible for this high sucrose and fructose consumption seems perverse however. The idea that high carbohydrates are harmful to your health is accepted by most clinicians and health authorities the world over. The mayor of New York recently tried to ban the sale of super-sized drinks on health grounds: this is about as mainstream as an idea can possibly get !

For at least the last three decades the recommended dietary guidelines from the American Heart Association have been simple: lower your saturated fat intake, and replace those calories with whole grains, fruits, vegetables and nuts; eat some fish regularly.

If everyone followed those guidelines, derived directly from scientific discoveries, there would be no problem. It is not the fault of clinicians that people will not follow their advice.

Or wait a minute you could choose to believe this meta study a meta-analysis of 11 randomized controlled trials involving 65,229 participants which found no such evidence.

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.

http://www.ncbi.nlm.nih.gov/pubmed/20585067

And the heart foundation in Australia is still giving its tick of approval to all those low fat high sugar products that are supposed to be good for heart health. What a joke. They were also recommended high carb diets as a way to ward off heart disease clearly wrong but don't let the facts get in the way of your fantasies.

What is true is that mainstream medicine is finally and belatedly starting to realise the advice it has been giving for the last few decades has been wrong and is seeing sugar and carbs as a bigger issue in the whole heart disease debate. A little bit after the horse has bolted I might add but there you go.

'Secondly the low fat recommendations of the last 50 years have not been a fiasco, and are not the wrong advice. In this period mortality from heart disease in the US has fallen 60-70%, whereas all-cause mortality has fallen only 40%. The change in diet has played an important contributory role in this success story.'

This is your silliest statement to date.

How do you link low fat diet recommendations with that data? I think you have to look at major advances in heart surgery, better screening of patients and general medical advances here not consumption of low fat products. What is true is that many people who have heart attacks today or strokes survive and live on albeit still with major health problems whereas in days gone by they would not have survived thereby twisting the statistics.

[partington]

You dont even have do to much clinical research to see that it is sugar and refined carbs that is doing most of the damage because sugar consumption has rocketed over the last few decades yet consumption of fat has remained stable.

On the subject of statins all the research indicates that only those with CAD benefit from statins but 70 percent of people who have been prescribed statins dont have CAD thus they are unecessarily taking a potentially harmful product.

Although you say that "all the research" indicates that only those with CAD ( coronary artery disease) benefit from statins, I have to tell you that you are mistaken in this statement.

In the Lancet last year ( http://www.ncbi.nlm.nih.gov/pubmed/22607822 ) a meta-analysis was published that analysed data from 27 separate clinical trials of statins, done at different sites and by different groups all over the world. It therefore represents the conclusions of the majority of the clinical trials of statins that have ever been done.

This was extensively covered in the popular press, and created a stir because its major conclusions were that:

1. People with low CAD risk who would not normally be prescribed statins showed a clear benefit in terms of prevention of future coronary events and

2. These benefits were independent of whether they had existing CAD or not, that is, statins reduced future heart disease in people who did not already have it.

As I have given you the reference so you can look up the paper, I hope you will stop repeating the statement that only those with CAD benefit from statins, as I have shown you it is not supported by the scientific literature.

Secondly the low fat recommendations of the last 50 years have not been a fiasco, and are not the wrong advice. In this period mortality from heart disease in the US has fallen 60-70%, whereas all-cause mortality has fallen only 40%. The change in diet has played an important contributory role in this success story.

I suppose what depresses me most is that it seems really difficult to get across the idea that atherosclerosis has more than one risk factor, and they are all important. It is not a competition where a winner has to eliminate all the others!

It seems to me that for some people an almost faith-based need to criticise statin use causes a denial of the importance of plasma cholesterol to become an end in itself.

Nevertheless: high blood cholesterol increases your risk for heart disease. Smoking increases your risk for heart disease. High fructose/sucrose consumption increases your risk for heart disease. High blood pressure increases your risk for heart disease. Obesity increases your risk for heart disease. Diabetes increases your risk for heart disease. Unknown factors yet to be identified increase your risk for heart disease.

In recent years it is quite true an increased incidence of diabetes, metabolic syndrome and obesity has begun to reverse the benefits derived from cholesterol lowering strategies, reduction in smoking etc, and the consumption of high fructose corn syrup and sucrose containing foods is probably the major contributory factor to this increase.

To say that scientists or clinicians are somehow responsible for this high sucrose and fructose consumption seems perverse however. The idea that high carbohydrates are harmful to your health is accepted by most clinicians and health authorities the world over. The mayor of New York recently tried to ban the sale of super-sized drinks on health grounds: this is about as mainstream as an idea can possibly get !

For at least the last three decades the recommended dietary guidelines from the American Heart Association have been simple: lower your saturated fat intake, and replace those calories with whole grains, fruits, vegetables and nuts; eat some fish regularly.

If everyone followed those guidelines, derived directly from scientific discoveries, there would be no problem. It is not the fault of clinicians that people will not follow their advice.

Or wait a minute you could choose to believe this meta study a meta-analysis of 11 randomized controlled trials involving 65,229 participants which found no such evidence.

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.

http://www.ncbi.nlm.nih.gov/pubmed/20585067

And the heart foundation in Australia is still giving its tick of approval to all those low fat high sugar products that are supposed to be good for heart health. What a joke. They were also recommended high carb diets as a way to ward off heart disease clearly wrong but don't let the facts get in the way of your fantasies.

What is true is that mainstream medicine is finally and belatedly starting to realise the advice it has been giving for the last few decades has been wrong and is seeing sugar and carbs as a bigger issue in the whole heart disease debate. A little bit after the horse has bolted I might add but there you go.

'Secondly the low fat recommendations of the last 50 years have not been a fiasco, and are not the wrong advice. In this period mortality from heart disease in the US has fallen 60-70%, whereas all-cause mortality has fallen only 40%. The change in diet has played an important contributory role in this success story.'

This is your silliest statement to date.

How do you link low fat diet recommendations with that data? I think you have to look at major advances in heart surgery, better screening of patients and general medical advances here not consumption of low fat products. What is true is that many people who have heart attacks today or strokes survive and live on albeit still with major health problems whereas in days gone by they would not have survived thereby twisting the statistics.

It really isn't a matter of "choosing to believe one result over another." It is a matter of accepting that results you don't want to acknowledge actually exist.

Your claim was that "ALL the research shows that people without CAD do not benefit from statins", and this is not the case.

At very most , to state it fairly you should say "studies differ on whether statins reduce all cause mortality in high risk subjects without CAD." This is all you can say.

The paper you have referenced looks at death only, from all causes, not just heart disease, in a group selected from the data to include only those at 'high or intermediate' risk for CAD. These are defined as people with more than one serious risk factor, including smoking, hypertension, obesity, diabetes etc, which also have additional deleterious effects on health and survival that are not related to heart disease. The deaths not prevented by statins in this trial therefore include deaths resulting from, for example cancers, diabetes- and hypertension-related end organ damage, strokes and so on. There is no suggestion that statins prevent deaths from these causes. The paper does not look at the incidence of heart attacks that are not-fatal.

The Lancet paper looks at ALL groups, 'high, intermediate and low' risk, and looks at the incidence of heart disease specifically in those groups, both fatal and non-fatal. Statins are taken to prevent heart disease and this is the claim this paper tests. They are looking at different things.

I myself would take statins to prevent a heart attack, even if it was a non-fatal one, and the evidence shows that statins do prevent these in low risk people. The paper you quote does not address these subjects or this question at all.

I'd like a reference to back up your claim about the Australian Heart Foundation's recommendations for high sugar diets to ward off heart disease, as i wasn't aware of this at all and would be very interested .

Edited August 10, 2013 by partington

[partington]

partington

I admire your stamina !

However ,I suspect your efforts are falling on infertile ground !

Well this is one of the few things I know anything at all about, so it's probably worth a go, and I've got a bit of time on my hands at the moment.

I don't realistically expect to change the set minds of the Mercola brigade, but I'm sort of hoping that other people who read these exchanges might be influenced a bit, if only by noticing the slightly over-defensive anger of some of the responses!

I hope I try to reserve my criticism for the ideas themselves, not the posters of the ideas, and rather wish they would do the same to me.

[richard_smith237]

For approximately 3 years my Cholesterol was considered high, being just outside the acceptable range. Exercising and diet made no difference, I was already exercising and eating well, any improvements to my existing diet made little difference.

After a DVT (sustained from a soccer injury) resulting Pulmonary Embolism detailed Cardio Pulmonary examinations showed my heart to be in A1 condition, with (at the time) 0 chance of Coronary Artery Disease (which I think they meant that there was zero chance that any ill symptoms I was feeling were related to any issue with my Arteries). Cholesterol was still high, however.

Thus: With my cardiologists agreement I take 20mg of Lipitor each day as a precautionary measure against the long term consequences of high Cholesterol. My Cholesterol is now well within safe limits.

I will never know if there is any benefit to taking Lipitor as I would never truly know what may happen otherwise had I not taken it - But, I believe it to be a healthy precaution.

[Tolley]

You dont even have do to much clinical research to see that it is sugar and refined carbs that is doing most of the damage because sugar consumption has rocketed over the last few decades yet consumption of fat has remained stable.

On the subject of statins all the research indicates that only those with CAD benefit from statins but 70 percent of people who have been prescribed statins dont have CAD thus they are unecessarily taking a potentially harmful product.

Although you say that "all the research" indicates that only those with CAD ( coronary artery disease) benefit from statins, I have to tell you that you are mistaken in this statement.

In the Lancet last year ( http://www.ncbi.nlm.nih.gov/pubmed/22607822 ) a meta-analysis was published that analysed data from 27 separate clinical trials of statins, done at different sites and by different groups all over the world. It therefore represents the conclusions of the majority of the clinical trials of statins that have ever been done.

This was extensively covered in the popular press, and created a stir because its major conclusions were that:

1. People with low CAD risk who would not normally be prescribed statins showed a clear benefit in terms of prevention of future coronary events and

2. These benefits were independent of whether they had existing CAD or not, that is, statins reduced future heart disease in people who did not already have it.

As I have given you the reference so you can look up the paper, I hope you will stop repeating the statement that only those with CAD benefit from statins, as I have shown you it is not supported by the scientific literature.

Secondly the low fat recommendations of the last 50 years have not been a fiasco, and are not the wrong advice. In this period mortality from heart disease in the US has fallen 60-70%, whereas all-cause mortality has fallen only 40%. The change in diet has played an important contributory role in this success story.

I suppose what depresses me most is that it seems really difficult to get across the idea that atherosclerosis has more than one risk factor, and they are all important. It is not a competition where a winner has to eliminate all the others!

It seems to me that for some people an almost faith-based need to criticise statin use causes a denial of the importance of plasma cholesterol to become an end in itself.

Nevertheless: high blood cholesterol increases your risk for heart disease. Smoking increases your risk for heart disease. High fructose/sucrose consumption increases your risk for heart disease. High blood pressure increases your risk for heart disease. Obesity increases your risk for heart disease. Diabetes increases your risk for heart disease. Unknown factors yet to be identified increase your risk for heart disease.

In recent years it is quite true an increased incidence of diabetes, metabolic syndrome and obesity has begun to reverse the benefits derived from cholesterol lowering strategies, reduction in smoking etc, and the consumption of high fructose corn syrup and sucrose containing foods is probably the major contributory factor to this increase.

To say that scientists or clinicians are somehow responsible for this high sucrose and fructose consumption seems perverse however. The idea that high carbohydrates are harmful to your health is accepted by most clinicians and health authorities the world over. The mayor of New York recently tried to ban the sale of super-sized drinks on health grounds: this is about as mainstream as an idea can possibly get !

For at least the last three decades the recommended dietary guidelines from the American Heart Association have been simple: lower your saturated fat intake, and replace those calories with whole grains, fruits, vegetables and nuts; eat some fish regularly.

If everyone followed those guidelines, derived directly from scientific discoveries, there would be no problem. It is not the fault of clinicians that people will not follow their advice.

Or wait a minute you could choose to believe this meta study a meta-analysis of 11 randomized controlled trials involving 65,229 participants which found no such evidence.

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.

http://www.ncbi.nlm.nih.gov/pubmed/20585067

And the heart foundation in Australia is still giving its tick of approval to all those low fat high sugar products that are supposed to be good for heart health. What a joke. They were also recommended high carb diets as a way to ward off heart disease clearly wrong but don't let the facts get in the way of your fantasies.

What is true is that mainstream medicine is finally and belatedly starting to realise the advice it has been giving for the last few decades has been wrong and is seeing sugar and carbs as a bigger issue in the whole heart disease debate. A little bit after the horse has bolted I might add but there you go.

'Secondly the low fat recommendations of the last 50 years have not been a fiasco, and are not the wrong advice. In this period mortality from heart disease in the US has fallen 60-70%, whereas all-cause mortality has fallen only 40%. The change in diet has played an important contributory role in this success story.'

This is your silliest statement to date.

How do you link low fat diet recommendations with that data? I think you have to look at major advances in heart surgery, better screening of patients and general medical advances here not consumption of low fat products. What is true is that many people who have heart attacks today or strokes survive and live on albeit still with major health problems whereas in days gone by they would not have survived thereby twisting the statistics.

It really isn't a matter of "choosing to believe one result over another." It is a matter of accepting that results you don't want to acknowledge actually exist.

Your claim was that "ALL the research shows that people without CAD do not benefit from statins", and this is not the case.

At very most , to state it fairly you should say "studies differ on whether statins reduce all cause mortality in high risk subjects without CAD." This is all you can say.

The paper you have referenced looks at death only, from all causes, not just heart disease, in a group selected from the data to include only those at 'high or intermediate' risk for CAD. These are defined as people with more than one serious risk factor, including smoking, hypertension, obesity, diabetes etc, which also have additional deleterious effects on health and survival that are not related to heart disease. The deaths not prevented by statins in this trial therefore include deaths resulting from, for example cancers, diabetes- and hypertension-related end organ damage, strokes and so on. There is no suggestion that statins prevent deaths from these causes. The paper does not look at the incidence of heart attacks that are not-fatal.

The Lancet paper looks at ALL groups, 'high, intermediate and low' risk, and looks at the incidence of heart disease specifically in those groups, both fatal and non-fatal. Statins are taken to prevent heart disease and this is the claim this paper tests. They are looking at different things.

I myself would take statins to prevent a heart attack, even if it was a non-fatal one, and the evidence shows that statins do prevent these in low risk people. The paper you quote does not address these subjects or this question at all.

I'd like a reference to back up your claim about the Australian Heart Foundation's recommendations for high sugar diets to ward off heart disease, as i wasn't aware of this at all and would be very interested .

Why any intelligent person would take statins if they were either low risk or didn't have CAD is beyond me.

Considering all the potential dangerous side effects of statins and considering that there are other researched therapies for reducing cholesterol with zero side effects why would you?

[cheeryble]

Partington

Thankyou for your valuable contribution.

Do you have any comment on the line taken in "cholesterol myth" literature that the metastudies show that statin therapy does not reduce all-cause-mortality in women?

[cheeryble]

I have quickly perused the Lancet paper thankyou Partington.

I refer to the main theme.... the increase in "major vascular events avoided" with reduced TC.

As we were talking previously about non-high risk patients I have to make a stab and guess that your average subject in that category has less than a 10% risk of a MVE in five years (feel free to disagree I've no doubt we could look this up) so comes in the first two groupings, less than 5%, and 5 to 10%.

My point being that whilst the relative improvements in lowering TC are impressive on the charts, the absolute improvement in the two lower risk groups I mention look like a very small improvement......about 4.3% for the most radical reduction in TC.

At first glance this would suggest the absolute improvement is that low....avoiding an event in less than 1 in 20 subjects ( or less than 1 in 80 if low riskers only have <5% risk of MVE IN 5 years, possible more accurate).....that any downsides of statin use, even if they are not nearly as weighty as an MVE, would need to be assessed carefully to decide on their use or non-use.

I've heard bad stuff about statins, but i also hear bad stuff about telephone transmitters, so the question is....is it true?

ps I think it behoves us not to accept lockstep clinicians ability to decide policy based in figures as it has been shown repeatedly they are poor at this and most wouldn't know Bayes Theorem if it hit them in the head.

Witness the recent complete turnaround in PSA testing in asymptomatic patients now contra-recommended by the USPSTF to howls from the urologists who a year later have at lat accepted they were wrong.

Edited August 12, 2013 by cheeryble

[partington]

I have quickly perused the Lancet paper thankyou Partington.

I refer to the main theme.... the increase in "major vascular events avoided" with reduced TC.

As we were talking previously about non-high risk patients I have to make a stab and guess that your average subject in that category has less than a 10% risk of a MVE in five years (feel free to disagree I've no doubt we could look this up) so comes in the first two groupings, less than 5%, and 5 to 10%.

My point being that whilst the relative improvements in lowering TC are impressive on the charts, the absolute improvement in the two lower risk groups I mention look like a very small improvement......about 4.3% for the most radical reduction in TC.

At first glance this would suggest the absolute improvement is that low....avoiding an event in less than 1 in 20 subjects ( or less than 1 in 80 if low riskers only have <5% risk of MVE IN 5 years, possible more accurate).....that any downsides of statin use, even if they are not nearly as weighty as an MVE, would need to be assessed carefully to decide on their use or non-use.

I've heard bad stuff about statins, but i also hear bad stuff about telephone transmitters, so the question is....is it true?

ps I think it behoves us not to accept lockstep clinicians ability to decide policy based in figures as it has been shown repeatedly they are poor at this and most wouldn't know Bayes Theorem if it hit them in the head.

Witness the recent complete turnaround in PSA testing in asymptomatic patients now contra-recommended by the USPSTF to howls from the urologists who a year later have at lat accepted they were wrong.

I would need to check the figures but they sound plausible to me, so for argument's sake let's say you're about right.

To me, preventing a cardiovascular event in even 1 in 20 to 80 low risk subjects over 5 years is an extremely significant public health benefit if applied over ,say, the entire population of the US and EU.

As you say, the benefits of avoiding MVE must be weighed against the downside of statins. I would say that , despite the heavy criticism of statins- notably by websites whose income increases in direct proportion to the number of people they can persuade to use the 'supplements' they are selling instead of statins - they are unusually safe drugs. So much so that to me the downside is extremely small compared to the upside.

The incidence of side effects, for example, is extremely well documented from clinical trials. The incidence of serious side effects, bad enough to stop the patients taking them is in the range of 1 in 10, 000 patient years: that is if 10,000 people take the drug for a year, one of them would get muscle aches so bad that they would have to leave the study.

Clinicians always report much higher incidences than are found in clinical trials though. Some of this is obviously real, and some due to the fact that patients are warned that muscle aches are a possible side effect, and to report them if they occur. Muscle aches are pretty common in the age groups that commonly take statins, and so can be attributed to the drug mistakenly.

Simply lowering the dose pretty often solves the problem and if not, the drug can just be stopped. Evidence of lasting harm from statins is effectively non-existent.

As an interesting (possibly!) digression, I would like to hear the' cholesterol myth' explanation of the symptoms of FH homozygotes. People with this genetic disease have no functional LDL receptors ( these are the proteins that remove LDL from the blood and so control its level) , and as a result their LDL can be 600mg/dl (15mM) or higher from birth.

They get atherosclerosis (measured by coronary angiography as arterial narrowing) at age 5- 10 years . Without treatment they usually die of heart attacks in their late teens or early twenties.

How do you treat them ? Statins don't work- statins work by causing the liver to express huge numbers of LDL receptors which take LDL out of the blood. The liver can then excrete the cholesterol from LDL into the gut, the only way the body can jettison excess cholesterol. But FH homozygotes don't have LDL receptors that work, so statins are no good!

Clinicians physically remove the LDL from their blood, by a non-drug method called plasma apheresis. Their veins are hooked up to a pump and all their blood is run out through a machine that contains filters that stick onto the LDL. The blood is then returned to their bodies with 70% or more of the LDL removed. They have to do this every week or so for their entire lives.

The physical removal of LDL from the plasma of these patients results in regression of their atherosclerosis (as measured by angiography), and their life spans are usually extended from their late teens if left untreated, to well into their forties and beyond.

Because these patients are so rare (1 in a million in the population) , and because it would be unethical to deprive them of the treatment, double blind trials can't be done. Yet the evidence that direct removal of LDL extends their lives by up to 30 years is fairly unassailable.

Edited August 12, 2013 by partington

[rsokolowski]

I had a stroke a few years ago at age 47 (mostly recovered now), my total cholesterol at the time was 198, but I also had borderline high blood pressure (hypertension). I would recommend you find a good doctor, get a thorough exam and ask about getting on cholesterol medicine.

Take it from someone that has been there and make sure your blood pressure and cholesterol are where they should be. There are medications available if diet and exercise are not enough. I would recommend using them if a doctor determines that this is an option for you.

Good luck.

[Tolley]

I have quickly perused the Lancet paper thankyou Partington.

I refer to the main theme.... the increase in "major vascular events avoided" with reduced TC.

As we were talking previously about non-high risk patients I have to make a stab and guess that your average subject in that category has less than a 10% risk of a MVE in five years (feel free to disagree I've no doubt we could look this up) so comes in the first two groupings, less than 5%, and 5 to 10%.

My point being that whilst the relative improvements in lowering TC are impressive on the charts, the absolute improvement in the two lower risk groups I mention look like a very small improvement......about 4.3% for the most radical reduction in TC.

At first glance this would suggest the absolute improvement is that low....avoiding an event in less than 1 in 20 subjects ( or less than 1 in 80 if low riskers only have <5% risk of MVE IN 5 years, possible more accurate).....that any downsides of statin use, even if they are not nearly as weighty as an MVE, would need to be assessed carefully to decide on their use or non-use.

I've heard bad stuff about statins, but i also hear bad stuff about telephone transmitters, so the question is....is it true?

ps I think it behoves us not to accept lockstep clinicians ability to decide policy based in figures as it has been shown repeatedly they are poor at this and most wouldn't know Bayes Theorem if it hit them in the head.

Witness the recent complete turnaround in PSA testing in asymptomatic patients now contra-recommended by the USPSTF to howls from the urologists who a year later have at lat accepted they were wrong.

I would need to check the figures but they sound plausible to me, so for argument's sake let's say you're about right.

To me, preventing a cardiovascular event in even 1 in 20 to 80 low risk subjects over 5 years is an extremely significant public health benefit if applied over ,say, the entire population of the US and EU.

As you say, the benefits of avoiding MVE must be weighed against the downside of statins. I would say that , despite the heavy criticism of statins- notably by websites whose income increases in direct proportion to the number of people they can persuade to use the 'supplements' they are selling instead of statins - they are unusually safe drugs. So much so that to me the downside is extremely small compared to the upside.

The incidence of side effects, for example, is extremely well documented from clinical trials. The incidence of serious side effects, bad enough to stop the patients taking them is in the range of 1 in 10, 000 patient years: that is if 10,000 people take the drug for a year, one of them would get muscle aches so bad that they would have to leave the study.

Clinicians always report much higher incidences than are found in clinical trials though. Some of this is obviously real, and some due to the fact that patients are warned that muscle aches are a possible side effect, and to report them if they occur. Muscle aches are pretty common in the age groups that commonly take statins, and so can be attributed to the drug mistakenly.

Simply lowering the dose pretty often solves the problem and if not, the drug can just be stopped. Evidence of lasting harm from statins is effectively non-existent.

As an interesting (possibly!) digression, I would like to hear the' cholesterol myth' explanation of the symptoms of FH homozygotes. People with this genetic disease have no functional LDL receptors ( these are the proteins that remove LDL from the blood and so control its level) , and as a result their LDL can be 600mg/dl (15mM) or higher from birth.

They get atherosclerosis (measured by coronary angiography as arterial narrowing) at age 5- 10 years . Without treatment they usually die of heart attacks in their late teens or early twenties.

How do you treat them ? Statins don't work- statins work by causing the liver to express huge numbers of LDL receptors which take LDL out of the blood. The liver can then excrete the cholesterol from LDL into the gut, the only way the body can jettison excess cholesterol. But FH homozygotes don't have LDL receptors that work, so statins are no good!

Clinicians physically remove the LDL from their blood, by a non-drug method called plasma apheresis. Their veins are hooked up to a pump and all their blood is run out through a machine that contains filters that stick onto the LDL. The blood is then returned to their bodies with 70% or more of the LDL removed. They have to do this every week or so for their entire lives.

The physical removal of LDL from the plasma of these patients results in regression of their atherosclerosis (as measured by angiography), and their life spans are usually extended from their late teens if left untreated, to well into their forties and beyond.

Because these patients are so rare (1 in a million in the population) , and because it would be unethical to deprive them of the treatment, double blind trials can't be done. Yet the evidence that direct removal of LDL extends their lives by up to 30 years is fairly unassailable.

It is interesting that you should accuse those who are selling supplements for cholesterol of having a vested interest yet choose to ignore those who really have the biggest vested interest in promoting statins which i believe is the big pharmaceutical companies. These are the vested interests making many billions a year out of statins. The money made from supplements is peanuts in comparison.

There is a huge amount of evidence out there exposing corrupt practices in the pharmaceutical industry so I guess it is only natural for most people to have a healthy degree of scepticism when it comes to any drug when you cant necessarly trust the medical profession, the integrity of the research or the overseeing govt bodies to do their jobs properly because of the vast amount of cash made by these businesses which has been used to corrupt those who have been chosen to be the guardians ofthe process. eg medical practioners, medical bodies, govt bodies

How much research and follow up really goes into researching side effects anyway and how long is this monitored for and how accurate would it be for people on multiple medications and how many people would actually know or realise that their problem originated from statins in any case?

If you dont have CAD or heart disease (70 percent of the statin market) then there is just too much room for doubt on the perceived benefit vs potential side effects especially when there are other effective non drug therapies for lowering cholesterol.

Edited August 13, 2013 by Tolley

[cheeryble]

UPDATE!

15 months ago I started this thread with very high TC and very high triglycerides.

I experimented. I cut right down on carbs and sugars, tried to eat some fish but otherwise didn't alter fats purposely.

I think the results were remarkable:

BEFORE

TC 298

Trig 165

HDL 57

LDL 208

AFTER

TC 221

Trig 160

HDL 50

LDL 139

Well three months ago I have done a repeat.....having slipped back to my bad old cake and ice cream ways my BEFORE levels were very similar to BEFORE above. I just dieted for three weeks and eating fish half my days at least I checked my lipids again:

TC 242

Trig 91

HDL 59

LDL 165

A very meaningful drop both times, the HDL, and the Triglycerides which Sheryl emphasises, are positively rosy!

I'm very pleased with these results and would probably be happy to live my life with those levels and not feel the need to go on statins (Comments?)

The only problem is.....I miss my ice cream and cakes (had a little bit) and I was obviously recidivist after improving my diet last year!

Is discipline possible?

Do I try having "weekends off" where I can eat more or less what I want and be good weekdays......or do I take a very low dose of statins?

Edited August 19, 2013 by cheeryble

[canman]

A heart surgeon is basically someone who is good with their hands who doesn't know much science.

Their ability to read understand, assimilate and analyse epidemiological data is no better than any other individual, and a single ill-informed surgeons's opinion is of no more value in deciding the validity of the weight of scientific evidence than a single astronomer, or anyone else.

Research decides truth. One man's opinion is not worth much, that is the whole basis of science.

Individual people are biased,and believe what they want to believe so you have to take the accumulated findings of thousands of people into account in order to reach the most probable viewpoint on what is true.

Your rather patronising statement is symptomatic of many who claim to be the only ones trained to understand or inteprept data from clinical research. In fact you need to be much more than trained in science to interpret research findings you need to look at many factors besides the supposed science behind any clinical research like who is funding the research who is benefitting from the findings how was the research conducted, how many other studies support the same findings etc etc etc

And there is a fair amount of evidence out there that where there is the likelihood of huge financial gain research findings are often manipulated, fudged, or even falsified so it really is buyer beware when it comes to any sort of research findings.

Finally a heart surgeons opinion whether it is backed by any scientific studies or not is still significant because that person has expertise in that particular area. ie in this case heart disease. That is not to say their opinion is necessarily right but still worth considering in light of their experience with heart disease.

In this case I think it would be correct to be sceptical of this particular doctors advise. "Between 2000 and 2008, Lundell was subjected to five regulatory actions by the Arizona Medical Board:" http://www.quackwatch.org/11Ind/lundell.html

[jrtmedic]

canman

You are correct in identifying "Quackwatch" as being an excellent resource which debunks the vast majority of the ludicrous "alternative" claims made by some individuals.

We owe a great debt of gratitude to Stephen Barrett, M.D. for his continuing and credible campaign which continues, successfully, to expose the quacks!

http://www.quackwatch.org/

Edited August 19, 2013 by jrtmedic

[A1Str8]

I would add my two yen.

It has been proven over and over again by extensive researches and scientific studies that cholesterol, unless you consume it in excessive amounts is actually good for you. That cholesterol is bad thing is nothing but a myth. I only know one bigger myth than that: cow milk is good for you.

Sent from my GT-I9500 using Thaivisa Connect Thailand mobile app

[canman]

UPDATE!

15 months ago I started this thread with very high TC and very high triglycerides.

I experimented. I cut right down on carbs and sugars, tried to eat some fish but otherwise didn't alter fats purposely.

I think the results were remarkable:

BEFORE

TC 298

Trig 165

HDL 57

LDL 208

AFTER

TC 221

Trig 160

HDL 50

LDL 139

Well three months ago I have done a repeat.....having slipped back to my bad old cake and ice cream ways my BEFORE levels were very similar to BEFORE above. I just dieted for three weeks and eating fish half my days at least I checked my lipids again:

TC 242

Trig 91

HDL 59

LDL 165

A very meaningful drop both times, the HDL, and the Triglycerides which Sheryl emphasises, are positively rosy!

I'm very pleased with these results and would probably be happy to live my life with those levels and not feel the need to go on statins (Comments?)

The only problem is.....I miss my ice cream and cakes (had a little bit) and I was obviously recidivist after improving my diet last year!

Is discipline possible?

Do I try having "weekends off" where I can eat more or less what I want and be good weekdays......or do I take a very low dose of statins?

Great job there cherryble.

I have just been diagnosed with a 50% blockage in one heart artery, LDL levels just into the danger zone and high trig. Stress test showed no abnormalites. liver function, thyroid function and all other blood work good. Like you I enjoy my sweets. 6 weeks ago I cut out most of the processed carbs I was eating almost every meal, bread, rice, potatoes and pasta. Have also cut out as much sugar as I can, need an alternative to the pomegrante juice I was drinking as it contained an absolutely stupid amount of sugar. Even my morning V8 is loaded with sugar, not sure if I am going to drop that one yet. Eating loads of sardines and salmon, walnits and almonds for snacks. It will be interesting to see what the numbers are in a couple months.

What are peoples opinion here on reversing atherosclerosis? Is any one aware of any studies done on this subject? I have just started researching if this is possible through diet and life style changes.

For the record I had ticked all the risk factor boxes, overweight, smoker, excess alcohol, high blood pressure, high stress. I have cut down on the drinking severely, quit the smokes after 35 years on them, reduced carbs and other junk food and will be starting an excercise regime assuming the cardiologist gives me the go ahead on Wednesday.

There is certainly a lot of contradictory advise out there and threads like this serve a good purpose by pulling together differing views and references in one spot. Its encouraging to see other peoples success which can serve as an additional motivator.

Edited August 19, 2013 by canman

[wilcopops]

If you think that your health can be summarised with a pageful of numbers, I would urge you to think again!

[Tolley]

UPDATE!

15 months ago I started this thread with very high TC and very high triglycerides.

I experimented. I cut right down on carbs and sugars, tried to eat some fish but otherwise didn't alter fats purposely.

I think the results were remarkable:

BEFORE

TC 298

Trig 165

HDL 57

LDL 208

AFTER

TC 221

Trig 160

HDL 50

LDL 139

Well three months ago I have done a repeat.....having slipped back to my bad old cake and ice cream ways my BEFORE levels were very similar to BEFORE above. I just dieted for three weeks and eating fish half my days at least I checked my lipids again:

TC 242

Trig 91

HDL 59

LDL 165

A very meaningful drop both times, the HDL, and the Triglycerides which Sheryl emphasises, are positively rosy!

I'm very pleased with these results and would probably be happy to live my life with those levels and not feel the need to go on statins (Comments?)

The only problem is.....I miss my ice cream and cakes (had a little bit) and I was obviously recidivist after improving my diet last year!

Is discipline possible?

Do I try having "weekends off" where I can eat more or less what I want and be good weekdays......or do I take a very low dose of statins?

HDL TC ratio is a much better predictor of heart attacks than looking at overall Cholesterol levels according to a lot or research papers. Ratio should be less than 2.

To that end fish oil is very effective at reducing TC levels.

[cheeryble]

Great job there cherryble.

I have just been diagnosed with a 50% blockage in one heart artery, LDL levels just into the danger zone and high trig. Stress test showed no abnormalites. liver function, thyroid function and all other blood work good. Like you I enjoy my sweets. 6 weeks ago I cut out most of the processed carbs I was eating almost every meal, bread, rice, potatoes and pasta. Have also cut out as much sugar as I can, need an alternative to the pomegrante juice I was drinking as it contained an absolutely stupid amount of sugar. Even my morning V8 is loaded with sugar, not sure if I am going to drop that one yet. Eating loads of sardines and salmon, walnits and almonds for snacks. It will be interesting to see what the numbers are in a couple months.

What are peoples opinion here on reversing atherosclerosis? Is any one aware of any studies done on this subject? I have just started researching if this is possible through diet and life style changes.

For the record I had ticked all the risk factor boxes, overweight, smoker, excess alcohol, high blood pressure, high stress. I have cut down on the drinking severely, quit the smokes after 35 years on them, reduced carbs and other junk food and will be starting an excercise regime assuming the cardiologist gives me the go ahead on Wednesday.

There is certainly a lot of contradictory advise out there and threads like this serve a good purpose by pulling together differing views and references in one spot. Its encouraging to see other peoples success which can serve as an additional motivator.

Great job yourself!

According to refs in Life Extension .org.....who I don't necessarily endorse.....pomegranate is the thing which can reverse atherosclerosis. IF repeat IFf you believe this I have been told the dried extract capsules work just as well and it doesn't have to be fresh juice. They also have refs whcih tell you it reverses prostate cancer sounds too good to be true.

Giving up drink and especially the smokes is not essy and is a big deal and you've done it!

[cheeryble]

If you think that your health can be summarised with a pageful of numbers, I would urge you to think again!

Measuring things and putting it in numbers is generally excellent stuff, it's a matter of knowing how meaningful the numbers are.

[cheeryble]

HDL TC ratio is a much better predictor of heart attacks than looking at overall Cholesterol levels according to a lot or research papers. Ratio should be less than 2.

To that end fish oil is very effective at reducing TC levels.

Presuming you mean HDL/TC ratio it's incomprehensible and even it's inverse doesn't make much sense.....

[cheeryble]

.

Edited August 19, 2013 by cheeryble

[Tolley]

HDL TC ratio is a much better predictor of heart attacks than looking at overall Cholesterol levels according to a lot or research papers. Ratio should be less than 2.

To that end fish oil is very effective at reducing TC levels.

Presuming you mean HDL/TC ratio it's incomprehensible and even it's inverse doesn't make much sense.....

The triglyceride/HDL-"good" cholesterol ratio should be below 2 (just divide your triglycerides level by your HDL).

http://www.yourmedicaldetective.com/public/523.cfm

Or more precisely, the triglyceride/HDL ratio:

2 or less is considered ideal

4 - high

6 - much too high

[cheeryble]

HDL TC ratio is a much better predictor of heart attacks than looking at overall Cholesterol levels according to a lot or research papers. Ratio should be less than 2.

To that end fish oil is very effective at reducing TC levels.

Presuming you mean HDL/TC ratio it's incomprehensible and even it's inverse doesn't make much sense.....

The triglyceride/HDL-"good" cholesterol ratio should be below 2 (just divide your triglycerides level by your HDL).

http://www.yourmedicaldetective.com/public/523.cfm

Or more precisely, the triglyceride/HDL ratio:

2 or less is considered ideal

4 - high

6 - much too high

Thanks for the correction, but I note the figure....which hey may well be right....came from a guy who's done courses in just about everything and starts by trying to impress..... "my name is Doctor Grimaldi"....but with no MD.

He gives no references, which is less than a journalist might do.

Do I take advice from a guy who thinks his unsupported opinion is enough for his online "patients"? ( I say patients because he is already offering paid advice on the first page. Of course it has a free teaser). Probably not.

Edited August 19, 2013 by cheeryble

[jrtmedic]

cheeryble

D.A.B.C.N https://www.sites.google.com/site/michigannutritionassociation/impact/diplomates-of-the-american-clinical-board-of-nutrition-dacbn

D.A.B.C.O http://www.dcorthoacademy.com/

Definate "quack" alert !

NB

Could not bothered to look up the other "qualifications"

[Tolley]

HDL TC ratio is a much better predictor of heart attacks than looking at overall Cholesterol levels according to a lot or research papers. Ratio should be less than 2.

To that end fish oil is very effective at reducing TC levels.

Presuming you mean HDL/TC ratio it's incomprehensible and even it's inverse doesn't make much sense.....

The triglyceride/HDL-"good" cholesterol ratio should be below 2 (just divide your triglycerides level by your HDL).

http://www.yourmedicaldetective.com/public/523.cfm

Or more precisely, the triglyceride/HDL ratio:

2 or less is considered ideal

4 - high

6 - much too high

Thanks for the correction, but I note the figure....which hey may well be right....came from a guy who's done courses in just about everything and starts by trying to impress..... "my name is Doctor Grimaldi"....but with no MD.

He gives no references, which is less than a journalist might do.

Do I take advice from a guy who thinks his unsupported opinion is enough for his online "patients"? ( I say patients because he is already offering paid advice on the first page. Of course it has a free teaser). Probably not.

Here is a published study of the ratio done on young adults.

http://www.ncbi.nlm.nih.gov/pubmed/23460684

And here is some detail on link to insulin dependency.

http://care.diabetesjournals.org/content/27/4/936.full

[canman]

Great job there cherryble.

I have just been diagnosed with a 50% blockage in one heart artery, LDL levels just into the danger zone and high trig. Stress test showed no abnormalites. liver function, thyroid function and all other blood work good. Like you I enjoy my sweets. 6 weeks ago I cut out most of the processed carbs I was eating almost every meal, bread, rice, potatoes and pasta. Have also cut out as much sugar as I can, need an alternative to the pomegrante juice I was drinking as it contained an absolutely stupid amount of sugar. Even my morning V8 is loaded with sugar, not sure if I am going to drop that one yet. Eating loads of sardines and salmon, walnits and almonds for snacks. It will be interesting to see what the numbers are in a couple months.

What are peoples opinion here on reversing atherosclerosis? Is any one aware of any studies done on this subject? I have just started researching if this is possible through diet and life style changes.

For the record I had ticked all the risk factor boxes, overweight, smoker, excess alcohol, high blood pressure, high stress. I have cut down on the drinking severely, quit the smokes after 35 years on them, reduced carbs and other junk food and will be starting an excercise regime assuming the cardiologist gives me the go ahead on Wednesday.

There is certainly a lot of contradictory advise out there and threads like this serve a good purpose by pulling together differing views and references in one spot. Its encouraging to see other peoples success which can serve as an additional motivator.

Great job yourself!

According to refs in Life Extension .org.....who I don't necessarily endorse.....pomegranate is the thing which can reverse atherosclerosis. IF repeat IFf you believe this I have been told the dried extract capsules work just as well and it doesn't have to be fresh juice. They also have refs whcih tell you it reverses prostate cancer sounds too good to be true.

Giving up drink and especially the smokes is not essy and is a big deal and you've done it!

I pretty much had to give up the drinks to enable giving up the smokes, I can go all day without a smoke but put a beer in my hand and I must have a smoke to go with it. I haven't made up my mind on the effectiveness of pomegrante in reversing atherosclerosis. So much misinformation out there it takes awhile. If I find an information source which turns out to be trying to sell me something I usually take all claims with copious grains of salt. There have been a few magic 'juices / fruit' promoted over the years; they come and go, rarely supported by a proper study.

[cheeryble]

I'm with you on all that Canman.....especially it's difficult to stop smoking and drink.

[jrtmedic]

Here is what the Mayo clinic say about pomegranate juice.

http://www.mayoclinic.com/health/pomegranate-juice/AN01227

[wilcopops]

The cardiologists may be right or wrong - the science isn't though.

Those who are wrong are those who suggest "cures" or preventions that are not scientifically verifiable.

you will never eat or drink yourself healthy whilst you continue to drink alcohol, smoke and otherwise abuse your body. - there is nothing in your kitchen larder that will cure you from anything.

Edited August 21, 2013 by wilcopops