Not on cholesterol meds? New guidelines may change that

[ack]

Oops, had not refreshed the thread...

 

[Steve Williams]

Never was a fan of statins , believe in diet i-e quality of food, quantity of food and choice of foods. Exercise and diet are key in maintaining and increasing one's health. This has been known for centuries but pills are more profitable... Color me skeptical.

So Myles

no one will disagree but from your position it seems that you feel that all patients will get a favorable result from diet and exercise and the world goes on and everyone is healthy.

There are those who just inherited bad genes and continue to face health issues as lipids remain high or those who are compliant with diet and exercise but have had less than favorable results. According to you you would do nothing more. Statins do have a place. End of story.

 

[RBFC]

There are those who just inherited bad genes and continue to face health issues as lipids remain high or those who are compliant with diet and exercise but have had less than favorable results. According to you you would do nothing more. Statins do have a place. End of story.

I've seen this situation hundreds of times, and agree with Steve here. While I'm a huge proponent of lifestyle-mediated approaches, there is a subset of the population for whom it is insufficient. We operate on these folks weekly. They can be active, athletic folks who have received "bad genes" and have high cholesterol regardless of their diet/activity plans. Statistically, yes, diet and exercise will reduce risks for a good percentage of the population who use that approach, but does not work for certain individuals.

Lee

 

[rbbert]

...Statins do have a place. End of story.

Of course they do (see my last post), but you started this thread on the newly issued "guidelines" for statin use, and I think it's clear these are extremely controversial and probably "misguided"

 

[Steve Williams]

anyone remember David Letterman in 2000 at age 53 when he had a quintuple bypass. IIRC his triglycerides were over 700. I wonder what could have happened. Or how about those patients with high LDL who are as thin as toothpicks as they exercise, diet and do everything the doctor ordered. I suppose according to those naysayers they would have their patient continue to exercise and diet with the hope for more favorable results. It just doesn't happen. The treatment is a three legged stool.....diet, exercise and meds (statins, ASA and possible beta blockers)

I would change doctors if any of you naysayers were my cardiologist trying to continue to have me exercise and diet with a promise of a pot of gold at the end of the rainbow

All meds have benefits, risks, alternatives and complications.

Myles, Frantz, rbbrt et al....put yourselves in the position of the patient who has CAD or who has suffered a cardiac event. You are now out of the hospital having had a PTCA or CABG or whatever. The doctor sits you down in his office and discusses the three legged stool as a foundation of therapy. Are you going to look your doctor in the face after his discussion and tell him you are going to pass on medications.

It's easy to be naysayer as you are all on the outside looking in. I know all three of you and you are all exceptionally well fit. What if it happens to you as it did to my friends son this weekend. Tell me honestly that if it were you in the patient's shoes you would decline statins and decide to exercise and diet only

How do you spell H-U-B-R-I-S

 

[FrantzM]

So Myles

no one will disagree but from your position it seems that you feel that all patients will get a favorable result from diet and exercise and the world goes on and everyone is healthy.

There are those who just inherited bad genes and continue to face health issues as lipids remain high or those who are compliant with diet and exercise but have had less than favorable results. According to you you would do nothing more. Statins do have a place. End of story.

I've seen this situation hundreds of times, and agree with Steve here. While I'm a huge proponent of lifestyle-mediated approaches, there is a subset of the population for whom it is insufficient. We operate on these folks weekly. They can be active, athletic folks who have received "bad genes" and have high cholesterol regardless of their diet/activity plans. Statistically, yes, diet and exercise will reduce risks for a good percentage of the population who use that approach, but does not work for certain individuals.

Lee

I know we are venturing in diffcult/dangerous trerritorry, that of a person health, thus life. I am extremely careful when it comes to that. One of the most interesting aspect of this forum are those debates and I am willing to engage in them citing the aformentioned reservations. It is your health, your life and if you feel comfortable and have found results using a given medication please continue to do so.

This out of the way, is there a correlation between high cholesterol and cardio-vascular health? No one can discuss that fact. The data is there and the sources numerous.
Is there causation that high cholesterol results in cardio-vascular diseases? There the data is less convincing.
Statins drug work on reducing the cholsterol output from the Liver... The question I ask is what causes the liver to produce more cholesterol? is reducing the activity of the liver a good thing in itself? What are the consequences of a reduced liver output?

As for the need for statins for some people, even the most virulent substances may have their use in some cases, This is my honest opinon based on reading and researching un-orthodox sources whose voices are being heard a little more every day. YMMV.

Am I becoming so much like Myles that we are being mistaken for each other For the record I do not believe in cables .. There! I opened a Pandora box

N

 

[Steve Williams]

I know we are venturing in diffcult/dangerous trerritorry, that of a person health, thus life. I am extremely careful when it comes to that. One of the most interesting aspect of this forum are those debates and I am willing to engage in them citing the aformentioned reservations. It is your health, your life and if you feel comfortable and have found results using a given medication please continue to do so.

This out of the way, is there a correlation between high cholesterol and cardio-vascular health? No one can discuss that fact. The data is there and the sources numerous.
Is there causation that high cholesterol results in cardio-vascular diseases? There the data is less convincing.
Statins drug work on reducing the cholsterol output from the Liver... The question I ask is what causes the liver to produce more cholesterol? is reducing the activity of the liver a good thing in itself? What are the consequences of a reduced liver output?

As for the need for statins for some people, even the most virulent substances may have their use in some cases, This is my honest opinon based on reading and researching un-orthodox sources whose voices are being heard a little more every day. YMMV.

Am I becoming so much like Myles that we are being mistaken for each other For the record I do not believe in cables .. There! I opened a Pandora box

It's not difficult territory to me because I'm a physician as well as a patient. You and Myles no doubt are in excellent health with normal lipids. IOW you are on the outside looking in. It is easy to decline the use of something that you don't need but ask yourselves what you would say if it were your doctor counseling you after a cardiac event. Or better yet would you as the doctor exhibit your bias and elect not to treat the patient based on your own beliefs. IMO this is treading in dangerous water if you don't

I agree..."it IS our life" and we choose as we see fit BUT please let's think outside the box rather than exerting your beliefs on your patients

This is similar to an ObGyn who sees a pregnant patient who asks for elective termination. Obviously we all feel differently about this and I don't want to open another can of worms.However all too often a doctor's personal beliefs get in the way of a patient asking for medical care. Most patients get turned away without treatment. I say don't let your personal beliefs get in the way of treating patients and refer the patient to someone else for care.If you as the doctor don't believe in statins does that mean you won't discuss it with your patient or refer them for a second opinion

There was a movie made in 1991 called The Doctor with William Hurt who plays an MD with throat cancer. It shows the view of the doctor as a successful cardiac surgeon in the OR and then as a patient with laryngeal cancer. Definitely worth watching as it shows both sides

My point is simple. I believe that the 3 of you based on your convictions (which are fine by me, even though I strongly disagree) and your own health would be swayed by your bias in your discussion with the cardiac patient

one last thought.....

Is there causation that high cholesterol results in cardio-vascular diseases? There the data is less convincing.

Really

 

[rbbert]

...rbbrt et al....put yourselves in the position of the patient who has CAD or who has suffered a cardiac event. You are now out of the hospital having had a PTCA or CABG or whatever. The doctor sits you down in his office and discusses the three legged stool as a foundation of therapy. Are you going to look your doctor in the face after his discussion and tell him you are going to pass on medications.

It's easy to be naysayer as you are all on the outside looking in. I know all three of you and you are all exceptionally well fit. What if it happens to you as it did to my friends son this weekend. Tell me honestly that if it were you in the patient's shoes you would decline statins and decide to exercise and diet only

How do you spell H-U-B-R-I-S

Steve, not to be rude, but I don't think you are reading my posts

 

[Steve Williams]

I am and I understand precisely your position. I know you feel there is a place. I have re read your thoughts several times. Being an ER doc puts you in a whole different arena as you see all the body thumps as they enter the ER.

To me (and I am no cardiologist) I would follow the three legged stool way and offer diet, exercise and statins

I would be interested in knowing what percent (if any) of patients who enter cardiac rehab are not on meds

It's a wonderful feeling to be heart healthy however I don't believe that it is fair for someone such as this project their beliefs on accepted medical care

BTW, I did enjoy reading that there is indeed a pause in the thought of these new recommendations

No one BTW has said if they would recommend my friend's 33 yo son who suffered the MI to take statins as well as having a talk with his 35 yo brother as to the thought that he also do the same

 

[rbbert]

...
No one BTW has said if they would recommend my friend's 33 yo son who suffered the MI to take statins as well as having a talk with his 35 yo brother as to the thought that he also do the same

I don't have anywhere near enough information to have an opinion on this.

Back to your OP on this topic and the new guidelines. First, it's very unclear and definitely not emphasized that diet and exercise are still part of the "program" (although I think they are); second, do you really think that half of all adult Americans should be taking statins?

 

[FrantzM]

Steve

Coming from an EE, not physician. Can you point me toward the mechanism by which high cholesterol causes cardio-vascular diseases? I will benefit as I am under the impression that there is a strong correlation but the mechanism by which the presence of high cholesterol causes cardio-vascular disease is not well understood.

As for my straight answer to a doctor telling me to take statins, it will be a, No. I am a serious proponent of diet change and lifestyle in health maintenance. I try not to proselytize but those are game changer and the effect are surprising.
The most interesting thing about the diet and exercise thing is that it doesn't have to be extreme. If there is interest to that someone may open a thread about this. This is to me a fascinating an interesting subject. I have some thoughts on the matter ...

 

[Steve Williams]

Steve

Coming from an EE, not physician. Can you point me toward the mechanism by which high cholesterol causes cardio-vascular diseases? I will benefit as I am under the impression that there is astrong correlation but the mechanism by which the presence of high cholesterol causes cardio-vacular disease.

As for my straight answer to a doctor telling to take statins the answer will be, No. I am a serious proponent of diet change and lifestyle in health maintenance. I try not to proselytize but those are game changer and the effect are surprising.
The most interesting thing about the diet and exercise thing is that it doesn't have to be extreme. If there is interest to that someone may open a thread about this. This is to me a fascinating an interesting subject. I have some thoughts on the matter ...

I respect your decision because you have made an informed one having been appraised of th benefits risks alternatives and complications

Now to answer your question Frantz, allow me to answer with perhaps another question by asking if there is more of a correlation amongst those with elevated lipids and CAD than with those having normal lipids and CAD

 

[Asamel]

It is important to understand that the mechanism of action of statins appears to go beyond cholesterol control. Many believe that they have an anti-inflammatory role as well.

 

[Steve Williams]

It is important to understand that the mechanism of action of statins appears to go beyond cholesterol control. Many believe that they have an anti-inflammatory role as well.

I agree

 

[jap]

It's a wonderful feeling to be heart healthy however I don't believe that it is fair for someone such as this project their beliefs on accepted medical care

How much did statin use lower your cholesterol levels?

 

[MylesBAstor]

It is important to understand that the mechanism of action of statins appears to go beyond cholesterol control. Many believe that they have an anti-inflammatory role as well.

But once you have plaque formation and an inflammatory response, no drug is going is going to reverse the blockage. (That is unless you believe this doc-and I don't totally buy into it : http://www.heartattackproof.com. )Hence, this person would have needed a stent, statins or not. Yes?

 

[rockitman]

But once you have plaque formation and an inflammatory response, no drug is going is going to reverse the blockage. (That is unless you believe this doc-and I don't totally buy into it : http://www.heartattackproof.com. )Hence, this person would have needed a stent, statins or not. Yes?

there are studies showing pre-existing plaque can be reduced via use of statins, diet and exercise. In any event, I am not going to argue the case. Everyone has to make the best decision for themselves. I will trust my cardiologist's advice over a hi-fi critic's any day...

 

[FrantzM]

there are studies showing pre-existing plaque can be reduced via use of statins, diet and exercise. In any event, I am not going to argue the case. Everyone has to make the best decision for themselves. I will trust my cardiologist's advice over a hi-fi critic's any day...;)

unwarranted IMO

 

[Steve Williams]

How much did statin use lower your cholesterol levels?

lets put it this way

My cholesterol is now 125. It went down 100 points in case you're interested. My LDL is 66 and my HDL over 70 now. I exercise 5 days a week for over an hour and like to think that I eat well

Do any of you arm chair quarterbacks also believe that after a cardiac event it isn't necessary to lower ones LDL below 70 and do you all believe that "everyone" can do that with just diet and exercise? Not me

This really has become an interesting debate inasmuch as there are 2 schools of thought. I have, still do and will always believe that correct therapy is analogous to that 3 legged stool with diet, exercise and statins.

 

[jap]

lets put it this way

My cholesterol is now 125. It went down 100 points in case you're interested. My LDL is 66 and my HDL over 70 now. I exercise 5 days a week for over an hour and like to think that I eat well

Do any of you arm chair quarterbacks also believe that after a cardiac event it isn't necessary to lower ones LDL below 70 and do you all believe that "everyone" can do that with just diet and exercise? Not me

This really has become an interesting debate inasmuch as there are 2 schools of thought. I have, still do and will always believe that correct therapy is analogous to that 3 legged stool with diet, exercise and statins.

Thanks for the info and congrats on your success.

My HDL is good, but my LDL is high and after reading this thread I'm trying to decide on a course of action.

Had negative reactions to statin samples my doctor gave me, so I guess I'll have to amp up the other two legs of the stool.