Cholesterol-lowering medication: Yes or No?

[Will M]

I didn't post any numbers earlier because frankly I was afraid someone would tell me I was already dead and didn't know it. After using your formula though the numbers ,except for triglycerids, don't appear to be that horrible. These are the numbers the Dr. gave me. I don't know why he didn't list LDL. Total cholesterol 249, HDL 29, and tryglycerides are off the chart at 549. If I calculated that correctly then, my LDL should be 110. Cholesterol seems a bit high and low but not shockingly so considering a diet thats not tooo bad and lifestyle that isn't as bad as it once was but still not what it could be. What concerns me is why my triglycerides would be so seemingly out of whack with the other numbers?

And I just found the note on the drug the Dr. was wanting to prescribe. It's not a statin but prescription Omega 3 (Lovaza). Any reason why my triglycerides would be that high?

you have a problem with low HDL. this is a lot harder to treat than high LDL.
here are the things that would give you a low HDL & high trigylcerides:
-being a diabetic
-eating a diet high in sugar
-heavy alcohol consumption
-being overweight
-lack of exercise
-bad genetics

you definitely have a problem. your cholesterol/HDL is ~9 which is really bad.
you need to work closely with your family physician or internist to get your lipids better and keep them better. most of the time patients don't need to see a lipid specialist but occasionally they do. here in Cincinnati there are a couple doctors who just treat lipids.

the Lovaza is a concentrated omega 3 fatty acid mix that has a more consistent amount of omega 3 fatty acids than random over the counter mix

FYI - LDL is calculated not measured. the calculated LDL level becomes somewhat inaccurate when your TG get too high. if you get your TGs down then a more accurate LDL can be calculeted.

[Rojo]

I don't know if this actually helps but a few years ago I started eating "real oatmeal", actual steel-cut oats. Cooking them can be a pain, which is why everyone eats the instant stuff. But here's a trick I invented.

Before I go to bed, I load a small crockpot with oats and water and set a timer to turn the pot on four hours before I wake up and stop about 1/2 before I wake up.

I get up, dump some frozen blueberries in there, take a shower. When I'm ready, I scoop into a bowl and a tiny pat of butter and a teaspoon of raw honey. It's delicious, warm and filling.

If you cook oats, the ratio is 1/4 cups oats to 1 cup water. After some trial and error, I've found that for a crockpot, 1/4 oats cups to 1 and 1/2 cups of water works better. Probably have to adjust for climate, taste, altitude, all that jazz.

[westofyou]

I don't know if this actually helps but a few years ago I started eating "real oatmeal", actual steel-cut oats. Cooking them can be a pain, which is why everyone eats the instant stuff. But here's a trick I invented.

Before I go to bed, I load a small crockpot with oats and water and set a timer to turn the pot on four hours before I wake up and stop about 1/2 before I wake up.

I get up, dump some frozen blueberries in there, take a shower. When I'm ready, I scoop into a bowl and a tiny pat of butter and a teaspoon of raw honey. It's delicious, warm and filling.

If you cook oats, the ratio is 1/4 cups oats to 1 cup water. After some trial and error, I've found that for a crockpot, 1/4 oats cups to 1 and 1/2 cups of water works better. Probably have to adjust for climate, taste, altitude, all that jazz.

Steel Cut is some tough stuff, good approach.

[ochre]

My statistics background isn't top notch. Isn't there a bit of a problem basing far reaching conclusions on a study done, primarily, with such a limited population (not entirely, or at all, representative of the whole)?

The Original Cohort of the Framingham Heart Study consisted of 5,209 respondents of a random sample of 2/3 of the adult population of Framingham, Massachusetts, 30 to 62 years of age by household, in 1948. Exam 28 for the Original Cohort ended in December of 2005. Exam 29 for the Original Cohort began in April of 2006.

The adult population of Framingham, Massachusetts? I would think (again I don't know) a small/medium sized New England community such as this would tend to be a fairly narrow genetic base as these sorts of things go.

I did find a British study that had the following results and conclusion:

Results Of 6643 men, 2.8% (95% confidence interval 2.4% to 3.2%) died from coronary heart disease compared with 4.1% predicted (relative overestimation 47%, P < 0.0001). A fatal or non-fatal coronary heart disease event occurred in 10.2% (9.5% to 10.9%) of the men compared with 16.0% predicted (relative overestimation 57%, P < 0.0001). These relative degrees of overestimation were similar at all levels of coronary heart disease risk, so that overestimation of absolute risk was greatest for those at highest risk. A simple adjustment provided an improved level of accuracy. In a "high risk score" approach, most cases occur in the low risk group. In this case, 84% of the deaths from coronary heart disease and non-fatal events occurred in the 93% of men classified at low risk (< 30% in 10 years) by the Framingham score.

Conclusion Guidelines for the primary prevention of coronary heart disease advocate offering preventive measures to individuals at high risk. Currently recommended risk scoring methods derived from the Framingham study significantly overestimate the absolute coronary risk assigned to individuals in the United Kingdom.

[acredsfan]

You can sit around and argue statistics all day, but the fact of the matter is there is a proven link between high cholesterol and heart disease. The question then becomes is my risk of heart disease greater than the risk of having side effects from the medication. In this case I would come to the conclusion that if my levels are high, I would take my chances with the medication rather than with heart disease. But, I have never had adverse reactions to any medication and I've been on a lot of different things. I've seen too many people die of heart disease that had high cholesterol, and I also feel that the bad reactions to drugs get blown way out of proportion. Out of the millions of people that take a certain drug, less than 5% generally have any problems, and most of those reactions are mild. I'm not advocating drugging up everybody, but medication when prescribed responsibly can save your life.

[gonelong]

I don't know if this actually helps but a few years ago I started eating "real oatmeal", actual steel-cut oats. Cooking them can be a pain, which is why everyone eats the instant stuff. But here's a trick I invented.

Before I go to bed, I load a small crockpot with oats and water and set a timer to turn the pot on four hours before I wake up and stop about 1/2 before I wake up.

I get up, dump some frozen blueberries in there, take a shower. When I'm ready, I scoop into a bowl and a tiny pat of butter and a teaspoon of raw honey. It's delicious, warm and filling.

If you cook oats, the ratio is 1/4 cups oats to 1 cup water. After some trial and error, I've found that for a crockpot, 1/4 oats cups to 1 and 1/2 cups of water works better. Probably have to adjust for climate, taste, altitude, all that jazz.

Niiiiiiiiiiiiiice. Will be trying this out this week. Really, a great idea. I'd be eating more rough-cut myself, but it's too darn inconvenient. This is no problem.

GL

[ochre]

You can sit around and argue statistics all day, but the fact of the matter is there is a proven link between high cholesterol and heart disease. The question then becomes is my risk of heart disease greater than the risk of having side effects from the medication. In this case I would come to the conclusion that if my levels are high, I would take my chances with the medication rather than with heart disease. But, I have never had adverse reactions to any medication and I've been on a lot of different things. I've seen too many people die of heart disease that had high cholesterol, and I also feel that the bad reactions to drugs get blown way out of proportion. Out of the millions of people that take a certain drug, less than 5% generally have any problems, and most of those reactions are mild. I'm not advocating drugging up everybody, but medication when prescribed responsibly can save your life.

What was that proven link again? So far, the Framingham study is the one I've seen brought up and is the one I'm talking about.

I think the population for the sample for the Framingham study isn't necessarily representative of the population the derived scoring system is being applied to.

[*BaseClogger*]

I don't know if this actually helps but a few years ago I started eating "real oatmeal", actual steel-cut oats. Cooking them can be a pain, which is why everyone eats the instant stuff. But here's a trick I invented.

Before I go to bed, I load a small crockpot with oats and water and set a timer to turn the pot on four hours before I wake up and stop about 1/2 before I wake up.

I get up, dump some frozen blueberries in there, take a shower. When I'm ready, I scoop into a bowl and a tiny pat of butter and a teaspoon of raw honey. It's delicious, warm and filling.

If you cook oats, the ratio is 1/4 cups oats to 1 cup water. After some trial and error, I've found that for a crockpot, 1/4 oats cups to 1 and 1/2 cups of water works better. Probably have to adjust for climate, taste, altitude, all that jazz.

Somebody has seen Alton Brown's Good Eats oatmeal episode...

[Will M]

What was that proven link again? So far, the Framingham study is the one I've seen brought up and is the one I'm talking about.

I think the population for the sample for the Framingham study isn't necessarily representative of the population the derived scoring system is being applied to.

FYI - I am a general internist who finished residency in 1993. I have treated hundreds of patient with poor lipids.

lets say a middle aged man with moderate to high LDL levels fails to get them down with diet, exercise & weight loss. it would be MALPRACTICE for his physician not to recommend a statin. absolute indefensable malpractice.

the link between high LDL & heart disease is OVERWHELMING. absolutely OVERWHELMING.

Here are 3 more studies. There have been dozens more with similar results.

The West of Scotland Coronary Prevention Study (WOSCOPS) showed that cholesterol lowering with pravastatin reduced both the number of nonfatal myocardial infarctions and coronary herat disease mortality in middle-aged men with a serum LDL above 155.

The Air Force Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) showed that lovastatin reduced the incidence of a first major coronary event in low-risk men and women without clinical evidence of cardiovascular disease and LDL levels near the average for the general population (range 130 to 190 mg). For every 1000 men and women treated with lovastatin for five years, 19 major coronary events, 12 myocardial infarctions, and 17 coronary revascularizations could be prevented.

The JUPITER trial of rosuvastatin 20 mg daily in healthy adult men and women with elevated C reactive protein levels and LDLlevels below 130 found a marked reduction in the primary endpoint of first major cardiovascular events.

[RedsFan75]

Interesting discussion let me add my $.02....

This is all personal observation and how it's done me..

First on the diet and exercise, I'm one of the genetic predisposed ones... diet and exercise only helped a very small amount..

And steel cut oats are GREAT, and Alton Browns recipe's are VERY tasty, his crockpot thing didn't work for me, so much like Rojo, I did my own experimentation. His water to oats recipe is about what I use, but I put it on low for about 8hrs..

Second, be careful of the statins. Everyone's body reacts differently. I had trouble with Lipitor... first noticed was issues that I would have needed the little blue pill to fix, then I started having Leg muscle issues.... Next they put me on Crestor, but our insurance stopped covering it citing that it wasn't safe, so they put me on another one and I can't remember which one it was but caused me problems too, then they put me on Zocor, and now I'm off it, cause it really caused my arthritis to flare and I had a LOT of joint pain with it. So now I'm trying a 'natural' approach with some supplements my Dr has given me, my Insurance won't cover them, but they are not that expensive....

My mom has the same type of issues with statins, in that most of them have given her physical reactions as well... guess it's another genetic thing...

So I think it's important to get your cholesterol under control just watch your body as YMMV as to what works for you...

[ochre]

FYI - I am a general internist who finished residency in 1993. I have treated hundreds of patient with poor lipids.

lets say a middle aged man with moderate to high LDL levels fails to get them down with diet, exercise & weight loss. it would be MALPRACTICE for his physician not to recommend a statin. absolute indefensable malpractice.

the link between high LDL & heart disease is OVERWHELMING. absolutely OVERWHELMING.

Here are 3 more studies. There have been dozens more with similar results.

The West of Scotland Coronary Prevention Study (WOSCOPS) showed that cholesterol lowering with pravastatin reduced both the number of nonfatal myocardial infarctions and coronary herat disease mortality in middle-aged men with a serum LDL above 155.

The Air Force Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) showed that lovastatin reduced the incidence of a first major coronary event in low-risk men and women without clinical evidence of cardiovascular disease and LDL levels near the average for the general population (range 130 to 190 mg). For every 1000 men and women treated with lovastatin for five years, 19 major coronary events, 12 myocardial infarctions, and 17 coronary revascularizations could be prevented.

The JUPITER trial of rosuvastatin 20 mg daily in healthy adult men and women with elevated C reactive protein levels and LDLlevels below 130 found a marked reduction in the primary endpoint of first major cardiovascular events.

Trust me, I'm not saying there is anything wrong with your approach. I imagine it is amazingly complicated to keep up with all the advances in medicine. The standard of care is precisely as you describe.

I am a skeptic pretty much through and through, though, so excuse my inquiries as attempts at (personal) edification.

The studies you linked are helpful in that regard. I do have problems with Framingham (as I've mentioned). I think I could probably develop some objections with the WOSCOPS based on similar grounds (relatively isolated population w/ potential for narrow genetic base.

From what I've been able to glean this morning, the Number Needed to Treat (NNT - if I understand correctly = the number of patients on the medicine to prevent 1 incident) for (at least some of these drugs) varies from 25, 50, 71, or even as high as 170 depending on how one groups the treated (usually by risk factor). I am not 100% sure on exactly which statins these NNTs belong to.

One of the things I saw that I found to be potentially troublesome was a study summarized by this new release:

02-23-09
Contacts:
Yeon-Kyun Shin, Biochemistry, Biophysics and Molecular Biology, (515) 294-2530, colishin@iastate.edu
Dan Kuester, News Service, 515-294-0704, kuester@iastate.edu

Cholesterol-reducing drugs may lessen brain function, says ISU researcher

AMES, Iowa -- Research by an Iowa State University scientist suggests that cholesterol-reducing drugs known as statins may lessen brain function.
Yeon-Kyun Shin, a biophysics professor in the department of biochemistry, biophysics and molecular biology, says the results of his study show that drugs that inhibit the liver from making cholesterol may also keep the brain from making cholesterol, which is vital to efficient brain function.
"If you deprive cholesterol from the brain, then you directly affect the machinery that triggers the release of neurotransmitters," said Shin. "Neurotransmitters affect the data-processing and memory functions. In other words -- how smart you are and how well you remember things."
Shin's findings will be published in this month's edition of the journal Proceedings of the National Academy of Sciences of the United States of America.
Cholesterol is one of the building blocks of cells and is made in the liver. Low-density lipoprotein (LDL) -- often referred to as bad cholesterol -- is cholesterol in the bloodstream from the liver on the way to cells in the body. High-density lipoprotein (HDL) -- so-called good cholesterol -- is cholesterol being removed from cells. Too much LDL going to cells and not enough being removed can lead to cholesterol deposits and hardening of the cells.
"If you have too much cholesterol, your internal machinery is not going to be able to take away enough cholesterol from the cells," said Shin. "Then cells harden and you can get these deposits."
Cholesterol-reducing statin drugs are helpful because they keep the liver from synthesizing cholesterol so less of the substance is carried to the cells. This lowers LDL cholesterol.
It is the function of reducing the synthesis of cholesterol that Shin's study shows may also harm brain function.
"If you try to lower the cholesterol by taking medicine that is attacking the machinery of cholesterol synthesis in the liver, that medicine goes to the brain too. And then it reduces the synthesis of cholesterol which is necessary in the brain," said Shin.
In his experiments, Shin tested the activity of the neurotransmitter-release machinery from brain cells without cholesterol present and measured how well the machinery functioned. He then included cholesterol in the system and again measured the protein function. Cholesterol increased protein function by five times.
"Our study shows there is a direct link between cholesterol and the neurotransmitter release," said Shin. "And we know exactly the molecular mechanics of what happens in the cells. Cholesterol changes the shape of the protein to stimulate thinking and memory."
While reducing the cholesterol in the brain may make you have less memory and cognitive skills, more cholesterol in the blood does not make people smarter. Because cholesterol in the blood cannot get across the blood brain barrier, there is no connection to the amount of cholesterol a person eats and brain function.
Shin says that for many people taking cholesterol-lower statins can be very healthful and they should listen to their doctor when taking medication.

That would seem to be a side-effect that is tough to measure, or document. I recognise the study is mearly biomechanical at this point, but I think it is potentially troubling that it could have such an effect. I'd really like to see a study on dementia rates correllated to the increase in the prescription of these types of drugs.

I've read a couple of different perspectives on CoQ10 and statins. Generally, it would seem the consensus is that CoQ10 be added as a supplement due to statins inhibiting (not sure if that's the exact term) it. It would seem that CoQ10 might help with the muscle type side effects, but I also read from other sources that this was, at this time, indeterminant. Anecdotal (not a big fan of anecdotal "reports", just want your perspective if you are willing to give it) accounts seem to indicate that the problems created (occurence frequency debates aside) linger well beyond the point that the patient stops treatment. There are also indications, particularly in trials -- with people leaving the trial in early stages -- that the incidences of detrimental effects are downplayed. To me the NNT needs to balance with the expected rate of detrimental effects as well. I've not seen much/any formal data on this.

On another front, I saw someone mention (can't remember where) that statins have an anti-inflammatory effect as well? Do you know if that is true? If it is true, in a similar manner as aspirin, couldn't the effectiveness of statins as cholesterol reducers be coincidental to some degree?

Again, I understand that you are bound by the "best practices" standards of treatment. I'm really not questioning you, or that. I just would like to know more. I have personal reservations regarding the way pharmaceutical companies influence these studies, but I'm willing to accept the results if they seem scientifically sound. There are problems that are inherently difficult to surpass, though, with any type of study such as this. Personally, I think it is very difficult to verify that principles such as "double blind" and random sampling of a general population are being met by any of these studies, or if it is even possible that they be met. That is where you and other doctors are bound to abide by the general medical consensus.

[Will M]

i personally suspect that overall statins reduce the risk of dementia. a lot of dementia isn't the Alzheimers type. it is "multi infarct dementia". an mri on your average 80 year old shows diffuse small vessel ischemia even if they clinically haven't had a stroke.

I don't see anyone on coenzyme Q. For the last 5 years I have worked as a hospitalist taking care of patients who are sick in the hospital. I don't treat outpatients anymore. I can't recall the last patient I saw on coenzyme Q admiteed to the hospital. when i was in practice i remember the data being inconclusive. a few years back ther was a giant boom in totally unproven 'natural' remedies. every other patient i saw was on St Johns wort, vitamin E, saw palmetto, co enzyme Q, etc. this has (thankfully) died down. as a physician in the trenches i want to treat my patients with evidence based medicine, not based on some antecdotal reports or a study in 12 patients. most of these 'natural' remedies when put through clinical trials were found ineffectice.

the common side effects of statins are liver irritation and muscle aches. generally both are dose dependent but the liver irritation more so than the muscle aches. these side effects go away quickly when the statin is stopped.
pravachol causes less muscle aches than the other statins but its LDL lowering effect is much less than lipitor or crestor. i would often put patients on a tiny dose of lipitor or crestor and get 30-50% lowering of their LDL.

the antiinflammatory effect is under study. a person with a normal LDL but a high CRP (indicative of inflammation) is at risk for heart attack. these patients are usually put on 81mg aspirin daily plus a low dose statin. the antiinflammatory effect is independent of statin's LDL lowering effect.

FYI: my interest in the theoretical aspects of medicine is dwarfed by my interests in the practical aspects of medicine. the general concensus of expert physician groups is how i practice. i personally use a web based constantly updated textbook type site called "Uptodate".
i see and treat an amazing number of disease processes on a daily basis. i would be insane trying to read every medical study out there and come up with my own conclusions on every disease process.

- Will

[ochre]

i personally suspect that overall statins reduce the risk of dementia. a lot of dementia isn't the Alzheimers type. it is "multi infarct dementia". an mri on your average 80 year old shows diffuse small vessel ischemia even if they clinically haven't had a stroke.

I don't see anyone on coenzyme Q. For the last 5 years I have worked as a hospitalist taking care of patients who are sick in the hospital. I don't treat outpatients anymore. I can't recall the last patient I saw on coenzyme Q admiteed to the hospital. when i was in practice i remember the data being inconclusive. a few years back ther was a giant boom in totally unproven 'natural' remedies. every other patient i saw was on St Johns wort, vitamin E, saw palmetto, co enzyme Q, etc. this has (thankfully) died down. as a physician in the trenches i want to treat my patients with evidence based medicine, not based on some antecdotal reports or a study in 12 patients. most of these 'natural' remedies when put through clinical trials were found ineffectice.

the common side effects of statins are liver irritation and muscle aches. generally both are dose dependent but the liver irritation more so than the muscle aches. these side effects go away quickly when the statin is stopped.
pravachol causes less muscle aches than the other statins but its LDL lowering effect is much less than lipitor or crestor. i would often put patients on a tiny dose of lipitor or crestor and get 30-50% lowering of their LDL.

the antiinflammatory effect is under study. a person with a normal LDL but a high CRP (indicative of inflammation) is at risk for heart attack. these patients are usually put on 81mg aspirin daily plus a low dose statin. the antiinflammatory effect is independent of statin's LDL lowering effect.

FYI: my interest in the theoretical aspects of medicine is dwarfed by my interests in the practical aspects of medicine. the general concensus of expert physician groups is how i practice. i personally use a web based constantly updated textbook type site called "Uptodate".
i see and treat an amazing number of disease processes on a daily basis. i would be insane trying to read every medical study out there and come up with my own conclusions on every disease process.

- Will

Thanks very much for the response. I definitely don't envy you the volume of data and other inputs that are involved with your job.

I'm probably dragging this thread way off from the original intent, though, so I'll stop .

I have found a lot of interesting information at http://www.sciencebasedmedicine.org/.

Maybe that would be useful to the original poster as well.

[Rojo]

Somebody has seen Alton Brown's Good Eats oatmeal episode...

I really don't know who Alton Brown is but if he came up with the same thing, he must be a very smart dude.

[*BaseClogger*]

I really don't know who Alton Brown is but if he came up with the same thing, he must be a very smart dude.

Haha it's a show on the Food Network. I highly doubt he came up with it, but I saw him do it on the show. Here's the episode:

http://www.youtube.com/watch?v=eH8tEw938RM

http://www.youtube.com/watch?v=-j-Hk...eature=related