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  • Are statins effective and does cholesterol matter????

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    Old 01-24-2008, 09:14 PM   #1
    mmvic
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    Are statins effective and does cholesterol matter????

    This week, the most respected weekly business magazine in the US did an excellent extensive and documented article on statins, cholesterol and the pharmaceutical industry. Basically, the article cites experts that question the effectiveness of statins in people without CHD or stroke and the role of TC and LDL cholesterol in CHD and lifespan.

    The 36% improvement in heart attacks alluded to in TV commercials for one of the statins is actually a change from 3% events in people taking a placebo to 2% taking Lipitor- a difference of 1 in 100 or a Number Needed to Treat (NNT) of 100! That means for every 100 people taking the drug only 1 will see a benefit!!! This data is from the ad. The article also reveals that after age 60,statins are basically ineffective in extending lifespan and TC and LDL is immaterial in line with Zetia ENHANCE results.

    Great, straight forward scientific discussion of the pros and cons including side effects like muscle pain, nerve problems that are not 100 NNTT but near 15 NNT.

    Last edited by mmvic; 01-24-2008 at 09:19 PM.

     
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    Old 01-25-2008, 06:01 PM   #2
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    Re: Are statins effective and does cholesterol matter????

    Are you saying that according to the add/study that only 1 in 100 person benefits from statin drugs?
    does that mean no matter what the numbers are, only 1% benefit????
    Very interresting data indeed!

     
    Old 01-25-2008, 06:51 PM   #3
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by mmvic View Post
    This week, the most respected weekly business magazine in the US did an excellent extensive and documented article on statins, cholesterol and the pharmaceutical industry. Basically, the article cites experts that question the effectiveness of statins in people without CHD or stroke and the role of TC and LDL cholesterol in CHD and lifespan.

    The 36% improvement in heart attacks alluded to in TV commercials for one of the statins is actually a change from 3% events in people taking a placebo to 2% taking Lipitor- a difference of 1 in 100 or a Number Needed to Treat (NNT) of 100! That means for every 100 people taking the drug only 1 will see a benefit!!! This data is from the ad. The article also reveals that after age 60,statins are basically ineffective in extending lifespan and TC and LDL is immaterial in line with Zetia ENHANCE results.

    Great, straight forward scientific discussion of the pros and cons including side effects like muscle pain, nerve problems that are not 100 NNTT but near 15 NNT.
    For a drug that generates $12 billion in annual sales in the USA the evidence looks a little weak IMO.

     
    Old 01-25-2008, 10:36 PM   #4
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    Re: Are statins effective and does cholesterol matter????

    Boubou, multiple studies done by the pharmas themselves. 1% and in some cases, such as people with low risk factors, the benefit is pretty much non-existent. Some of what this article say has been published before or has been suspected but this was the best compilation of expert opinions and published data I've seen on this.

    The Zetia/Vitorin trial has called into question not only the value of Zetia and the ethics of Merck again but, even more importantly, also the concept that cholesterol causes heart disease rather than being just an indirect marker. The same thing occured with C reacive protein that cardiologists thought caused cardiac inflammation but turned out to be a marker.

    Last edited by mmvic; 01-25-2008 at 10:38 PM.

     
    Old 01-25-2008, 11:23 PM   #5
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    Re: Are statins effective and does cholesterol matter????

    I think lipid sub-classes matter, particle sizes, Lp(a) and HDL. And when thinking about it, I'm not sure if statins play a big role for any of those. Perhaps they can shift LDL to large particle sizes... maybe... a little bit?

    Inflammation reduction, or some other benefit may be why statins do help some people. But they should really only be prescribed for high risk people or those with existing heart disease.

    Anyone else out there notice all the new advertisements for Zetia and Vytorin? It's sort of disgusting. My newspaper has been running these full page ads for both lately, disputing the recent study and making a big deal on how their drugs reduce cholesterol.

    Last edited by namelessme; 01-25-2008 at 11:28 PM.

     
    Old 01-26-2008, 03:50 AM   #6
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by namelessme View Post
    they should really only be prescribed for high risk people or those with existing heart disease.
    That's EXACTLY what I think. I have no other risks, other than maybe my mother which is 63 and is on coumadin and had a stroke but she has hemochromatosis, smokes like a chimney, eats everything and anything no matter how greasy it is. We don't know for a fact that her heart disease is lifestyle, hemochromatosis which was discovered late and causes heart disease or both I'm sure. She takes statins but only preventative, her numbers where actually good (go figure)------aimless rant--------

    What do you think about high numbers tho? I thought NO RX for high but what if numbers (not mine, just for the sake of argument) wouldn't budge for some people without hearth disease risks and stay in the 300's ?

     
    Old 01-26-2008, 03:58 AM   #7
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by mmvic View Post
    such as people with low risk factors, the benefit is pretty much non-existent.
    also the concept that cholesterol causes heart disease rather than being just an indirect marker. The same thing occured with C reacive protein that cardiologists thought caused cardiac inflammation but turned out to be a marker.
    Didn't they found that plaque was forming even while on zetia?
    plaque formation is very significant in hearth disease so is the study actually saying that lowering cholesterol doesn't reduce plaque formation therefore useless?
    That's how I understood the study I read anyways.

    Also, that was on Zetia etc...but what about lipitor and others that weren't named?

     
    Old 01-26-2008, 11:18 AM   #8
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by boubou View Post

    What do you think about high numbers tho? I thought NO RX for high but what if numbers (not mine, just for the sake of argument) wouldn't budge for some people without hearth disease risks and stay in the 300's ?
    Yeah, that can be the tricky part -- defining high risk for heart disease. Those with high lipid values might be considered high risk, just due to lipid subclasses, Lp(a), HDL, etc.

    A calcium scoring can tell people if they have plaque or not, so I suppose that's one way to check if a person is truly at a high risk of a heart attack.

    If a person has moderately bad cholesterol levels or is borderline, with minimal additional risk factors, and diet and exercise doesn't help, I'd personally lean towards niacin + fish oil + vitamin D, over a statin, and see how it works out. That's what I'm doing myself, under a doctor's care.

    But if a person has super high LDL levels, Lp(a), small particle sizes and/or other risk factors, a statin might be helpful, as those indicators probably would put that person at a high risk for heart disease.

     
    Old 01-26-2008, 02:51 PM   #9
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by namelessme View Post
    But if a person has super high LDL levels, Lp(a), small particle sizes and/or other risk factors, a statin might be helpful, as those indicators probably would put that person at a high risk for heart disease.
    But the question really is: are the statins really helping these people??

     
    Old 01-26-2008, 08:59 PM   #10
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    Re: Are statins effective and does cholesterol matter????

    The real summary from these studies is Lpa, TC, LDL and lipids in people with low risk factors-non smokers, no family history, not obese do not appear to correlate at all to CHD. High levels may not harm you and low levels may not be an all clear either. I personally have come to this same view over the years from reading the various studies, conclusions and statistics.

    Extermely high levels over 300 or people with CHD appear to be another matter. There seems to be someting else going on such as inflammation for which the cholestrol maybe a marker. Therefore, just becasue you lower the marker does not mean you eliminate the underlying process, This is what came form the Zetia studies. The same was found for C reative protein.

    I encourage you to read the overview article and makeup your own mind. It's very informative and presents different viewpoints very well.

    Last edited by mmvic; 01-26-2008 at 09:01 PM.

     
    Old 01-27-2008, 12:00 PM   #11
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by mmvic View Post
    This week, the most respected weekly business magazine in the US did an excellent extensive and documented article on statins, cholesterol and the pharmaceutical industry. Basically, the article cites experts that question the effectiveness of statins in people without CHD or stroke and the role of TC and LDL cholesterol in CHD and lifespan.

    The 36% improvement in heart attacks alluded to in TV commercials for one of the statins is actually a change from 3% events in people taking a placebo to 2% taking Lipitor- a difference of 1 in 100 or a Number Needed to Treat (NNT) of 100! That means for every 100 people taking the drug only 1 will see a benefit!!! This data is from the ad. The article also reveals that after age 60,statins are basically ineffective in extending lifespan and TC and LDL is immaterial in line with Zetia ENHANCE results.

    Great, straight forward scientific discussion of the pros and cons including side effects like muscle pain, nerve problems that are not 100 NNTT but near 15 NNT.
    I guess I was right when I posted last August that he theory that high cholesterol causes heart disease has been created by the drug companies and the American Heart Association to sell cholesterol lowering drugs. Is truth finally coming out? One of the things that was in article is that the real reason behind cholesterol drugs is not that they are trying to fight heart disease but rather they were pushed by the pharmaceutical companies who are after the profits. The article even uses the term pseudo science.

    [url]http://www.healthboards.com/boards/showthread.php?t=528326[/url]

     
    Old 01-27-2008, 01:05 PM   #12
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by boubou View Post
    Quote:
    Originally Posted by namelessme View Post
    But if a person has super high LDL levels, Lp(a), small particle sizes and/or other risk factors, a statin might be helpful, as those indicators probably would put that person at a high risk for heart disease.
    But the question really is: are the statins really helping these people??
    The short answer to that is "no", as far as I can see. While high LDL may be a marker for increased heart attack risk, reducing that cholesterol doesn't lower the risk. You don't need high cholesterol to have a heart attack. The message is at last getting through that taking drugs and/or supplements to reduce cholesterol is counterproductive, to say the least. And that eating well, getting lots of exercise, losing weight (if neccessary) and de-stressing are no doubt the most effective therapeautic interventions.
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    Last edited by Mark1e; 01-27-2008 at 01:20 PM.

     
    Old 01-27-2008, 01:51 PM   #13
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by Mark1e View Post
    The message is at last getting through that taking drugs and/or supplements to reduce cholesterol is counterproductive, to say the least. And that eating well, getting lots of exercise, losing weight (if neccessary) and de-stressing are no doubt the most effective therapeautic interventions.
    Hoora!!!!!!!!!!!!!!!!!!!! well said.
    Althoug this is NOT what all of us want to hear, (some of us are realist and do not beleive in miracles. That's the reason I am stuck to exercise and healthy eating. Healthy eating doesn't mean deprivation, but it means intelligent choices and portion control.),
    there is no magic pill

     
    Old 01-27-2008, 02:24 PM   #14
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by Mark1e View Post
    The short answer to that is "no", as far as I can see. While high LDL may be a marker for increased heart attack risk, reducing that cholesterol doesn't lower the risk. You don't need high cholesterol to have a heart attack. The message is at last getting through that taking drugs and/or supplements to reduce cholesterol is counterproductive, to say the least. And that eating well, getting lots of exercise, losing weight (if neccessary) and de-stressing are no doubt the most effective therapeautic interventions.
    It's difficult to say a definitive "no" without knowing a person's lipoprotein numbers. I see a lot of posts referencing LDL, total cholesterol values, etc. -- and you are probably correct stating lowering LDL doesn't lower risk. Unless that person has an LDL like 200-300+, that is, consisting of all small particles.

    People shouldn't focus so much on lowering cholesterol/LDL... it's about lipoproteins, particle sizes, Lp(a), HDL and inflammation. And if a person has terrible lipoprotein/particle sizes leading to plaque build-up, a statin has been shown to help slow down plaque growth. There are other methods of slowing, or possibly even decreasing plaque without statins (ex. Dr. Davis' patients), but it again depends on what the person's numbers/plaque levels are.

    And you are correct in stating that exercise, diet and such are the most important preventative strategies. But I wouldn't say statins have no value to someone with terrible lipoprotein numbers, plaque build-up and/or other risk factors.

     
    Old 01-27-2008, 05:03 PM   #15
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    Re: Are statins effective and does cholesterol matter????

    Quote:
    Originally Posted by namelessme View Post
    .... if a person has terrible lipoprotein/particle sizes leading to plaque build-up, a statin has been shown to help slow down plaque growth. ....
    I keep on reading about "experts" saying this. But I haven't seen a study that actually supports it. I would like to see such a study, if you could point me in the right direction.

    The theory is that small LDL particles are able to penetrate the endothelium in major arteries and are used in forming plaque deposits. The counter arguement is, if artery walls are inflammed, suitable LDL particles will be sourced regardless of the number and size of LDL particles circulating in the bloodstream. A number of butresses have been thrown up to support the crumbling lipid hypothesis cathedral. And the question in my mind is, could the particle size arguement just be one of them?
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