Are statins effective and does cholesterol matter????

Originally Posted by boubou

But the question really is: are the statins really helping these people??

Over a period from 10/29/07 until 12/10/2007, my LDL went from 181 to 102. Starting on 10/29, I took 40mg daily of Pravachol, radically altered my diet and upped my exercise level. In the same period, my TC dropped from 270 to 164 and triglycerides from 262 t0 117.

My Dr. attributed all of these reductions, with the exception of the LDL, to diet and exercise.

My diet and weight have been in much better balance at other times in my life, but my cholesterol has always been elevated. For many years, before the widespread use of the internet and online medical forums, I've consumed fish oil, various EFA's, psyllium etc. and they have never impacted my lipids to any great extent.

I'm not a booster of statins and indeed, I'm anxious to see if I can forego them altogether with a committment to lifestyle change instead of a temporary diet. Other studies though besides the one being cited in this thread, have shown that statins reduced the instance of heart / attack stroke to the same degree in people with "normal" lipid levels. I find that quite interesting because it makes an argument for the empirical use of statins where heart disease might be a concern.

To the extent that I can do so for myself, I'll experiment for a period of time without statins, when the other parameters of my health are in a normal range, specifically, optimum weight and diet.

The problem in testing these substances is that they are rarely given to people who's overall lifestyle appears to be normal. They usually get prescribed to people with other things going on or factors that place them in a certain risk category. Statins may be a blunderbuss instead of a laser guided weapon but, they are still doing some remarkable things.

Dr.'s would be much happier people if patients actively engaged in their own health and followed good advice but sadly, the majority want a pill instead. That's partly why you have statins.

Originally Posted by Mark1e

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?

Unfortunately we can't post forum links here, so I can't give you any direct links to studies. But I know of an impaired endothelium dysfuntion study and remember reading a coronary artery study a while ago, which put the blame on small LDL. I also know a lot of cardiologists consider small LDL a big culprit in coronary disease, including Dr. Davis, of 'Track your plaque' fame. I think the idea is that large LDL can't fit so well into the endothelium, so even if it's inflamed, LDL won't cause plaque. If this is true or not... *shrugs* not sure.

But you do have an interesting argument, that if one's arteries are inflamed, it won't matter as to the size of the particles, which I admit could be possible for all I know, as I'm not a super expert or anything. I think one of the other problems with small LDL is that it generally has a bunch of lousy friends with it too: high tryglycerides, low HDL and a very carbohydrate-heavy diet. A person with such a pattern, who changed their diet, increased exercise, etc could probably shift their LDL to large, lower triglycerides, etc.

Maybe small LDL is a marker for inflammation then, due to diet, lifestyle, or genetics that would put a person at a greater risk for heart disease? Although one could then say if this small LDL isn't corrected, inflammation still exists and a statin could be helpful (maybe just for anti-inflammatory reasons).

Originally Posted by namelessme

Maybe small LDL is a marker for inflammation then, due to diet, lifestyle, or genetics that would put a person at a greater risk for heart disease? Although one could then say if this small LDL isn't corrected, inflammation still exists and a statin could be helpful (maybe just for anti-inflammatory reasons).

This is about what the current overview article described. The thinking is the LDL is a marker for the inflammation. Reducing the marker may not do anything for CHD. Do note that the summary and citations did say that statins were effective for people with heart disease -thye just didn't appear to prevent it. Most people today are put on them as a preventative but that does not appear to be happening.

Originally Posted by dmer

Dr.'s would be much happier people if patients actively engaged in their own health and followed good advice but sadly, the majority want a pill instead. That's partly why you have statins.

My point Exactly!
I think that if WE are actively involved in our health, good diet, exercise and common sense, then we should be able to control the amount of necessary medicine going into our bodies. Not the other way around: cholesterol? oh well, ok, gimme a pill and don't worry about a thing and keep eating and living it up attitude taken by a lot of people I know. Pills fix everything!

Originally Posted by boubou

My point Exactly!
I think that if WE are actively involved in our health, good diet, exercise and common sense, then we should be able to control the amount of necessary medicine going into our bodies.

That probably describes no more than 5% of the potential patients who walk into a Dr.'s office. Don't sell stock in the pharmaceutical companies anytime soon. BTW, they do some amazing things for society.

Originally Posted by dmer

That probably describes no more than 5% of the potential patients who walk into a Dr.'s office. Don't sell stock in the pharmaceutical companies anytime soon. BTW, they do some amazing things for society.

Sadly, that is the truth. All you go to do is look at the food people fill their shopping carts with. Sometimes I am amazed at all the junk food people buy. And then most people are the first ones to cry that health care is so expensive. Well if everybody went out there and wrecked their cars, auto insurance rates would skyrocket too. People never think that they are the number one reason health care is so expensive. The pharmaceutical companies are happy to bank on it. They are now saying that obesity in children is causing an epidemic of diabetes which is going to really increase the amount of money spent on health care. Where is all the money going to come from? We may already be at the breaking point.

Originally Posted by aamsaams1

look at the food people fill their shopping carts with. Sometimes I am amazed at all the junk food people buy.

But they don't see their eating habit as a problem and they are quite happy to take the little pills just to make the problem go away and carry on eating and smoking. I see it all the time, actually, I think that's the majority of people.

Originally Posted by aamsaams1

are now saying that obesity in children is causing an epidemic of diabetes .

Again, I blame kids obesity on parenting!!! the parents don't see the problem for themselves, then they don't see it for the kids. They are not ready to take responsabiltiy for the kids health which is sad really! To see the kids overweight and out of shape should really wake the parents up to DO something about it![/QUOTE]

Again, I blame kids obesity on parenting!!! the parents don't see the problem for themselves, then they don't see it for the kids. They are not ready to take responsabiltiy for the kids health which is sad really! To see the kids overweight and out of shape should really wake the parents up to DO something about it!

I agree 100% with you boubou. Kids today are entertained with the TV and video games. Parents use these for babysitting services. That is why you see so many overweight kids today with health problems. I never heard of a kid having high cholesterol years ago. But today you hear alot of it. When I was young, and when my kids were young they were always outside playing, and getting exercise. You don't see many kids today playing outside...they would rather be indoors. I know times has changed, but if parents would think about it and take a look at their children and see how fat they are getting, maybe..just maybe, they would do something about it.

I have had high cholesterol ever since it was first checked in my early 20s and it has remained at the same level (6.5) throughout (I am now 68). A few months ago, my doctor decided to put me on Crestor "just as a precaution". At the same time, he sent me for an ultrasound scan on my carotid arteries. That showed they are completely clear but he still feels it is sensible to stay on Crestor particularly as my cholesterol ratio has dropped to 3.5, although the HDL level is still below the 'normal' range.
It may be coincidence but since shortly after going onto Crestor, I have been suffering with a problem in one eye (vitreous shrinkage).
All this talk about the value of statins to those who have no existing vascular problems is very worrying. As an engineer, I was always taught to work on the principle of "If it ain't broke don't fix it" and that seems to apply here.
The possible risks associated with all of the statins are quite scary so is it really sensible to blindly follow the advice of doctors who are being cajoled by the pharmaceutical reps? My wife was a medical secretary in the UK for 17 years and she says the amount of entertaining that the reps offer is a powerful influence on the prescribers.

Originally Posted by brianmf

I have had high cholesterol ever since it was first checked in my early 20s and it has remained at the same level (6.5) throughout (I am now 68). A few months ago, my doctor decided to put me on Crestor "just as a precaution". At the same time, he sent me for an ultrasound scan on my carotid arteries. That showed they are completely clear but he still feels it is sensible to stay on Crestor particularly as my cholesterol ratio has dropped to 3.5, although the HDL level is still below the 'normal' range.
As an engineer, I was always taught to work on the principle of "If it ain't broke don't fix it" and that seems to apply here.

Well, you know what I think...it's all up to you mate! you know your history and risks factors, so you can judge all this to make your choice.

Originally Posted by brianmf

... my doctor ... sent me for an ultrasound scan on my carotid arteries. That showed they are completely clear ... As an engineer, I was always taught to work on the principle of "If it ain't broke don't fix it" and that seems to apply here.
The possible risks associated with all of the statins are quite scary so is it really sensible to blindly follow the advice of doctors who are being cajoled by the pharmaceutical reps? ...

You have kinda answered your own question here. The scan reveals that you don't have plaque buildup, and your cholesterol is not high anyway. Taking a statin "just as a precaution" simply doesn't make sense. Especially since, in terms of overall mortality, the only people who benefit by taking statins are middle aged men who have already had heart attacks. You fail that test on both counts. Because the body requires more repair & maintenance as we age, we need increased amounts of cholesterol. And using drugs to inhibit the production of cholesterol at your age is non-sensical, IMO.

I have been wondering a lot lately since my Doctor has put me on Niacin if HDL is now becoming more important than previously thought? They say the higher ones HDL the better despite having higher than average LDL. I see many on the board do not need medication as their HDL is high and have low triglycerides as well. This can go with this statin debate. Can we count on an old stand bye like Niacin? It seems that Niacin offers some protection? I am just awfully confused.

Originally Posted by boubou

Well, you know what I think...it's all up to you mate! you know your history and risks factors, so you can judge all this to make your choice.

Certainly true but it is a major decision to go against the advice of your doctor in a life or death situation. However, I am more and more coming to the conclusion that doctors do not know everything and that they are often driven by commercial pressures.

Originally Posted by Mark1e

You have kinda answered your own question here. The scan reveals that you don't have plaque buildup, and your cholesterol is not high anyway.

Well I was always told that 6.5 was high and that it should be below 4.5.
My LDL has always been outside the upper 'normal' range and HDL outside the lower limit. Since going on statins mid last year, the LDL has come down to mid-range but HDL remains low.
I guess I'm dithering about going against my doctor's advice.

Originally Posted by Arizona77

I have been wondering a lot lately since my Doctor has put me on Niacin if HDL is now becoming more important than previously thought? They say the higher ones HDL the better despite having higher than average LDL. I see many on the board do not need medication as their HDL is high and have low triglycerides as well. This can go with this statin debate. Can we count on an old stand bye like Niacin? It seems that Niacin offers some protection? I am just awfully confused.

Your post prompted me to do a bit of research on Niacin and I would strongly recommend you to do the same. It seems that Niacin can cause liver damage in certain cases but it is considered to be an effective medication for raising HDL levels. Apparently, it can also inhibit the effectiveness of statins in lowering LDL if taken at the same time. However, as you have said, it also seems that raising HDL is now considered more important that lowering LDL in cases where the LDL level is not sky high.
I shall certainly take this up with my doctor so many thanks for the tip.