re: Dr Wants to Prescribe Statins..I Disagree

quote:

---

How about the fact that statin use decreases CVI risk only in men who have previously had CVIs and has been shown to decrease overall mortality across the board.

---

There is a big difference between the "fact" that it decreases recurrent cardiovascular events and the lack of data from good, high-quality randomized controlled trials to show that it prevents primary events.

Going further, though, there is pretty good data that statins in high-risk diabetics does prevent cardiovascular events. So I don't buy your first statement that statins don't prevent primary events.

The current question, to which we do not know the answer (again, very different than "we know that they don't...") is which patients do we prevent primary events by using a statin? The answer isn't "none"- see first link. The answer isnt "all"- also see first link.

quote:

---

So yes, if you take a statin you are less likely to have a heart attack or stroke if you've already had one. Otherwise, taking a statin gives you a higher risk of death from all causes

---

I think this statement is inaccurate for a few reasons. While on itw surface, it may be correct, it fails to address where the data comes from. As previously stated, it's probably appropriate to put
1) all patients who have had an event and
2) patients at high risk of an event
on a statin
Are some moderate to lower risk patients on statins? I'm sure there are. Are they most of the people on them? Probably not. So, would you be surprised to find out that people at high risk of CVD or have had previous CVD have an increased mortality va the general population? I wouldn't. If you can show me data suggesting low-risk patients went head to head on placebo and statin and the statin group had increased mortality, I'd love to see it.
Until then, I'll rely on data showing that people at high risk of having or known CVD have deceased mortality with statin than without them.

quote:

---

And that's if you believe statins work by decreasing cholesterolThere are competing theories out there that posit statins work by decreasing inflammation and the decrease in cholesterol is only an accessory outcome

---

I'll have to partially agree at best. It isn't a coincidence that an Hmg-CoA reductase inhibitor stops the synthesis of cholesterol. I don't believe that it'ss particularly debatable without some peer reviewed literature I'd like to see you produce since you brought it up.

That said, I think there's the novel idea floating about that LDL is a pro-inflammatory substance and that inflammation is reduced in the lowering of the LDL. While this isn't exactly proven or disproven, there's no denying that patients who suffer from disease states that are pro-inflammatory, particularly RA, IBD and things where you have markedly elevated markers of inflammation suffer higher rates of cardiovascular events even without other risk factors for coronary disease (I'll find a link if you'd like), but there's several other states without marked elevated levels of inflammatory markers that are heavily associated with coronary disease.

Without getting TOO deep into other examples of treating LDL in hopes to prevent vascular events, check out PCSK9 inhibitors. These are monoclonal antibodies which inhibit LDL production in a pretty significant way. Their use has consistently shown fewer cardiovascular events. You'll see that all-cause mortality was not statistically significantly different in this meta analysis, but if you look specifically at the group that had high LDL concentrations that were treated with the drug, they had the most drastic/significant mortality benefit.


Trials specifically to look at mortality of the group with high LDL vs placebo would be considered unethical given the significant amount of data we have to show that lowering LDL- typically with a statin- prevents cardiovascular events and morbidity, and in several cases mortality as well.

Lastly, go back in my earlier post or Google the "IMPROVE IT" trial looking at ezetimibe and its effect on LDL lowering through a distinctly separate mechanism as statins and note that it also prevents all cause mortality in the known CAD group.

quote:

---

Plenty of scientists don't believe cholesterol is the ultimate cause of heart disease.

---

Can you please provide one instance of such a scientist published in any textbook or peer-reviewed journal since the introduction of 1) ezetimibe and 2) PCSK9 inhibitors that gives a plausible biological role for all three medications' ability to lower inflammation primarily while having LDL lowered as a secondary effect. Bonus points if there's evidence of statins having a different mechanism of action or the role of Hmg-CoA reductase in inflammation exclusive of LDL-lowering.

Now, if you mean to say that cholesterol isn't the only factor and that it's multifactorial, that's one thing. But there a lot of solid evidence from pretty credible places that when you treat LDL in a nutshell (as best you can, of course), you prevent heart attacks and strokes in a pretty significant way.

There are a bunch of fvcking retards in this thread. Not reading past the first page, but holy sh!t at the level of ignorance.

quote:

---

Sweet Christ no. Do literally the opposite of whatever he says to do, and you should be good

---

.

I’ll read or watch anything. Doesn’t mean I will believe it, but my mind is open to being changed.

While you're awake, can I ask you something specific about blood sugar? Specifically, a reading of 16

quote:

---

I believe I'm catching the joke, but did you realize that January marks the 10-year anniversary of drug companies not giving out essentially any branded materials (excludes St conferences and FDA-scrutinized and approved handouts to doctors)?


Further, thanks to the Sunshine Act, it's supposed to be public knowledge every time a physician received a meal or samples from a drug company. The way it's currently reported is through the CMS website.

You can see the Dollar amount of what they received and how many different encounters were reported.

---

Excellent answers by Hopeful Doc. Very accurate with his answers. Amazed at the phobia with statins and the poor rationale for not taking them. A lot of misinformation and basic lack of knowledge on how to interpret studies by the public. Keep up the good work. As you stated earlier, all statins are generic except for one which is rarely prescribed anyway.
One rule of thumb- run tests only if it will affect or change your treatment plan.

Time to lay off the popeyes baw.

quote:

---

 If you can show me data suggesting low-risk patients went head to head on placebo and statin and the statin group had increased mortality, I'd love to see it.

---

There is no study like this that I am aware of. However, there was a study that looked at high-risk patients who were separated between placebo and statin groups. The statin groups died less of heart attack and stroke, but had more deaths overall. So, you were more likely to die from taking statins than if you didn't.
study

I want to state that I'm genuinely curious about this issue and regret that I came off callous and cock sure in my previous posts. (I was hopped up on caffeine at the gym with my blood pumping pretty good while reading this thread.)

I appreciate your thoughtful responses and would be honored to be a patient under your care, Doc.

All I wanted to get across is that heart disease is not as easy a fix as 'just take a statin'. What causes heart attacks is multi-factorial and not fully understood at this time.

In medicine, I think it is healthy to be skeptical. Objective truths in science are only verified when all studies come to the same conclusion, even those trying to prove the opposite.

As a physician, you have to go off of your best available evidence...both legally and morally.

As patients, we have the responsibility to be educated about what we put into our bodies.

Thanks for the civil discussion...my mind is always open.

Cheers, Doc.

Doc wants to get those nice vacations in before he gets too old to take them!!!

I don’t see the usuals here from the health board, and haven’t read through this thread, but will go back now. Your lipid panel is unique as you have high HDL and lower triglycerides, and high ldl. There have literally been no studies looking at a scenario like yours, and if you can find one I’ll give you $200. Your numbers appear to be that of someone on a low-carb diet, they have low triglycerides, high HDL, and moderately high LDL.