Look at # 48 & 49

http://www.ti.ubc.ca/pages/letter.html

..........................

http://www.yourdiseaserisk.harvard.edu/hccpquiz.pl?func=start&quiz=heart

Play with this. I mean notice how your real or fake numbers matter.

Bill

I don't think so, and a recent, good scientific publication posted here
indicated that the lowering to targets did not confer benefits claimed,
though it suggested somehow or other statins did help.

I am of the opinon that statin use is a triumph of marketing over
science.  I achieved excellent lipid ratio improvements by taking
pantethine, 900 mg per day.

Did your cardiologist discuss the role of high insulinogenic nutrition
in the metabolic syndrome leading to dyslipidemia and CVD?

If not, you may want to look into the role of high glycemic load in
elevating CVD risk.

Here's some info on pantethine, which is so atoxic that it completely
safely works in dialysis and hepatitis patients.  Even Dr. Ornish is
recommending it now, it used to be Dr. Atkins pet product:

1: Minerva Med. 1990 Jun;81(6):475-9.     Related Articles, Links

[Evaluation of the cholesterol-lowering effectiveness of pantethine in
women in perimenopausal age]

[Article in Italian]

Binaghi P, Cellina G, Lo Cicero G, Bruschi F, Porcaro E, Penotti M.

Servizio di Cardiologia, Istitut Clinici di Perfezionamento, Milano.

Cardiovascular diseases are the main cause of death also in women. Their
incidence, rapidly growing in the peri-menopausal period, is related to
serum levels of total cholesterol and its LDL fraction. It was also
shown that the peroxidation of LDL is an additional factor in the
genesis of atherosclerotic vascular disease. As long-term treatments
with synthetic lipid-lowering drugs may cause undesirable side effects,
while pantethine is known to be well tolerated, we treated 24
hypercholesterolemic women (total serum cholesterol greater than or
equal to 240 mg/dl), in perimenopausal age (range: 45-55 years, mean +/-
SD = 51.6 +/- 2.4) with 900 mg/day of pantethine. This is a precursor of
coenzyme A, with an antiperoxidation effect in vivo, and our aim was to
confirm its lipid lowering activity in this particular type of patients.
After 16 weeks of treatment, significant reductions of total
cholesterol, LDL-cholesterol and LDL-C/HDL-C ratio could be observed. No
remarkable changes of the main laboratory parameters (fasting blood
sugar, B.U.N., creatinine, uric acid) were seen. Efficacy percentages of
the treatment were about 80%. None of the patients complained of adverse
reactions due to the treatment with pantethine. In conclusion, we
suggest that pantethine should be considered in the long-term treatment
of lipid derangements occurring in the perimenopausal age.

PMID: 2359503 [PubMed - indexed for MEDLINE]
1: Acta Biomed Ateneo Parmense. 1984;55(1):25-42.     Related Articles, Links

[Hyperlipidemia, diabetes and atherosclerosis: efficacy of treatment
with pantethine]

[Article in Italian]

Arsenio L, Caronna S, Lateana M, Magnati G, Strata A, Zammarchi G.

The hypolipidemizing effects of Pantethine were investigated by the
Authors in 37 hypercholesterolemic and/or hypertriglyceridemic patients.
Of these, 21 were also diabetic, in a satisfying glucidic compensation,
in order to verify the action of this drug also in this metabolic
condition. The study was carried out for three months and during this
period the patients were given Pantethine at the dose of 600 mg/die
orally. At the 30th, the 60th, the 90th day of treatment the following
parameters were controlled: cholesterolemia, HDL cholesterol,
apolipoproteins A and B, triglyceridemia, systolic and diastolic
arterial pressure, uricemia, body weight. Thirty days after suspending
the treatment, the parameters were controlled again to detect a possible
"rebound" effect. The results were analyzed on the whole case-record,
subdividing the patients in dislipidemic and diabetic-dislipidemic, and
on the basis of the Fredrickson's classification. Pantethine induced in
all groups a quick and progressive decrease of cholesterolemia,
triglyceridemia, LDL cholesterol and Apolipoproteins B with increased
HDL cholesterol and Apolipoproteins A. After suspending the treatment,
there is a clear inversion of the state of these parameters. The Authors
conclude that the present work shows that Pantethine, a natural and
atoxic substance, an important component of Coenzyme A, is efficacious
in determining a clear tendency towards normalization of the lipidic values.

PMID: 6232801 [PubMed - indexed for MEDLINE]
1: Atherosclerosis. 1984 Jan;50(1):73-83.     Related Articles, Links

Controlled evaluation of pantethine, a natural hypolipidemic compound,
in patients with different forms of hyperlipoproteinemia.

Gaddi A, Descovich GC, Noseda G, Fragiacomo C, Colombo L, Craveri A,
Montanari G, Sirtori CR.

Pantethine (P), the stable disulphate form of pantetheine, major
component and precursor of coenzyme A, was evaluated within a
double-blind protocol (8 weeks for P or for a corresponding placebo) in
29 patients, 11 with type IIB hyperlipoproteinemia, 15 with type IV, and
3 with an isolated reduction of high density lipoprotein cholesterol
(HDL-C) levels. In type IIB patients, P (300 mg t.i.d.) determined a
highly significant lowering of plasma total and low density lipoprotein
(LDL) associated cholesterol (-13.5% for both parameters). In the same
patients, HDL-C levels increased about 10% at the end of treatment.
Switching from P to placebo was associated with a rapid return to the
baseline cholesterolemia. Both in type IIB and type IV patients, plasma
triglyceride levels were reduced around 30%, when P was given as the
first treatment; when it was preceded by placebo, reductions were less
striking (respectively, -17.8% for type IIB and -13.0% for type IV, at
the end of P treatment). HDL-C levels were not increased by P, either in
type IV, and in the patients with low HDL cholesterolemia. In type IV,
LDL cholesterol levels showed a variable response to P: they tended to
increase when below 132 mg/dl, prior to treatment, and to be reduced
when above this level. This study provides evidence for a significant
hypocholesterolemic effect of P, a natural compound free of overt side
effects. It also indicates that P may raise HDL-C levels in type IIB
patients, while moderately reducing triglyceridemia.

Publication Types:
•    Clinical Trial
•    Controlled Clinical Trial

PMID: 6365107 [PubMed - indexed for MEDLINE]
1: Int J Clin Pharmacol Ther Toxicol. 1986 Nov;24(11):630-7.     Related
Articles, Links

Lipoprotein changes induced by pantethine in hyperlipoproteinemic
patients: adults and children.

Bertolini S, Donati C, Elicio N, Daga A, Cuzzolaro S, Marcenaro A,
Saturnino M, Balestreri R.

Following a brief outline of current knowledge concerning
atherosclerosis and its treatment, the authors describe the results
obtained by treating with pantethine (900-1200 mg daily for 3 to 6
months) a series of 7 children and 65 adults suffering from
hypercholesterolemia alone or associated with hypertriglyceridemia
(types IIa and IIb of Fredrickson's classification). Pantethine
treatment produced significant reduction of the better known risk
factors (total cholesterol, LDL-cholesterol, triglycerides, and apo-B)
and a significant increase of HDL-cholesterol (signally HDL2) and
apolipoprotein A-I. The authors conclude with a discussion of these
results and of the possible role of pantethine in the treatment of
hyperlipoproteinemia, in view of its perfect tolerability and
demonstrated therapeutic effectiveness.

PMID: 3098691 [PubMed - indexed for MEDLINE]

Pantethine reduces plasma cholesterol and the severity of arterial
lesions in experimental hypercholesterolemic rabbits.

Carrara P, Matturri L, Galbussera M, Lovati MR, Franceschini G, Sirtori CR.

Pantethine (P), a coenzyme A precursor, was administered to
cholesterol-fed rabbits (0.5% cholesterol diet + 1% pantethine) for 90
days. At the end of treatment, plasma total cholesterol levels were
reduced 64.7% and the HDL/total cholesterol ratio increased in P-treated
animals; a significant rise of the apo A-I/A-II ratio was detected in
HDL. VLDL lipid and protein levels were, on the other hand, reduced by
P. The cholesterol-ester content of both liver and aortic tissues was
not significantly affected by P. Although the total aortic area with
evident plaques was reduced only 18.2%, the microscopical examination of
sections from the major vessels of P-treated animals, showed a reduction
in the severity of lesions, both in the aorta and in the coronary
arteries. These findings suggest that P, in addition to significantly
lowering plasma cholesterol levels in rabbits on an experimental diet,
may modify lipid deposition in major arteries, possibly by affecting
lipoprotein composition and/or exerting an arterial protective effect.

PMID: 6442152 [PubMed - indexed for MEDLINE]
Clin Ther. 1986;8(5):537-45.     Related Articles, Links

Effectiveness of long-term treatment with pantethine in patients with
dyslipidemia.

Arsenio L, Bodria P, Magnati G, Strata A, Trovato R.

A one-year clinical trial with pantethine was conducted in 24 patients
with established dyslipidemia of Fredrickson's types II A, II B, and IV,
alone or associated with diabetes mellitus. The treatment was well
tolerated by all patients with no subjective complaints or detectable
side effects. Blood lipid assays repeated after 1, 3, 6, 9, and 12
months of treatment revealed consistent and statistically significant
reductions of all atherogenic lipid fractions (total cholesterol,
low-density lipoprotein cholesterol, and apolipoprotein B) with parallel
increases of high-density lipoprotein cholesterol and apolipoprotein A.
The results were equally good in patients with uncomplicated
dyslipidemia and in those with associated diabetes mellitus. The authors
conclude that pantethine (a drug entity related to the natural compound,
pantetheine) represents a valid therapeutic support for patients with
dyslipidemia not amenable to satisfactory correction of blood lipids by
diet alone.

PMID: 3094958 [PubMed - indexed for MEDLINE]
Acta Biomed Ateneo Parmense. 1987;58(5-6):143-52.     Related Articles, Links

[Clinical use of pantethine by parenteral route in the treatment of
hyperlipidemia]

[Article in Italian]

Arsenio L, Bodria P, Bossi S, Lateana M, Strata A.

Servizio di Malattie del Ricambio e Diabetologia, Ospedali Riuniti, Parma.

Recent investigations have confirmed the effectiveness and the excellent
tolerability of pantethine, a derivative of pantetheine, an essential
part of the acetylation coenzyme CoA, administered P.O., in normalizing
the blood lipid concentrations of patients with hyperlipidemias. A group
of 18 patients with hyperlipidemias (9 M, 9 F), with an average age of
52.6 years, was submitted to pantethine parenteral treatment. After a 20
days wash-out, pantethine (400 mg/day; BID) was administered
intramuscularly, for 20 days. Total cholesterol, triglycerides,
HDL-cholesterol, apo A-1 and B lipoprotein, uric acid in serum,
glycemia, CBC, B.U.N., creatininemia, E.S.R., SGOT, SGPT, bilirubinemia,
cardiac frequency, blood pressure and body weight were controlled before
and after treatment. The drug showed to have a therapeutic effectiveness
by a rapid and significant improvement in the blood lipid pattern with
reduction of total cholesterol, triglycerides and apo-B lipoprotein and
increase of HDL-cholesterol and apo A-1 lipoprotein. The tolerability of
pantethine at the stated dosage and mode of administration was
invariably excellent, with non complaints or visible side effects
imputable to the test drug. BUN, creatininemia, glycemia, SGOT, SGPT,
bilirubinemia, E.S.R., CBC, cardiac frequency and blood pressure
readings showed no noteworthy changes throughout the study.

PMID: 2970754 [PubMed - indexed for MEDLINE]

[Clinical use of pantethine by parenteral route in the treatment of
hyperlipidemia]

[Article in Italian]

Arsenio L, Bodria P, Bossi S, Lateana M, Strata A.

Servizio di Malattie del Ricambio e Diabetologia, Ospedali Riuniti, Parma.

Recent investigations have confirmed the effectiveness and the excellent
tolerability of pantethine, a derivative of pantetheine, an essential
part of the acetylation coenzyme CoA, administered P.O., in normalizing
the blood lipid concentrations of patients with hyperlipidemias. A group
of 18 patients with hyperlipidemias (9 M, 9 F), with an average age of
52.6 years, was submitted to pantethine parenteral treatment. After a 20
days wash-out, pantethine (400 mg/day; BID) was administered
intramuscularly, for 20 days. Total cholesterol, triglycerides,
HDL-cholesterol, apo A-1 and B lipoprotein, uric acid in serum,
glycemia, CBC, B.U.N., creatininemia, E.S.R., SGOT, SGPT, bilirubinemia,
cardiac frequency, blood pressure and body weight were controlled before
and after treatment. The drug showed to have a therapeutic effectiveness
by a rapid and significant improvement in the blood lipid pattern with
reduction of total cholesterol, triglycerides and apo-B lipoprotein and
increase of HDL-cholesterol and apo A-1 lipoprotein. The tolerability of
pantethine at the stated dosage and mode of administration was
invariably excellent, with non complaints or visible side effects
imputable to the test drug. BUN, creatininemia, glycemia, SGOT, SGPT,
bilirubinemia, E.S.R., CBC, cardiac frequency and blood pressure
readings showed no noteworthy changes throughout the study.

PMID: 2970754 [PubMed - indexed for MEDLINE]

Atherosclerosis. 1987 Nov;68(1-2):41-9.     Related Articles, Links

    Pantethine lipomodulation: evidence for cysteamine mediation in
vitro and in vivo.

    Wittwer CT, Graves CP, Peterson MA, Jorgensen E, Wilson DE, Thoene
JG, Wyse BW, Windham CT, Hansen RG.

    Department of Pathology, University of Utah Medical School, Salt
Lake City 84132.

    Recent human studies suggest rapid in vivo hydrolysis of the
lipid-lowering drug, pantethine, to the vitamin pantothenic acid and the
small aminothiol compound, cysteamine. To test whether the active agent
is a hydrolysis product, we repeated three experimental models of
pantethine's effect with pantothenate and cysteamine. In vitro
experiments with human fetal fibroblasts showed equivalent modulation of
cholesterol and methyl sterol synthesis by pantethine, cysteamine, or
cystamine (the disulfide of cysteamine), but pantothenate had no effect.
Similarly, in vivo experiments with 0.5% cholesterol-fed rabbits showed
oral pantethine or equimolar cystamine significantly lowered plasma
cholesterol, while pantothenate, cystine, and 2-hydroxyethyl disulfide
did not. Lastly, diabetic male rats (40 mg/kg streptozotocin) fed 0.1%
pantethine and lower plasma free fatty acids after 2 weeks than
controls, an effect not seen with pantothenate and largely duplicated by
cystamine. The efficacy of pantethine has previously been attributed to
altered vitamin metabolism and increased coenzyme A concentration.
Pantethine did increase CoA levels 45% in rat liver homogenates while
equivalent amounts of cystamine or pantothenate did not. However, a
causal relationship between CoA levels and pantethine's action as a
hypolipemic agent has never been shown. At least in 3 independent
experimental models, the lipomodulating effect of pantethine appears
instead to be mediated by the hydrolysis product cysteamine.

    PMID: 3689482 [PubMed - indexed for MEDLINE]

Susan

It depends tremendously on your baseline risk. You have the basic
concept right: the percentage relative benefit of statins is much
greater than the percentage absolute benefit. The actual relative risk
reduction with statins for cardiac events is around 30% (not the 50% you
suggested), and for mortality is more like 20-25%.

If you are in a high risk category (as I suppose you might be since you
have a cardiologist), you might have a 20% or 30% chance of having a
cardiac event over the next ten years. Dropping that by a relative 30%
(from an absolute 20% to 13%, or from an absolute 30% to 20%) is an
amount most people would think was worth some risk of side effects.

For people whose baseline risk is quite low, this relative risk
reduction probably won't make for an absolute risk reduction that is
worth it to a lot of people.

The same argument can't be made for "lowering of bad cholesterol numbers
in general." We really don't know that other methods of lowering
cholesterol have the same efficacy (there are reasons to think they
don't), or even that the primary way statins reduce risk is by lowering
bad (LDL) cholesterol.

However, despite anything you may have read here or elsewhere, statins
really do work to reduce cardiac risk and mortality. This has been
proven again and again in randomized trials.