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Medical Forum / General / Cardiology / August 2007to take statins or not
My brother recently had a blood test and his cardiologist and GP disagreed on whether or not to take statins. His total Cholesterol was 300 and his HDL was 70, triglycerides 85. He does not smoke, bmi is 22, and he does not have High blood pressure in fact its below 120. OTOH our father died of a stroke at the age of 44 caused by a blood clot. Mother is 78 has total cholesterol of 290 and hdl over 80. Father had high cholesterol but no one knows what his hdl was. Interestingly cardiologist say does not need statins whereas GP says he does. Any opinions appreciated. Mike > My brother recently had a blood test and his cardiologist and GP > disagreed on whether or not to take statins. His total Cholesterol was > 300 and his HDL was 70, triglycerides 85. This information allows us to calculate his LDL to be 213 mg/dl. This is far from optimal (less than 100 mg/dl). > He does not smoke, bmi is > 22, and he does not have High blood pressure in fact its below 120. If his WHR (Waist to Hip Ratio) is greater than 0.85, his visceral adipose tissue (VAT) is contributing to the elevation in LDL. > OTOH our father died of a stroke at the age of 44 caused by a blood > clot. Uh-oh. > Mother is 78 has total cholesterol of 290 and hdl over 80. > Father had high cholesterol but no one knows what his hdl was. > Interestingly cardiologist say does not need statins whereas GP says > he does. It would be wise for your brother to do something to get his LDL lower. > Any opinions appreciated. Thanks be to GOD. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > My brother recently had a blood test and his cardiologist and GP > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 7 lines] > > Mike Looks like his LDL is about 200. I'd do another test and ask his doc's to confer. Maybe get another opinion too. Best! Bill 44 is young! I think 60 is young!  SignatureS Jersey USA Zone 5 Shade This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. http://www.ocutech.com/ High tech Vison aid mike <mcole8883@yahoo.com> wrote in part: >My brother recently had a blood test and his cardiologist and GP >disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 7 lines] > >Mike Given his TGL/HDL ratio is good, I'd think he might try to reduce his LDL to improve his risk. Weight loss, monounsaturates, maybe sterols/stanols and watching saturated fat intake. It will take a combination of things to have a good impact. -- Jim Chinnis Warrenton, Virginia, USA > mike <mcole8...@yahoo.com> wrote in part: > [quoted text clipped - 16 lines] > -- > Jim Chinnis Warrenton, Virginia, USA Jim, Dr. Chung, and William, Thank you all for the responses. I called my brother and he measured his w and hips. his hips were 39 and waist was 37. he measuered widest part of hips and around belly button without sucking in his belly. I guess that is not ideal but certainly not bad and for a middle aged guy probably way better than many, as for the diet angle he tried plant stanols several times and zilch also tried pantethine, policosanol, and Niacin over the counter which he said was totally intolerable although it did lower his cholesterol some but not enough according to his GP who tells him he is foolish not to take statins. GP would like him on Crestor. He also eats a very heart healthy diet beans, olive oil, nuts and lots of veggies.. appears ldl is genetically driven. He also rides a bike almost daily Mike > > mike <mcole8...@yahoo.com> wrote in part: > > [quoted text clipped - 19 lines] > Thank you all for the responses. I called my brother and he measured > his w and hips. his hips were 39 and waist was 37. Uh-oh. This gives a WHR of 0.95 where optimal is less than 0.85 for men as VAT goes to zero. > he measuered widest > part of hips and around belly button without sucking in his belly. Correct. > I > guess that is not ideal but certainly not bad and for a middle aged [quoted text clipped - 6 lines] > beans, olive oil, nuts and lots of veggies.. appears ldl is > genetically driven. He also rides a bike almost daily Neither diet nor exercise are very effective in getting rid of the VAT. Would suggest your brother have his doctor supervise his using the 2PD- OMER Approach to get his VAT to zero as WHR goes to less than 0.85 (for women it would be less than 0.75): http://HeartMDPhD.com/wtloss.asp It is very likely that his LDL will become less than 100 mg/dl as his WHR goes below 0.85. Meanwhile, policosanol starts to work as effectively as statins as soon as intake is reduced down to the optimal amount. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist mike <mcole8883@yahoo.com> wrote in part: >his hips were 39 and waist was 37. he measuered widest >part of hips and around belly button without sucking in his belly. I >guess that is not ideal but certainly not bad and for a middle aged >guy probably way better than many But most middle-aged men are at high risk for heart disease. His waist is plenty large enough to put him at elevated risk. It's possible that his LDL would fall a lot if he were to shed a few inches around the middle. -- Jim Chinnis Warrenton, Virginia, USA > > mike <mcole8...@yahoo.com> wrote in part: > > [quoted text clipped - 33 lines] > > Mike Perhaps useful Mike. http://www.bmi-calculator.net/waist-to-hip-ratio-calculator/ Bill SignatureS Jersey USA Zone 5 Shade This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. http://www.ocutech.com/ High tech Vison aid > In article <1188065067.236969.95...@q3g2000prf.googlegroups.com>, > [quoted text clipped - 53 lines] > > - Show quoted text - Jim, Dr.Chung and Bill, I thought it was interesting that the waist to hip calculator provided by Bill showed a <0.95 waist to hip ratio as low risk which is about where my brothers ratio is. Discussed with brother possibility of lowering w/h ratio who has already lost considerable amount of weight with good results excepting for ldl reduction =zilch. Weight loss has significantly lowered triglycerides and blood pressure though. His GP even had his HS crp level checked and it was 0.2 which the GP and Cardiologist agreed was excellent. Brother says he may kick up the exercise level but doesn't really want to lower his weight below current level. Feels he is already "too thin." at BMI 22. I think he feels comforted by his heart doc's recommendation to stay the course and forget about taking statins, but i know he is still worried about those damn high ldl levels considering our family history and all. Again thanks to all of you for your helpful insights. Mike > > In article <1188065067.236969.95...@q3g2000prf.googlegroups.com>, > > > > mike <mcole8...@yahoo.com> wrote in part: [quoted text clipped - 58 lines] > by Bill showed a <0.95 waist to hip ratio as low risk which is about > where my brothers ratio is. Men with WHR > 0.85 (women with WHR > 0.75) are at a higher risk of developing coronary atherosclerosis. Source: Lee et al. Am J Clin Nutr.2007; 86: 48-54 You may use the Google archives to access earlier discussion in SMC about this article. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist mike <mcole8883@yahoo.com> wrote in part: >I thought it was interesting that the waist to hip calculator provided >by Bill showed a <0.95 waist to hip ratio as low risk which is about >where my brothers ratio is. Newer evidence is that at least some people have a problem with WHR lower than 0.95. I think people vary. Some apparently "thin' people with no known risk factors die of heart attacks. I suspect some of them have problems with visceral fat, based on the current research. Most people would say I am at an ideal weight. But I'm losing some until I drop below 0.85, based on the latest research. -- Jim Chinnis Warrenton, Virginia, USA > mike <mcole8883@yahoo.com> wrote in part: > [quoted text clipped - 9 lines] > Most people would say I am at an ideal weight. But I'm losing some until I > drop below 0.85, based on the latest research. That would be wise. With a WHR less than 0.85, you will become much healthier (hungrier). Hunger is wonderful :-) Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > > mike <mcole8883@yahoo.com> wrote in part: > > [quoted text clipped - 26 lines] > Andrew B. Chung, MD/PhD > Cardiologist personally , i'd rather eat something > Andrew, in the Holy Spirit, boldly wrote: > > > mike <mcole8883@yahoo.com> wrote in part: [quoted text clipped - 28 lines] > > > personally , i'd rather eat something If what you eat is good for you and you weigh the food to keep from overeating, you will be hungrier :-) May GOD bless you in HIS mighty way making you healthier (hungrier) than ever: http://HeartMDPhD.com/HolySpirit/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > > Andrew, in the Holy Spirit, boldly wrote: > > > > mike <mcole8883@yahoo.com> wrote in part: [quoted text clipped - 43 lines] > Andrew B. Chung, MD/PhD > Cardiologist then i will be more blessed hurray for me > Andrew, in the Holy Spirit, boldly wrote: > > > Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 43 lines] > > then i will be more blessed hurray for me Redirecting all praise and glory to GOD so that we will both be that much more blessed (hungrier :-). Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist How does your approach different from Dr. Mehmat Oz? >> Andrew, in the Holy Spirit, boldly wrote: >> > > Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 53 lines] > Andrew B. Chung, MD/PhD > Cardiologist > Andrew, in the Holy Spirit, boldly wrote: > >> Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 49 lines] > > How does your approach different from Dr. Mehmat Oz? The 2PD-OMER Approach is not a diet. Diets including the one by Dr. Oz decrease hunger (health). The 2PD-OMER Approach makes people hungrier (healthier): http://HeartMDPhD.com/HolySpirit/Healing The 2PD-OMER Approach is completely free and comes with free cardiologist support via usenet. The 2PD-OMER Approach includes an unprecedented million-dollar guarantee: http://TruthRUS.org/Guarantee Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist On Aug 29, 6:36 pm, "Andrew B. Chung, MD/PhD" <and...@emorycardiology.com> wrote: > > Andrew, in the Holy Spirit, boldly wrote: > > >> Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 78 lines] > > - Show quoted text - Thanks again to all for much to think about. I think the waist hip thing looks like the probable answer for folks like my brother who have these cardio related problems. The literature on this is quite impressive and it explains why BMI has not been a very reliable method to assess risk as Dr. Chung has repeatedly pointed out. But one problem some folks would lose more weight on their hips as they lost weight and then the ratio would not improve --correct??? Mike > Andrew, in the Holy Spirit, boldly wrote: > > > Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 72 lines] > > Thanks again to all for much to think about. You are welcome, Mike :-) Redirecting all thanks and praises to GOD to that we will both be that much more blessed (hungrier). > I think the waist hip > thing looks like the probable answer for folks like my brother who [quoted text clipped - 3 lines] > problem some folks would lose more weight on their hips as they lost > weight and then the ratio would not improve --correct??? This is what happens with dieting, where the rate of decrease in SAT is greater than the rate of decrease in VAT. Measuring WHR allows folks to see that the must be hungrier (stomachs singing and laughing loudly :-) to decrease WHR. Truly, it is only when we are hungry that our bodies get rid of the VAT. Hunger is wonderful :-) Be hungry. Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist LIARS are of Satan. Satiation or the lack of it are not "hunger" LIAR > Andrew, in the Holy Spirit, boldly wrote: > > LIARS are of Satan. > > Satiation or the lack of it are not "hunger" > LIAR Clearly you have satan's lie in your heart about hunger. This simply shows that the Holy Spirit is absolutely right to convict you: http://HeartMDPhD.com/Convicts Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > My brother recently had a blood test and his cardiologist and GP > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 7 lines] > > Mike That cardiologist is not like any cardiologists I have heard of. The ones I know would be pulling out their prescription pad to prescribe a statin in a minute, and probably a high dose, too. It is up to him but if I were him I would get a second opinion from another cardiologist. He should pursue diet and exercise too but with LDL that high it is unlikely they will be sufficient. Marilyn > My brother recently had a blood test and his cardiologist and GP > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 7 lines] > > Mike If you are within traveling distance of a major medical center, you and your brother may want to go to a lipid clinic for more expert advice. Marilyn > My brother recently had a blood test and his cardiologist and GP > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 7 lines] > > Mike Sorry for the multiple messages, but I just want to say one more thing. That his HDL, BMI and blood pressure are good and he is a nonsmoker does not cancel out the fact that his LDL is very high. It just doesn't work that way, unfortunately. Marilyn > > My brother recently had a blood test and his cardiologist and GP > > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 14 lines] > > Marilyn try omega 3 fish oil > > My brother recently had a blood test and his cardiologist and GP > > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 12 lines] > nonsmoker does not cancel out the fact that his LDL is very high. It > just doesn't work that way, unfortunately. Perhaps his cardiologist was aware of the fact that a new study found that Cholesterol Fractions and Apolipoproteins as Risk Factors for Heart Disease Mortality in Older Men Robert Clarke, FRCP; Jonathan R. Emberson, PhD; Sarah Parish, DPhil; Alison Palmer, MSc; Martin Shipley, MSc; Pamela Linksted, MSc; Paul Sherliker, BSc; Sarah Clark, DPhil; Jane Armitage, FRCP, FFPHM; Astrid Fletcher, PhD; Rory Collins, FRCP Arch Intern Med. 2007;167:1373-1378. '"Results Ischemic heart disease mortality was not significantly associated with total cholesterol levels in all men (HR, 1.05), but a significant positive association in men without CVD and a slight nonsignificant inverse association in men with CVD were observed (HR, 1.47 vs 0.84). The patterns were similar for low-density lipoprotein cholesterol levels (HR, 1.50 vs 0.98) and for apolipoprotein B levels (HR, 1.68 vs 0.93). So the fact that the 2 strongest indicators are " Ischemic heart disease risks were inversely associated with high- density lipoprotein cholesterol levels and with apolipoprotein A1 levels in men with and without CVD. Ischemic heart disease risks were strongly associated with total-high-density lipoprotein cholesterol levels (HR, 1.57) and apolipoprotein B-apolipoprotien A1 levels (HR, 1.54), and remained strongly related at all ages. " The total to HDL ratio or apolipoprotein B-apolipoprotien A1 levels stronger indicators than theLDL level. Perhaps the cardiologist was on to something. In fact if this study is accurate higher levels of hdl do cancell out higher levels of ldl . if as the study found that ratio ratio is the better indicator. Or perhaps his cardiologist just felt like this one Questioning the benefits of statins Eddie Vos* and Colin P. Rose *Sutton, Que.; Cardiologist, McGill University, Montr?al, Que. 'The assessment by Douglas Manuel and associates1 of the 2003 Canadian dyslipidemia guidelines2 is welcome, but they overlooked the all-cause mortality issue, where statins have essentially failed to deliver.1 There are no statin trials with even the slightest hint of a mortality benefit in women,3,4,5 and women should be told so. Likewise, evidence in patients over 70 years old shows no mortality benefit of statin therapy: in the PROSPER trial there were 28 fewer deaths from coronary artery disease in patients who received pravastatin versus placebo, offset by 24 more cancer deaths.6 The failure of statins to decrease all-cause mortality is possibly best illustrated by atorvastatin: while both the ASCOT7 and TNT8 trials found that atorvastatin therapy decreased the risk of cardiovascular events, in the ASCOT trial (placebo v. 10 mg atorvastatin daily) the all-cause mortality curves effectively touched at mean study end (3.3 years) and in the TNT trial (10 v. 80 mg of atorvastatin daily) there were 26 fewer deaths from coronary artery disease in patients taking the higher dose offset by 31 more noncardiovascular deaths at median study end (4.9 years). Incidentally, the ASCOT trial failed to find a cardiac benefit of statin therapy in women and patients with diabetes. The Web site of the ALLHAT study says it best:9 "trials [primarily in middle-aged men] demonstrating a reduction in [coronary artery disease] from cholesterol lowering have not demonstrated a net reduction in all-cause mortality." What is the point of decreasing the number of "events" without decreasing overall mortality, when the harm caused by the side effects of statin therapy is factored in? ' In either case the cardiologist in guestion must have felt the risk just where not worth the benefits. Thanks Vince > > > My brother recently had a blood test and his cardiologist and GP > > > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 89 lines] > > - Show quoted text - Vince, we are talking about a middle-aged man. In that study you are citing the men were in their seventies. Here we have someone with an LDL of around 200. I do not think you can say his HDL level cancels out the risk associated with an LDL level that high. In any case, Apo- B is highly correlated with LDL. I am not versed in the details of all these statin trials, but I do know statins have shown a benefit for total mortality in middle-aged men, at least at a standard dose. No one is saying you have to take a statin. Marilyn > > > > My brother recently had a blood test and his cardiologist and GP > > > > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 103 lines] > > - Show quoted text - dr. chung will know--was it middle aged men with prior coronary event who benefited from statins? not all middle aged men, esp. for primary prevention??? > > > > > My brother recently had a blood test and his cardiologist and GP > > > > > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 103 lines] > > > dr. chung will know-- All knowledge and wisdom is from GOD. > was it middle aged men with prior coronary event > who benefited from statins? These would also necessarily have a prior diagnosis of coronary disease. > not all middle aged men, esp. for primary > prevention??? For those with a prior diagnosis of coronary disease, it would no longer be primary prevention but proven secondary prevention. It remains wise for all folks with family history of cardiovascular disease (strokes included) to assume they have coronary disease until proven otherwise. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist Here is what David said awhile back in the context of statins for primary prevention: "There's at least modest evidence that the relative benefits of statins for primary prevention are similar to the benefits in secondary prevention. However, for many people this relative benefit translates into a tiny absolute risk reduction such that most people at low risk would not think it worth the cost, annoyance of taking a pill, and risk of side effects." The person being discussed in this thread appears to be at fairly *high* risk due to his family history and his LDL level. All I'm saying is that he would want to take this into account in deciding whether to take a statin or not. Marilyn > > > > My brother recently had a blood test and his cardiologist and GP > > > > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 41 lines] > > levels (HR, 1.57) and apolipoprotein B-apolipoprotien A1 levels (HR, > > 1.54), and remained strongly related at all ages. " > > In either case the cardiologist in guestion must have felt the risk > > just where not worth the benefits. > > Vince, we are talking about a middle-aged man. In that study you are > citing the men were in their seventies. The study found that the relation ship of HDL to LDL was across all age groups . But that has been know for some time heres a good article TUESDAY, Aug. 14 2004 (HealthDay News) -- Measuring total cholesterol and so-called "good" cholesterol or HDL is sufficient to predict heart disease risk without measuring other blood lipids, according to a new study. Measuring other types of fatty substances in the blood -- substances called apolipoprotein B and A-I -- does not give any added value, said co-researcher Dr. Ramachandran S. Vasan, professor of medicine at Boston University School of Medicine. "In the United States, [measuring] total cholesterol and HDL are part of the standard lipid profile," he said. But elsewhere, guidelines also recommend measuring apolipoprotein B and A-I and computing their ratio. Apo B is the main protein component of low-density lipoprotein (LDL), the so-called "bad" cholesterol. A-I is the main component of HDL. Apo B proteins spur hardening of the arteries, while Apo A-I proteins protect against it. Some research has suggested that measuring the ratio of Apo B and A-I might be superior to using the ratio of total cholesterol and HDL to figure out heart disease risk. So, Vasan and his colleagues decided to compare the two approaches to see if one was superior. Their findings are published in the Aug. 15 issue of the Journal of the American Medical Association. Vasan's team followed more than 3,300 middle-aged participants in the Framingham Offspring Study, a major study launched in 1971. Cholesterol measurements were taken in the years 1987 to 1991, when the men and women were free of heart disease. After a follow-up of about 15 years, 291 participants, including 198 men, developed heart disease. Measurements of the apo B to apo A-I ratio were compared with measuring the total cholesterol to HDL ratio to see how well each approach predicted the participants' heart disease. The researchers concluded that the total cholesterol-to-HDL ratio was sufficient and that the other ratio does not substantially improve the accuracy of the prediction. Apo B and apo A-I measurements are not routinely available, Vasan said, but are offered at some labs. For years, researchers have debated whether measurement of the apolipoproteins should be added routinely to predict a person's heart disease risk. But it seems that the old standby, "total cholesterol over HDL, is capturing most of the information that is in the apo B over A-I measurement," Vasan said. "If you know your total and HDL cholesterol, our data do not support the need for additional measurements of apo B and A-I," he said. Physicians divide total cholesterol by HDL cholesterol to get a ratio of total cholesterol to the healthy HDL cholesterol, Vasan explained. "A ratio below 3.5 is ideal," he said. For instance, if total cholesterol is 150 and HDL is 50, the ratio is 3, and the risk for heart disease is low. If total cholesterol is 175 and HDL is 50, the ratio is 3.5.' http://health.ivillage.com/heart/hnews/0,,wbnews_bzs6nfld,00.html Here's the important part Physicians divide total cholesterol by HDL cholesterol to get a ratio of total cholesterol to the healthy HDL cholesterol, Vasan explained. "A ratio below 3.5 is ideal," he said. For instance, if total cholesterol is 150 and HDL is 50, the ratio is 3, and the risk for heart disease is low. If total cholesterol is 175 and HDL is 50, the ratio is 3.5.' If the cardiologist who recommended against statin use followed that formula I think that the ratio is less than 3.5 t0 1 > Here we have someone with an > LDL of around 200. I do not think you can say his HDL level cancels > out the risk associated with an LDL level that high. Again from the article. I'm sorry this is a little redundant Here's the important part " Physicians divide total cholesterol by HDL cholesterol to get a ratio of total cholesterol to the healthy HDL cholesterol, Vasan explained. "A ratio below 3.5 is ideal," he said. For instance, if total cholesterol is 150 and HDL is 50, the ratio is 3, and the risk for heart disease is low. If total cholesterol is 175 and HDL is 50, the ratio is 3.5.' If the cardiologist who recommended against statin use followed that formula I think that the ratio is less than 3.5 t0 1 I am not versed in the details of > all these statin trials, but I do know statins have shown a benefit > for total mortality in middle-aged men, at least at a standard dose. Not when used in primary prevention. This is so set not supported by the evidence let me cite two sources; 'Primary Prevention of Cardiovascular Diseases With Statin Therapy A Meta-analysis of Randomized Controlled Trials Paaladinesh Thavendiranathan, MD, MSc; Akshay Bagai, MD; M. Alan Brookhart, PhD; Niteesh K. Choudhry, MD, PhD Arch Intern Med. 2006;166:2307-2313. Background While the role of hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) in secondary prevention of cardiovascular (CV) events and mortality is established, their value for primary prevention is less clear. To clarify the role of statins for patients without CV disease, we performed a meta-analysis of randomized controlled trials (RCTs). Methods MEDLINE, EMBASE, Cochrane Collaboration, and American College of Physicians Journal Club databases were searched for RCTs published between 1966 and June 2005. We included RCTs with follow-up of 1 year or longer, more than 100 major CV events, and 80% or more of the population without CV disease. From each trial, demographic data, lipid profile, CV outcomes, mortality, and adverse outcomes were recorded. Summary relative risk (RR) ratios with 95% confidence intervals (CIs) were calculated using a random effects model. Results Seven trials with 42 848 patients were included. Ninety percent had no history of CV disease. Mean follow-up was 4.3 years. Statin therapy reduced the RR of major coronary events, major cerebrovascular events, and revascularizations by 29.2% (95% CI, 16.7%-39.8%) (P<.001), 14.4% (95% CI, 2.8%-24.6%) (P = .02), and 33.8% (95% CI, 19.6%-45.5%) (P<.001), respectively. Statins produced a nonsignificant 22.6% RR reduction in coronary heart disease mortality (95% CI, 0.56-1.08) (P = .13). No significant reduction in overall mortality (RR, 0.92 [95% CI, 0.84-1.01]) (P = .09) or increases in cancer or levels of liver enzymes or creatine kinase were observed. Conclusion In patients without CV disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality. ' And from the original letter I posted a good look at several trails Questioning the benefits of statins CMAJ ? November 8, 2005; 173 (10). doi:10.1503/cmaj.1050120. Eddie Vos* and Colin P. Rose *Sutton, Que.; Cardiologist, McGill University, Montr?al, Que. ' The failure of statins to decrease all-cause mortality is possibly best illustrated by atorvastatin: while both the ASCOT7 and TNT8 trials found that atorvastatin therapy decreased the risk of cardiovascular events, in the ASCOT trial (placebo v. 10 mg atorvastatin daily) the all-cause mortality curves effectively touched at mean study end (3.3 years) and in the TNT trial (10 v. 80 mg of atorvastatin daily) there were 26 fewer deaths from coronary artery disease in patients taking the higher dose offset by 31 more noncardiovascular deaths at median study end (4.9 years). Incidentally, the ASCOT trial failed to find a cardiac benefit of statin therapy in women and patients with diabetes. The Web site of the ALLHAT study says it best:9 "trials [primarily in middle-aged men] demonstrating a reduction in [coronary artery disease] from cholesterol lowering have not demonstrated a net reduction in all-cause mortality." What is the point of decreasing the number of "events" without decreasing overall mortality, when the harm caused by the side effects of statin therapy is factored in? ' Thanks VInce > > > > > My brother recently had a blood test and his cardiologist and GP > > > > > disagreed on whether or not to take statins. His total Cholesterol was [quoted text clipped - 210 lines] > > - Show quoted text - The problem is that to the best of my knowledge there has been no primary prevention trial of statin therapy in middle-aged men with LDL around 200. I don't know that it matters that much which lipoprotein ratios you use. For someone at high risk of having a first CVD event, I think statin therapy is a reasonable choice. It is his choice, not yours or mine. Are you proposing that no one be prescribed a statin until after they experience a clinical event? Marilyn > > > > > > My brother recently had a blood test and his cardiologist and GP > > > > > > disagreed on whether or not to take statins. His total Cholesterol [quoted text clipped - 223 lines] > > Marilyn Seems to be controversial no ? Look at 48 and 49 in this URL. http://www.ti.ubc.ca/en/TherapeuticsLetters Bill SignatureS Jersey USA Zone 5 Shade This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. http://www.ocutech.com/ High tech Vison aid > Seems to be controversial no ? Look at 48 and 49 in this URL. > > http://www.ti.ubc.ca/en/TherapeuticsLetters > > Bill The problem is that it would be very difficult to do a primary prevention placebo-controlled trial in these kind of high-risk people. First, most people would consider it unethical. Second, a lot of the control group would end up on statins during the course of the trial, making the results unreliable. Marilyn >Look at 48 and 49 in this URL. >http://www.ti.ubc.ca/en/TherapeuticsLetters Thanks Bill, interesting stuff. I'm as puzzled as ever regarding why I'm on Lipitor. I'll see my Internist tomorrow and hopefully get some explaination, although it was my Cardiologist that put me on it (hopefully in consultation with my Internist). My Total Cholesterol has never been high. Ever. Unfortunately, I never paid particular attention to the my ldl/hdl breakdown until lately. I'm guessing my hdl was always low, which landed me in my predicament. So now, my ldl is *much* lower than normal.... so what? So is my hdl. ... and my docs don't seem to care that my hdl is too low and I don't know why. Seems to me they should have me on Crestor which claims, at least, to raise hdl. Whether it actually does or not, I dunno. Anyhow, I'm just thinking outloud and rambling. If anybody has a comment, I'm all ears. Thanks, Port Port@nospam.invalid wrote in part: >>Look at 48 and 49 in this URL. >>http://www.ti.ubc.ca/en/TherapeuticsLetters [quoted text clipped - 16 lines] >Thanks, >Port There are no trials showing that crestor reduces cardiac morbidity or mortality. A reason to give you Lipitor is that your hdl is low. Not because the statin increases hdl but because it reduces cardiac/stroke risks. -- Jim Chinnis Warrenton, Virginia, USA >A reason to give you Lipitor is that your hdl is low. Not because the statin >increases hdl but because it reduces cardiac/stroke risks. Saw my Internist this morning and that's essentially what he said. I raised my concern about my hdl level and he blew it off saying that with my LDL at 54, the low HDL didn't matter. Still, I'd like to get it up somehow. Port friend P...@nospam.invalid wrote: > >A reason to give you Lipitor is that your hdl is low. Not because the statin > >increases hdl but because it reduces cardiac/stroke risks. [quoted text clipped - 5 lines] > > Port Lose the VAT (WHR < 0.85 for men and WHR <0.75 in women) and your HDL likely will come up. Truly, it is only when we are hungry that our bodies get rid of the VAT. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > The problem is that to the best of my knowledge there has been no > primary prevention trial of statin therapy in middle-aged men with LDL [quoted text clipped - 3 lines] > yours or mine. Are you proposing that no one be prescribed a statin > until after they experience a clinical event? No but the cardiologist in this case recommended against statins.Perhaps aware of the side effects; not wanting this this individuals first clinical event to be an adverse reaction to statins. The 2 studies that I cited both agreed that total ratio of cholestorol over HDL was the best indicator for lipids. "Physicians divide total cholesterol by HDL cholesterol to get a ratio of total cholesterol to the healthy HDL cholesterol, Vasan explained. "A ratio below 3.5 is ideal," he said. For instance, if total cholesterol is 150 and HDL is 50, the ratio is 3, and the risk for heart disease is low. If total cholesterol is 175 and HDL is 50, the ratio is 3.5.'http:// health.ivillage.com/heart/hnews/0,,wbnews_bzs6nfld, 00.html " Why would you feel that this ratio is no longer important ?. Most statin studies would include people like this and the other reason the cardiologist might have recommended against statins is best summed up in a few quotes from the other piece 'Questioning the benefits of statins Eddie Vos* and Colin P. Rose *Sutton, Que.; Cardiologist, McGill University, Montréal, Que. "The assessment by Douglas Manuel and associates1 of the 2003 Canadian dyslipidemia guidelines 2 is welcome, but they overlooked the all- cause mortality issue, where statins have essentially failed to deliver. 1 " The Web site of the ALLHAT study says it best:9 "trials [primarily in middle-aged men] demonstrating a reduction in [coronary artery disease] from cholesterol lowering have not demonstrated a net reduction in all-cause mortality." What is the point of decreasing the number of "events" without decreasing overall mortality, when the harm caused by the side effects of statin therapy is factored in? Evidently the cardiologist in question takes a conservative approach to drug therapy. He just did not feel the risk was worth the benefit. Thanks Vince > they overlooked the all- >cause mortality issue, where statins have essentially failed to >deliver. 1 " Please pardon my ignorance, and I don't mean to sidetrack the conversation, but I see this "all cause mortality" term all over the place and I apparently don't understand it. If it means what it says, then subjects who died of plane crashes, gunshot wounds, and automobile accidents are all factored into it. What the heck would the resulting statistic reveal about a statin? Tia, Port Port@nospam.invalid wrote in part: >> they overlooked the all- >>cause mortality issue, where statins have essentially failed to [quoted text clipped - 10 lines] >Tia, >Port It doesn't make sense to agonize over why statins don't reduce all-cause mortality, because it isn't true. I think the biggest randomized controlled trial ever done on statins is the Heart Protection Study: BMC Med. 2005 Mar 16;3:6. The effects of cholesterol lowering with simvastatin on cause-specific mortality and on cancer incidence in 20,536 high-risk people: a randomised placebo-controlled trial [ISRCTN48489393].Heart Protection Study Collaborative Group. BACKGROUND: There have been concerns that low blood cholesterol concentrations may cause non-vascular mortality and morbidity. Randomisation of large numbers of people to receive a large, and prolonged, reduction in cholesterol concentrations provides an opportunity to address such concerns reliably. METHODS: 20,536 UK adults (aged 40-80 years) with vascular disease or diabetes were randomly allocated to receive 40 mg simvastatin daily or matching placebo. Prespecified safety analyses were of cause-specific mortality, and of total and site-specific cancer incidence. Comparisons between all simvastatin-allocated versus all placebo-allocated participants (ie, "intention-to-treat") involved an average difference in blood total cholesterol concentration of 1.2 mmol/L (46 mg/dL) during the scheduled 5-year treatment period. RESULTS: There was a highly significant 17% (95% CI 9-25) proportional reduction in vascular deaths, along with a non-significant reduction in all non-vascular deaths, which translated into a significant reduction in all-cause mortality (p = 0.0003). The proportional reduction in the vascular mortality rate was about one-sixth in each subcategory of participant studied, including: men and women; under and over 70 years at entry; and total cholesterol below 5.0 mmol/L or LDL cholesterol below 3.0 mmol/L. No significant excess of non-vascular mortality was observed in any subcategory of participant (including the elderly and those with pretreatment total cholesterol below 5.0 mmol/L), and there was no significant excess in any particular cause of non-vascular mortality. Cancer incidence rates were similar in the two groups, both overall and in particular subcategories of participant, as well as at particular primary sites. There was no suggestion that any adverse trends in non-vascular mortality or morbidity were beginning to emerge with more prolonged treatment. CONCLUSION: These findings, which are based on large numbers of deaths and non-fatal cancers, provide considerable reassurance that lowering total cholesterol concentrations by more than 1 mmol/L for an average of 5 years does not produce adverse effects on non-vascular mortality or cancer incidence. Moreover, among the many different types of high-risk individual studied, simvastatin 40 mg daily consistently produced substantial reductions in vascular (and, hence, all-cause) mortality, as well as in the rates of non-fatal heart attacks, strokes and revascularisation procedures. -- Jim Chinnis Warrenton, Virginia, USA > P...@nospam.invalid wrote in part: > [quoted text clipped - 64 lines] > > - Show quoted text - > > P...@nospam.invalid wrote in part: > [quoted text clipped - 20 lines] > I think the biggest randomized controlled trial ever done on statins is the > Heart Protection Study: Jim you make a statement about statins and cite a one study on a specific statin and claim somehow that applies to statins in general . By that logic Baycol should have the same profile unfortunately that statin was removed from the market caused to many liver failures.By that logic Advandia and Actos would be equal or atenolol would be egual to other newer beta blockers. That logic is flawed .Here are some other studys on statins and their effect on mortality rates from this link http://www.westonaprice.org/moderndiseases/statin.html ALLHAT (2002).......".ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), the largest North American cholesterol-lowering trial ever and the largest trial in the world using Lipitor,"......both groups showed the same rates of death, heart attack and heart disease. .... PROSPER (Prospective Study of Pravastatin in the Elderly at Risk)..".total mortality and total serious adverse events were unchanged by pravastatin as compared to the placebo and those in the treatment group had increased cancer. In other words: not one life saved."....... J-LIT (2002).... simvastatin.....Those with LDL cholesterol lower than 80 had a death rate of just over 3.5 at five years; those whose LDL was over 200 had a death rate of just over 3.5 at five years..... 'Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. The University of British Columbia Therapeutics Initiative came to the same conclusion, with the finding that statins offer no benefit to women for prevention of heart disease.'....... "Heart Protection Study (2002) Carried out at Oxford University,37 this study received widespread press coverage; researchers claimed "massive benefits" from cholesterol-lowering,38 leading one commentator to predict that statin drugs were "the new aspirin."39 But as Dr. Ravnskov points out,40 the benefits were far from massive. Those who took simvastatin had an 87.1 percent survival rate after five years compared to an 85.4 percent survival rate for the controls and these results were independent of the amount of cholesterol lowering. The authors of the Heart Protection Study never published cumulative mortality data, even though they received many requests to do so and even though they received funding and carried out a study to look at cumulative data. According to the authors, providing year-by-year mortality data would be an "inappropriate" way of publishing their study results.41 ' Source Dangers of Statin Drugs: What You Haven't Been Told About Popular Cholesterol-Lowering Medicines By Sally Fallon and Mary G. Enig, PhD Other good reviews are available http://www.laleva.org/eng/2004/04/statin_drugs_a_critical_review_of_the_riskbene fit_clinical_research.html and a recent Canadian study that looked at all the relevant data and found statins use had not decreased mortality rates or saved lives in primary prevention. Even the Chairman of the committee that allowed Advandia to stay on the market noted that trails need to focus on hard end points such as heart attacks and strokes . Instead of surrogate points such as LDL levels to make a blanket statement about statins as a group assumes that equal benefit comes from equal lipid lowering effects that has not been proven.. Thanks Vince bigvince <Vince.Miraglia@gmail.com> wrote in part: >> > P...@nospam.invalid wrote in part: >> [quoted text clipped - 23 lines] >Jim you make a statement about statins and cite a one study on a >specific statin and claim somehow that applies to statins in general . Actually, I was responding to the bit that you posted at the very beginning of the quoted material in this post: "they overlooked the all-cause mortality issue, where statins have essentially failed to deliver." I don't for a moment think that all statins are the same. >By that logic Baycol should have the same profile unfortunately that >statin was removed from the market caused to many liver failures.By [quoted text clipped - 9 lines] >using Lipitor,"......both groups showed the same rates of death, heart >attack and heart disease. .... And the non-statin group took more statin than the statin group. Frankly, anyone usung ALLHAT to make a point about statin treatment is up to no good in my book. Another thing. This is a science group. I think we do best when we stick with actual studies rather than opinion pieces by those with axes to grind. > PROSPER (Prospective Study of Pravastatin in the Elderly at >Risk)..".total mortality and total serious adverse events were [quoted text clipped - 5 lines] >80 had a death rate of just over 3.5 at five years; those whose LDL >was over 200 had a death rate of just over 3.5 at five years..... What does that have to do with the issue of whether statins save lives? >'Statins and Women (2003) >No study has shown a significant reduction in mortality in women >treated with statins. The University of British Columbia Therapeutics >Initiative came to the same conclusion, with the finding that statins >offer no benefit to women for prevention of heart disease.'....... As I read the studies, women do not seem different from men in how they respond to statins. Showing mortality benefits is harder because they live longer. >"Heart Protection Study (2002) >Carried out at Oxford University,37 this study received widespread [quoted text clipped - 13 lines] >Popular Cholesterol-Lowering Medicines >By Sally Fallon and Mary G. Enig, PhD This has some interesting things to say about "the cholesterol hypothesis" but not about the issue at hand. >Other good reviews are available >http://www.laleva.org/eng/2004/04/statin_drugs_a_critical_review_of_the_riskbene fit_clinical_research.html > >and a recent Canadian study that looked at all the relevant data and >found statins use had not decreased mortality rates or saved lives in >primary prevention. I don't expect a trial to ever show lives saved in primary prevention. The study would have to be too large to be affordable. We've been through this over and over. > Even the Chairman of the committee that allowed Advandia to stay on >the market noted that trails need to focus on hard end points such as >heart attacks and strokes . Instead of surrogate points such as LDL >levels to make a blanket statement about statins as a group assumes >that equal benefit comes from equal lipid lowering effects that has >not been proven.. Death is what we're talking about. I don't know of a harder end point. > Thanks Vince -- Jim Chinnis Warrenton, Virginia, USA > P...@nospam.invalid wrote in part: > [quoted text clipped - 18 lines] > I think the biggest randomized controlled trial ever done on statins is the > Heart Protection Study: > It doesn't make sense to agonize over why statins don't reduce all- cause > mortality, because it isn't true. > > I think the biggest randomized controlled trial ever done on statins is the > Heart Protection Study: Jim you make a statement about statins and cite a one study on a specific statin and claim somehow that applies to statins in general . By that logic Baycol should have the same profile unfortunately that statin was removed from the market caused to many liver failures.By that logic Advandia and Actos would be equal or atenolol would be egual to other newer beta blockers. That logic is flawed .Here are some other studys on statins and their effect on mortality rates from this link http://www.westonaprice.org/moderndiseases/statin.html ALLHAT (2002).......".ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), the largest North American cholesterol-lowering trial ever and the largest trial in the world using Lipitor,"......both groups showed the same rates of death, heart attack and heart disease. .... PROSPER (Prospective Study of Pravastatin in the Elderly at Risk)..".total mortality and total serious adverse events were unchanged by pravastatin as compared to the placebo and those in the treatment group had increased cancer. In other words: not one life saved."....... J-LIT (2002).... simvastatin.....Those with LDL cholesterol lower than 80 had a death rate of just over 3.5 at five years; those whose LDL was over 200 had a death rate of just over 3.5 at five years..... 'Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. The University of British Columbia Therapeutics Initiative came to the same conclusion, with the finding that statins offer no benefit to women for prevention of heart disease.'....... "Heart Protection Study (2002) Carried out at Oxford University,37 this study received widespread press coverage; researchers claimed "massive benefits" from cholesterol-lowering,38 leading one commentator to predict that statin drugs were "the new aspirin."39 But as Dr. Ravnskov points out,40 the benefits were far from massive. Those who took simvastatin had an 87.1 percent survival rate after five years compared to an 85.4 percent survival rate for the controls and these results were independent of the amount of cholesterol lowering. The authors of the Heart Protection Study never published cumulative mortality data, even though they received many requests to do so and even though they received funding and carried out a study to look at cumulative data. According to the authors, providing year-by-year mortality data would be an "inappropriate" way of publishing their study results.41 ' Source Dangers of Statin Drugs: What You Haven't Been Told About Popular Cholesterol-Lowering Medicines By Sally Fallon and Mary G. Enig, PhD Other good reviews are available http://www.laleva.org/eng/2004/04/statin_drugs_a_critical_review_of_the_riskbene fit_clinical_research.html and a recent Canadian study that looked at all the relevant data and found statins use had not decreased mortality rates or saved lives in primary prevention. Even the Chairman of the committee that allowed Advandia to stay on the market noted that trails need to focus on hard end points such as heart attacks and strokes . Instead of surrogate points such as LDL levels to make a blanket statement about statins as a group assumes that equal benefit comes from equal lipid lowering effects that has not been proven.. Thanks Vince Jim you make a statement about statins and cite a one study on a specific statin and claim somehow that applies to statins in general . By that logic Baycol should have the same profile unfortunately that statin was removed from the market caused to many liver failures.By that logic Advandia and Actos would be equal or atenolol would be egual to other newer beta blockers. That logic is flawed .Here are some other studys on statins and their effect on mortality rates from this link http://www.westonaprice.org/moderndiseases/statin.html ALLHAT (2002).......".ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), the largest North American cholesterol-lowering trial ever and the largest trial in the world using Lipitor,"......both groups showed the same rates of death, heart attack and heart disease. .... PROSPER (Prospective Study of Pravastatin in the Elderly at Risk)..".total mortality and total serious adverse events were unchanged by pravastatin as compared to the placebo and those in the treatment group had increased cancer. In other words: not one life saved."....... J-LIT (2002).... simvastatin.....Those with LDL cholesterol lower than 80 had a death rate of just over 3.5 at five years; those whose LDL was over 200 had a death rate of just over 3.5 at five years..... 'Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. The University of British Columbia Therapeutics Initiative came to the same conclusion, with the finding that statins offer no benefit to women for prevention of heart disease.'....... "Heart Protection Study (2002) Carried out at Oxford University,37 this study received widespread press coverage; researchers claimed "massive benefits" from cholesterol-lowering,38 leading one commentator to predict that statin drugs were "the new aspirin."39 But as Dr. Ravnskov points out,40 the benefits were far from massive. Those who took simvastatin had an 87.1 percent survival rate after five years compared to an 85.4 percent survival rate for the controls and these results were independent of the amount of cholesterol lowering. The authors of the Heart Protection Study never published cumulative mortality data, even though they received many requests to do so and even though they received funding and carried out a study to look at cumulative data. According to the authors, providing year-by-year mortality data would be an "inappropriate" way of publishing their study results.41 ' Source Dangers of Statin Drugs: What You Haven't Been Told About Popular Cholesterol-Lowering Medicines By Sally Fallon and Mary G. Enig, PhD Other good reviews are available http://www.laleva.org/eng/2004/04/statin_drugs_a_critical_review_of_the_riskbene fit_clinical_research.html and a recent Canadian study that looked at all the relevant data and found statins use had not decreased mortality rates or saved lives in primary prevention. Even the Chairman of the committee that allowed Advandia to stay on the market noted that trails need to focus on hard end points such as heart attacks and strokes . Instead of surrogate points such as LDL levels to make a blanket statement about statins as a group assumes that equal benefit comes from equal lipid lowering effects that has not been proven.. Thanks Vince |
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