to take statins or not
mike
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
Andrew B. Chung, MD/PhD
>
> 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
William Wagner
mike <mcol...@yahoo.com> wrote:
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!
--
S 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
Jim Chinnis
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
> mike <mcole8...@yahoo.com> wrote in part:
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
Andrew B. Chung, MD/PhD
> friend Jim Chinnis <jchin...@SPAMalum.mit.edu> wrote:
> > mike <mcole8...@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
> > >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
> >
> > 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.
>
>
> 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
> 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
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.
Jim Chinnis
>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.
William Wagner
mike <mcol...@yahoo.com> wrote:
Perhaps useful Mike.
http://www.bmi-calculator.net/waist-to-hip-ratio-calculator/
Bill
mike
> In article <1188065067.236969.95...@q3g2000prf.googlegroups.com>,
>
> - 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
Andrew B. Chung, MD/PhD
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.
Jim Chinnis
>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.
MarilynMann
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
MarilynMann
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
MarilynMann
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
eml
try omega 3 fish oil
bigvince
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, Montréal, 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
MarilynMann
>
> - 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
eml
>
> - Show quoted text -
who benefited from statins? not all middle aged men, esp. for primary
prevention???
Andrew B. Chung, MD/PhD
> friend MarilynMann <ma...@comcast.net> wrote:
> > friend bigvince <Vince.Mirag...@gmail.com> wrote:
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.
Andrew B. Chung, MD/PhD
That would be wise.
With a WHR less than 0.85, you will become much healthier (hungrier).
Hunger is wonderful :-)
bigvince
>
> > 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, Montréal, 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
%
"Andrew B. Chung, MD/PhD" <heart...@emorycardiology.com> wrote in
message news:1188221992.9...@y42g2000hsy.googlegroups.com...
personally , i'd rather eat something
Andrew B. Chung, MD/PhD
> Andrew, in the Holy Spirit, boldly wrote:
> > friend Jim Chinnis wrote:
> > > mike <mcol...@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.
> >
> > 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
> >
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
MarilynMann
>
> read more »- Hide quoted text -
>
> - 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
%
then i will be more blessed hurray for me
William Wagner
MarilynMann <ma...@comcast.net> wrote:
> > 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 ...
> >
> > read more ?- Hide quoted text -
> >
> > - 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
Seems to be controversial no ? Look at 48 and 49 in this URL.
http://www.ti.ubc.ca/en/TherapeuticsLetters
MarilynMann
>
> 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
@there Vernono O
LIARS are of Satan.
Satiation or the lack of it are not "hunger"
LIAR
Andrew B. Chung, MD/PhD
Redirecting all praise and glory to GOD so that we will both be that
much more blessed (hungrier :-).
Po...@nospam.invalid
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
bigvince
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
Po...@nospam.invalid
> 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
Jim Chinnis
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
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.
Po...@nospam.invalid
>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
bigvince
> P...@nospam.invalid wrote in part:
Andrew B. Chung, MD/PhD
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,
bigvince
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_riskbenefit_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 Chinnis
>On Aug 29, 8:55 am, bigvince <Vince.Mirag...@gmail.com> wrote:
>> On Aug 28, 6:07 pm, Jim Chinnis <jchin...@SPAMalum.mit.edu> wrote:
>>
>>
>>
>> > P...@nospam.invalid wrote in part:
>>
>> > >bigvince wrote:
>> > >> 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
>>
>> > It doesn't make sense to agonize over why statins don't reduce all-cause
>> > mortality, because it isn't true.
>> > 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 .
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
>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. ....
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
>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.....
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
>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
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_riskbenefit_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
Steve O
Andrew B. Chung, MD/PhD
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:
Be hungry... be healthy... be hungrier... be blessed:
http://TheWellnessFoundation.com/PressRelease
Prayerfully in Jesus' awesome love,
Andrew B. Chung, MD/PhD
> Andrew, in the Holy Spirit, boldly wrote:
>
>
> 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
mike
<and...@emorycardiology.com> wrote:
> convicted neighbor Steve O wrote:
>
>
>
>
>
> > Andrew, in the Holy Spirit, boldly wrote:
> > >% wrote:
> > >> Andrew, in the Holy Spirit, boldly wrote:
> > >> > % wrote:
> > >> > > Andrew, in the Holy Spirit, boldly wrote:
> > >> > > > friend Jim Chinnis wrote:
>
> > >> > > > > >I thought it was interesting that thewaisttohipcalculator
> > >> > > provided
>
> - 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 B. Chung, MD/PhD
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
> 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???
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,