The latest reports on Statins.

[Moxie75]

Nov 09 (Reuters Health) - Findings from a new study suggest that doctors should use "good" (HDL) cholesterol levels to determine which elderly patients are most likely to benefit from statin therapy.

According to the study, statin therapy is probably indicated if the HDL level falls below 45 mg/dL or if the ratio between "bad" (LDL) cholesterol and HDL is greater than 3.3.

In a nutshell, the results suggest that with higher HDL levels, little benefit is achieved with statin therapy.

"This was quite a surprise," lead author Dr. Christopher J. Packard, from the University of Glasgow in the UK, admitted in a statement. "We did not expect the benefits of statin therapy to vary according to starting HDL level. Also, unlike statin studies in younger persons, LDL was not what mattered."

According to a report in Circulation: Journal of the American Heart Association, Packard and colleagues assessed the ability of LDL and HDL to predict the combined endpoint of heart disease death, nonfatal heart attack, and stroke in some 5,800 subjects between 70 and 82 years of age.

Subjects with an HDL level of less than 45 mg/dL experienced a 33 percent reduction in risk of heart disease death, nonfatal heart attack and stroke when treated with pravastatin. By contrast, subjects with higher HDL levels derived no benefit from the drug.

Baseline LDL was not predictive of the combined endpoint in patients randomized to placebo or in those given pravastatin.

"If statin therapy could be targeted to at-risk elderly with low HDL levels who would benefit most, fewer people would have to be treated -- a substantial time and cost savings," Packard emphasized.

SOURCE: Circulation November 15, 2005.
Publish Date: November 09, 2005

[Lenin]

VERY good information, Moxie. Thank You.

Probably one of the reasons that I am VERY pro statins for people at risk of heart disease is my own case that started with a dismal HDL of 28 during the period I was beginning to feel "heartburn" on exercise. I was apparently the PERFECT candidate for atorvastatin (Lipior) which took my HDL to 35 but cut my total cholesterol by 100 points and my LDL's in half.
Not great but I got my TC/HDL NEAR 4.0 from NEAR 10 (Dead Man Walking!)!
Further fiddling with my diet like cutting butterfats a lot, eliminating trans-fats, losing 20 odd pounds, exercising more got my HDL's over 40 consistently and my ratio's just a teeny bit BELOW 4.0.
(Booze can take my HDL to 60...but that's another story!)

Now if someone can kindly come up with a treatment for lowering Lp(a) or better yet, one for dissolving arterial plaque, I'll live forever.

I think people with high HDL's can very well live a statin free life without too much worry about heart disease (the clogged arterial kind at least), but we who need to struggle to keep ours at 40 are in a different category entirely.

Of course, exceptions arise...a friend with HDL's consistenly over 100 for YEARS but who is on a VERY high fat diet (60%+) for nearly a decade just flunked her nuclear stress test...yep, ischemic angina. So the protective effect is protective, not miraculaous!

[NHone]

Lenin, the remake you made about protective , not miraculaous struck me. I believe that was the phrase i've been looking for. Statins, and cholesterol might be of some value in limited, and certain circumstances. They might be protective or benificial in some limited cases..but the are not the miraculaous drug that they have ben marketed to be. Also as the statin study has found, ldl is not as good a predictor as it was previously...in fact it is of little value. The Ldl is important. However the risk of cancer and other problems outweighs any benifit that elderly people recieve from cholesterol lowering. If you are on Lipitor, that could be a reason for elevated Lpa. Lipitor is known to increase Lpa, exactly what heart doctors do not want.

[Uff-Da!]

Here is a quote from another summary of the same research. Source: http://www.americanheart.org/presenter.jhtml?identifier=3035148

“Since low HDL is associated with high inflammation, itself a risk factor for heart disease, and we know statins have anti-inflammatory properties, my working hypothesis is that statins block inflammation and thereby reduce the deleterious effects of low HDL,” Packard said.

Interesting stuff. Of course, results of one study aren't enough to give one a great deal of confidence, but I do feel better now about rejecting my doctor's advice regarding increasing my medication in spite of my HDL of 85 and TC/HDL of 2.8. I'd begun to wonder if HDL was starting to be left out of the picture.

Keep in mind, though, that this study applied to "the elderly." Participants were 70-82 years of age. LDL did seem to matter in other studies with younger patients.

[NHone]

I hope people are going to start to understand that elderly people (and each group of people) will need to be tested individually. There is a warning on Crestor and people of Asian descent. It has always been know that statins contain an anti inflammatory. This was by chemical makeup and definition. It is inpossible to break a statin down and remove just the anti-inflammatory or the cholesterol lowering effect. I wonder if we are going to go full circle and find that aspirin is just as good as the expensive medications?