Is Adam wrong about dementia prevention? What about that U-shaped relationship between cholesterol and mortality? Can three people who agree argue about the benefits of statins?
Regarding statins. I am book marking the time slot of when you ask a primary care physician if they ran the numbers through a risk assessment calculator. My son is 37! He has I/DD. He is overweight right now due to medication, etc, but 37! I told them NO! I am going to give them the calculators and ask them to use them.
This is very timely for me. 45F, A1C 5.1%, BMI 20.4, blood pressure only high at the doctor (measured at home it is always normal), daily exercise, and high fiber, plant based diet. I average 8-14k steps a day.
My total cholesterol has always been 200-230. HDL is always 70+. LDL is usually 90-120. Triglycerides typically under 100. Until this year. They were 163. Lp(a) 87 and ApoB 93. I am not interested in a CAC. As one who has yearly mammograms, I don’t want more chest radiation, even if it is nominal. I also think a score of anything other than zero will just give me unneeded anxiety. When I put my stats into a risk calculator, it seems I am low risk, but my doctor is really pushing statins. It is hard to know whether the benefit of lowering LDL and ApoB would be worth the risk of side effects.
Andrew is 100% right about the general understanding re statins and the over-treatment and recommendations, especially (in my experience) for women. DO NOT ASSUME anybody, medical professionals or laypeople, have any kind of nuanced understanding of this.
Gentlemen, pleeeeease please read the best, largest dataset on CV risk, from this year: https://tinyurl.com/d7t9d2fx. 'Hypercholesterolemia' is not now—and never was—a risk factor. It stands alone as, in fact, arguably protective (NS). And the curve from Korea isn't as important as the one from the US (https://tinyurl.com/2tcs98tu), confirming: LDL doesn't matter. Period. Until it is >240, and even then, it's trifling. Statin studies do NOT show a 25% reduction in what matters to patients. They reduce revascularizations, which are universally non-beneficial. Patients take the drug to live longer, and statins don't do that. Extrapolations and projections about longer follow-up are nice, but theoretical. If theory, not data, are the basis for your recommendations patients should hear that from your mouth. Respectfully, DHN
Helo... Why would low cholesterol be a marker of risk, and high cholesterol a " risk factor" ? Couldn't both be markers of different immune-inflammatory profiles, each associated with vulnerability to different exposures and mortality risks, with their population distributions changing over time? https://pmc.ncbi.nlm.nih.gov/articles/PMC387427/
Cardiologist here resonating with all of you. Thank you for this discussion. I’ve definitely changed my approach to primary prevention and knee jerk statin treatment in the last few years. Trust and confidence has indeed been eroded but deservedly so. MAHA
Regarding statins. I am book marking the time slot of when you ask a primary care physician if they ran the numbers through a risk assessment calculator. My son is 37! He has I/DD. He is overweight right now due to medication, etc, but 37! I told them NO! I am going to give them the calculators and ask them to use them.
This is very timely for me. 45F, A1C 5.1%, BMI 20.4, blood pressure only high at the doctor (measured at home it is always normal), daily exercise, and high fiber, plant based diet. I average 8-14k steps a day.
My total cholesterol has always been 200-230. HDL is always 70+. LDL is usually 90-120. Triglycerides typically under 100. Until this year. They were 163. Lp(a) 87 and ApoB 93. I am not interested in a CAC. As one who has yearly mammograms, I don’t want more chest radiation, even if it is nominal. I also think a score of anything other than zero will just give me unneeded anxiety. When I put my stats into a risk calculator, it seems I am low risk, but my doctor is really pushing statins. It is hard to know whether the benefit of lowering LDL and ApoB would be worth the risk of side effects.
You sound like a wonderfully informed person!
Also, John, unknown unknowns of the harms of statins are as likely to appear after two-to-four years as the unknown unknown benefits. Correct?
Andrew is 100% right about the general understanding re statins and the over-treatment and recommendations, especially (in my experience) for women. DO NOT ASSUME anybody, medical professionals or laypeople, have any kind of nuanced understanding of this.
Gentlemen, pleeeeease please read the best, largest dataset on CV risk, from this year: https://tinyurl.com/d7t9d2fx. 'Hypercholesterolemia' is not now—and never was—a risk factor. It stands alone as, in fact, arguably protective (NS). And the curve from Korea isn't as important as the one from the US (https://tinyurl.com/2tcs98tu), confirming: LDL doesn't matter. Period. Until it is >240, and even then, it's trifling. Statin studies do NOT show a 25% reduction in what matters to patients. They reduce revascularizations, which are universally non-beneficial. Patients take the drug to live longer, and statins don't do that. Extrapolations and projections about longer follow-up are nice, but theoretical. If theory, not data, are the basis for your recommendations patients should hear that from your mouth. Respectfully, DHN
Helo... Why would low cholesterol be a marker of risk, and high cholesterol a " risk factor" ? Couldn't both be markers of different immune-inflammatory profiles, each associated with vulnerability to different exposures and mortality risks, with their population distributions changing over time? https://pmc.ncbi.nlm.nih.gov/articles/PMC387427/
We need to go beyond black-box epidemiology.
Regards
Maria Ines Azambuja
Cardiologist here resonating with all of you. Thank you for this discussion. I’ve definitely changed my approach to primary prevention and knee jerk statin treatment in the last few years. Trust and confidence has indeed been eroded but deservedly so. MAHA