Not on cholesterol meds? New guidelines may change that

[MylesBAstor]

No Myles. I love all of you arm chair quarterbacks who quote statistics. I understand. However based on what you say the risks outweigh the benefits do why treat anyone

Indeed it is and it was my impression when in academic research that the growing trend was not to treat everyone with a but to identify those or that specific sub population that would actually benefit from the drug.

 

[rockitman]

The best advice if you are middle age and have any risk factors is to seek advice from your cardiologist. If you don't have one, it's probably a good idea to see one to get an EKG, Stress Test, Carotid artery ultrasound and a calcium chest scan. The results of those tests may indicate a significant benefit by taking statins. Of course if you are a naysayer, you can roll the dice and see a cardiologist after an event...at which time the damage may be already done (heart Muscle damage) or worse yet, you expire.

 

[MylesBAstor]

The best advice if you are middle age and have any risk factors is to seek advice from your cardiologist. If you don't have one, it's probably a good idea to see one to get an EKG, Stress Test, Carotid artery ultrasound and a calcium chest scan. The results of those tests may indicate a significant benefit by taking statins. Of course if you are a naysayer, you can roll the dice and see a cardiologist after an event...at which time the damage may be already done (heart Muscle damage) or worse yet, you expire.

Or see your doctor, get clearance and begin an exercise program and nutrition program. Amazing how a little exercise can go a long way toward preventing many diseases. And studies show that--regardless of when you start--as long as you exercise regularly for two years, your risk factor decreases to a person who has been exercising their whole life. Moral of the story? It's never too late to start exercising!

To wit, I had an 85 yo husband of an old client start working with me two years ago and he's been seeing me like clockwork twice a week for the last two years. He couldn't do more than five mins on the bike when he started and he's now up to 40 mins. Yes, he's a poster child for exercising! Oh and his doctor has reduced or eliminated almost all of the meds he was on.

 

[steve williams]

Or see your doctor, get clearance and begin an exercise program and nutrition program. Amazing how a little exercise can go a long way toward preventing many diseases. And studies show that--regardless of when you start--as long as you exercise regularly for two years, your risk factor decreases to a person who has been exercising their whole life. Moral of the story? It's never too late to start exercising!

To wit, I had an 85 yo husband of an old client start working with me two years ago and he's been seeing me like clockwork twice a week for the last two years. He couldn't do more than five mins on the bike when he started and he's now up to 40 mins. Yes, he's a poster child for exercising! Oh and his doctor has reduced or eliminated almost all of the meds he was on.

Sorry Myles but Meds and rehab go hand in hand Myles. I'm with you Christian. Too many arm chair quarterbacks playing with peoples well being based on statistics.

 

[steve williams]

I'm a little stunned here to read that people don't believe that elevated lipids contribute to CAD. You all can roll the dice with your health but this isn't the way I practice and/or want things done for me. I treat patients not statistics

 

[MylesBAstor]

I'm a little stunned here to read that people don't believe that elevated lipids contribute to CAD. You all can roll the dice with your health but this isn't the way I practice and/or want things done for me. I treat patients not statistics

In Eastern medicine, a good doctor is one who prevents disease while a bad doctor is one who treats the disease. Something to be learned here.

Steve, how many people die of heart attacks that have normal lipid profiles?

 

[RBFC]

I'm a little stunned here to read that people don't believe that elevated lipids contribute to CAD. You all can roll the dice with your health but this isn't the way I practice and/or want things done for me. I treat patients not statistics

I've worked in open heart surgery for 32+ years, and the evidence linking elevated lipid profiles with coronary artery disease is indisputable IMO.

Lee

 

[MylesBAstor]

I've worked in open heart surgery for 32+ years, and the evidence linking elevated lipid profiles with coronary artery disease is indisputable IMO.

Lee

If we know so much, then why have the clinical trials with drugs that elevate HDL failed miserably?

Perhaps it's the VLDL fraction that is most prone to oxidation is more important? No I think it seems it's other lipids in the lipoproteins that are more important than simply cholesterol.

Not to mention that cholesterol on its own isn't a good predictor. What about that person with high cholesterol but normal or very good HDL/LDL vs. Someone with high cholesterol and bad HDL/HDL levels.

 

[cjfrbw]

There's always the catch 22 when people start throwing liability issues around. If I were a cardiologist, I would rather have patients who were having heart attacks when ON statins than having them angry that they had a heart attack without them. That isn't scientific, but it's all too common.

it's also a problem when you have a medicine with broad metabolic consequences that is used to basically control a test result. The placebo effect on the end user comes into play as well.

That being said, if I had risk factors or excessive test results, I would probably take statins. With my last panel, my results were all good, so I don't have to make that choice, but I do know that even placebos can have good results, if just for the psyche.

 

[rbbert]

I'm going back to my post about evidence based recommendations. Steve, I think anyone who falls into a population group where reasonably good scientific data support treatment with statins should have that treatment strongly recommended. My problems with these new recommendations is that they are in large part not evidence based, as I mentioned earlier. Basically what following these guidelines would do is make the asymptomatic American public participants in a huge unblinded observational experiment on the effects (positive and negative) of widespread statin use. That flies in the face of the Hippocratic oath and any reasonable ethical position.

As far as elevated lipids and CAD, there is certainly an association but the degree of causation is uncertain. A big part of the push for more widespread statin use is their anti-inflammatory effects, and that may turn out to be a good justification, but I think it should be further studied before being recommended.

 

[steve williams]

Robert

I agree there is a link and causation is not always understood BUT for me and my heart I always go by informed consent whether it is I who am dispensing it or me the patient who receives it. Let people make an informed decision. Nothing more. I don't want someone coming after the fact and say they're sorry for our loss

 

[steve williams]

There are so many drugs in medicine that are used for off label recommendations. This is a family of drugs where the recommendations are there. As Carl said one would rather have the patient with the MI who takes statins than have the MI and not be on them.

Every drug has side effects and potential complications. Discuss it with your patients and let them decide

Bear in mind that the drug could very well have extended their lives before they are admitted to the ER with an MI.

 

[rbbert]

...
Bear in mind that the drug could very well have extended their lives before they are admitted to the ER with an MI.

Steve, I posted that the overwhelming majority of the patients that I see with ACS have already been on statins. I know there are many more that the statins are probably keeping heart-healthy, but that's part of my point. The overwhelming majority of people likely to benefit from taking statins already are taking them. The discussion now revolves around the people in whom the benefits of taking statins are far less apparent if they exist at all.

 

[rbbert]

Robert

I agree there is a link and causation is not always understood BUT for me and my heart I always go by informed consent whether it is I who am dispensing it or me the patient who receives it. Let people make an informed decision. Nothing more. I don't want someone coming after the fact and say they're sorry for our loss

Didn't you say your friend with the recent AMI had decided not to take statins? That sounds like informed consent to me?

 

[RBFC]

Because hereditary and other individual factors are in play, I completely understand that using statistical analysis is only partially useful in this case. We simply cannot run simultaneous trials on a single subject with/without statins. Since the causative factors may not necessarily be the same for patients presenting with elevated lipids and associated ACS, it follows that we cannot make ironclad statements regarding statins and the disease process. The links have been made to show that a high percentage of patients who exhibit elevated lipids develop statistically higher incidences of ACS. It is very difficult to state that the lipids CAUSED their disease, but the lipid elevation is found in a higher percentage of those with ACS than in the "general" population. One confounding factor is the very common occurrence of behavioral (lifestyle) changes in patients once a "scary diagnosis" has been made and medication prescribed, thus clouding the cause/effect chain. It's probably safest to say that if one has elevated lipids, there should be an implied risk of ACS from a number of actual causes. Therefore, the "marker" is realistic in that it stimulates the wide-spectrum examination of an individual patient's risk factors.

Lee

 

[steve williams]

Didn't you say your friend with the recent AMI had decided not to take statins? That sounds like informed consent to me?

Yes it is.

For me this validates my point BUT my question to all you docs out there us what you are going to say and recommend to his brother. Further his dad (my friend) who heard the symptoms by phone advised his son to go star to the ER. He k if we have a young patient with colon or breast cancer etc don't we recommend the dibs be tested or have colonoscopy. How many negative tests are OK before a positive one and you've either prolonged or saved that patients life. Once again are we talking about "patients" or "lives""

BTW these are all my personal feelings coming from sitting at opposite ends of the examining table.

 

[FrantzM]

This is interesting reading.

From the NY Times. CLICK HERE


A snippet from this article:

The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population

Emphasis is mine and to me cause for more than pause ...

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.

 

[rbbert]

...
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.

I support all of this except the first phrase. I think statins are actually the wonder drugs of the last twenty years with incredible potential to benefit many people, but they are not a vitamin that needs to be taken by everybody, and their use in people with essentially "normal" cholesterol levels needs to be investigated in much more detail before being widely recommended and used.

 

[ack]

The new guidelines may be totally misguided??? http://www.nytimes.com/2013/11/18/h....html?nl=todaysheadlines&emc=edit_th_20131118

 

[rbbert]

The new guidelines may be totally misguided??? http://www.nytimes.com/2013/11/18/h....html?nl=todaysheadlines&emc=edit_th_20131118

see post #57?