Do you really need a cholesterol lowering drug?

[Villages PL]

About 20 million people take statin drugs to lower their cholesterol. But 3/4 of them take statins with no evidence of heart disease, and it's now being questioned whether this approach is of any value. Eleven clinical trials have now been conducted (with over 65,000 people) and the results showed no evidence of statins saving lives.

For those who are big believers in taking drugs to promote good health, this is an example of a drug possibly doing the opposite, assuming some may have suffered side effects needlessly. And not to mention the expense of it.

People, in my opinion, could do far better by lowering bad cholesterol through natural means.

:smiley:

[KayakerNC]

About 20 million people take statin drugs to lower their cholesterol. But 3/4 of them take statins with no evidence of heart disease, and it's now being questioned whether this approach is of any value. Eleven clinical trials have now been conducted (with over 65,000 people) and the results showed no evidence of statins saving lives.

For those who are big believers in taking drugs to promote good health, this is an example of a drug possibly doing the opposite, assuming some may have suffered side effects needlessly. And not to mention the expense of it.

People could do far better by lowering bad cholesterol through natural means.

:smiley:

Actually, people would do far better by listening to their Doctor and ignoring this kind of non-supported "information".
Google the JUPITER trial, or read the WebMD article.
Statins for Lowering Cholesterol Levels (http://www.webmd.com/cholesterol-management/features/when-your-doctor-orders-cholesterol-lowering-medications)

[Villages PL]

Actually, people would do far better by listening to their Doctor and ignoring this kind non-supported "information".
Google the JUPITER trial, or read the WebMD article.
Statins for Lowering Cholesterol Levels (http://www.webmd.com/cholesterol-management/features/when-your-doctor-orders-cholesterol-lowering-medications)

So we're talking about one clinical trial (JUPITER) versus 11 clinical trials totaling over 65,000 people? As far as I can tell, the WebMD article didn't mention how many people were in the JUPITER trial, did they? Did all of those in the trial have extremely high cholesterol? Can you provide a link that will give more details? My time is limited so it would help if you could provide such a link. Was it a double blind study? Legnth of time?

Hopefully, I'll have more time tomorrow to read the WebMD article. I just read it over fast. Perhaps I got the wrong impression but it seems to not be interested in full disclosure.

[pooh]

If I remember correctly, the statins were used in participants who didn't necessarily have high blood fats, but did have higher levels of C-reactive protein levels...and indicator of inflammation. Statins were shown to reduced inflammation levels and they are considered safer than asprin therapy for many.

From the New England Journal of Medicine.... MMS: Error (http://www.nejm.org/doi/pdf/10.1056/NEJMoa0807646)
Actually, I'm not certain the link will work, but there's lots to read.

Guess if we keep up this discussion, we're going to have to move over to the medical forum...;)

[Hal :-)]

The Jupiter trial was bought and paid for by Crestor. A study to determine if statins were effect for people with NORMAL cholesterol. What a joke. It worked well, I read somewhere a recommendation for young as 13 to take them. Thank you Big Pharma.

I learned long ago that our medical system doesn't working for us. All drug studies are funded by drug companies for one simple reason, generate profits. I learned my lesson when my wife refused HRT. I thought the simple treatment for menopause would make life easier for her. She was a nurse and had other ideas. Her mother died of breast cancer and she absolutely refused hormones.

After 20 years, a HRT study was suddenly cancelled and resulted in a recommendation for everyone to stop taking them immediately. I learned my lesson. I now believe that statins will someday be identified as a similar problem, when all the patents expire.

Statins produce a lot of muscular problems, especially in males. There's a real question if cholesterol is even a problem. Recent studies suggest that inflammation may the culprit (CRP). Although that concept may be driven by profits too, who knows. TNO (Trust No One).

In my opinion, you are on your own when it comes to your health in this country. Fortunately, there are good resources available and you can search the Internet. Just be careful to discriminate and keep an open mind.

[shcisamax]

My doctor told me that there really was no evidence that statins saved lives and did not recommend them automatically for moderately high cholestoral levels.
Further to the over prescribing for bottom line benefit of the pharmaceutical companies, there was recently released a series of studies of antidepressants which found, unless the person is very seriously depressed, they really don't do anything more than a placebo. And that the amount prescribed has increased to ridiculous proportions. I can't remember the numbers but it was really an eye opener.

[rubicon]

No one has mention the strength of the doses...How big of a dose (MG) create a problem 1 10 25 50 75 100 400?

[Hal :-)]

No one has mention the strength of the doses...How big of a dose (MG) create a problem 1 10 25 50 75 100 400?

That's a good question and I thought I'd Google it. But I quickly gave up. Too much medical jargon over my head. But this is interesting:
...many patients treated with statins have muscle symptoms, and some patients develop severe muscle toxicity. Little is known about the mechanism by which statin therapy leads to muscle toxicity. The recent withdrawal of cerivastatin from the U.S. market has highlighted both our ignorance and the need for postmarketing surveillance
Statin-Associated Myopathy with Normal Creatine Kinase Levels (http://annals.ba0.biz/content/137/7/581.full.pdf+html)

[TrudyM]

An artery 96% closed by plaque is not an issue of inflamation. My husband and I were both given statin drugs at low levels to help with the colesterol build up in our arteries When the alternative is death I think I will go with the statin. After 4 years my arteries show much less paque than they did. I am checked on a regular basis for side effects. I have several Drs in my family and they all say that changing ones diet is not always enough that low level statins for those with a genetic predisposition are necessary.

[ssmith]

I work as a Cardiology nurse soooo I am biased. Once the damage to your heart has been done ...you, for the most part, cannot undo it!!! Remember that build up in your arteries goes everywhere....not just your heart....could be your carotids that supply blood flow to the brain, could be your legs or your kidneys.

Our American diet is not condusive to good artery health. Yes, the absolute best approach is a good diet and to do it early and exercise; but even then, you may have bad genes which contribute to the build-up of plaque in your arteries.

The number one killer in America, by far, over all diseases is heart disease!!!! and that includes women!!!!

Yes, this med must be carefully monitored....I, for one, can't take statins due to rising of liver enzymes.

As many Cardiologists say " we are saving lives one non-compliant patient at a time" Sad but true....everyone is bitter once the damage to the heart occurs ....or the STROKE! but little think it will happen to them. Another thing I hear is that the individual doesn't care if they die since they have had a good time but remember....not everyone dies right away. Also not everyone wants to live with a debilitating stroke.

Ok, now I will get off of my high horse!!! Just care about you all and want you to enjoy a healthy life as long as you can!

[graciegirl]

I work as a Cardiology nurse soooo I am biased. Once the damage to your heart has been done ...you, for the most part, cannot undo it!!! Remember that build up in your arteries goes everywhere....not just your heart....could be your carotids that supply blood flow to the brain, could be your legs or your kidneys.

Our American diet is not condusive to good artery health. Yes, the absolute best approach is a good diet and to do it early and exercise; but even then, you may have bad genes which contribute to the build-up of plaque in your arteries.

The number one killer in America, by far, over all diseases is heart disease!!!! and that includes women!!!!

Yes, this med must be carefully monitored....I, for one, can't take statins due to rising of liver enzymes.

As many Cardiologists say " we are saving lives one non-compliant patient at a time" Sad but true....everyone is bitter once the damage to the heart occurs ....or the STROKE! but little think it will happen to them. Another thing I hear is that the individual doesn't care if they die since they have had a good time but remember....not everyone dies right away. Also not everyone wants to live with a debilitating stroke.

Ok, now I will get off of my high horse!!! Just care about you all and want you to enjoy a healthy life as long as you can!

Wonderful post and wonderful girl, SSmith. Refreshingly scientific!

It is just the luck of your genetic draw sometimes. I cook for our family and buy the food and my levels are low as were my parents. Sweetie does not have elevated cholesterol but is on statins due to being born with only one coronary artery and was prescribed it as a precaution. Our 46 year old daughter who lives with us has elevated levels, maybe also due to the fact she was born with Williams Syndrome. But we mostly eat the same food and she walks for one hour every day. We are seeing whether anything changes at the next test to see if she will choose to begin statins.

[Villages PL]

I work as a Cardiology nurse soooo I am biased. Once the damage to your heart has been done ...you, for the most part, cannot undo it!!!

Since you said, "for the most part", I agree. But when I started this thread, it didn't have that much to do with heart disease. (Well, okay, indirectly it did.) But it had more to do about people with elevated cholesterol, other risk factors, but otherwise healthy. These people represent 3/4 of the 20 million people on statins. It appears that the drug companies are doing their job well. And the report that I refered to was a "meta-analysis of eleven clinical trials involving more than 65,000 people."
On average, their LDL was lowered from 138 to 98. But lowering their LDL did not, "produce a measurable benefit by improving longevity." There was no evidence that statins saved any lives.

Our American diet is not condusive to good artery health. Yes, the absolute best approach is a good diet and to do it early and exercise; but even then, you may have bad genes which contribute to the build-up of plaque in your arteries.

I agree about the diet. And genes do play a part but I find that too many people are too quick to blame genes without really giving diet a fair shot.

Yes, this med must be carefully monitored....I, for one, can't take statins due to rising of liver enzymes.

And what about those who are taking multiple medications? What about adverse drug interactions? I think it could be dangerous. So, once again, I think we shouldn't be taking drugs unless it's absolutely necessary. All the more reason to pay attention to the study I refered to.

Note: Ray, K. K., et al. "A Meta-Analysis of 11 Randomized Controlled Trials Involving 65220 Participants." Arch. Intern. Med. 2010; 170:1007-1008.

[KayakerNC]

And the report that I refered to was a "meta-analysis of eleven clinical trials involving more than 65,000 people."

Note: Ray, K. K., et al. "A Meta-Analysis of 11 Randomized Controlled Trials Involving 65220 Participants." Arch. Intern. Med. 2010; 170:1007-1008.
From Wiki:
"If a meta-analysis is conducted by an individual or organization with a bias or predetermined desired outcome, it should be treated as highly suspect or having a high likelihood of being "junk science". From an integrity perspective, researchers with a bias should avoid meta-analysis and use a less abuse-prone (or independent) form of research."

Attacking JUPITER - Statins For Primary Prevention Assailed (http://heartdisease.about.com/b/2010/07/01/attacking-jupiter-statins-for-primary-prevention-assailed.htm)
"Ironically, the chief author of this critical paper is himself a member of a fringe medical group known as The International Network of Cholesterol Skeptics (THINCS), whose stated mission is to "oppose" the notion that high cholesterol and animal fat play a role in cardiovascular disease. Members of THINCS also take an extraordinarily strong position opposing statins for any clincal use whatsoever. The irony, of course, is that this striking bias was not disclosed in an article whose main thrust was to criticise the disclosed biases of the JUPITER investigators."

[Villages PL]

From Wiki:
"If a meta-analysis is conducted by an individual or organization with a bias or predetermined desired outcome, it should be treated as highly suspect or having a high likelihood of being "junk science". From an integrity perspective, researchers with a bias should avoid meta-analysis and use a less abuse-prone (or independent) form of research."

Attacking JUPITER - Statins For Primary Prevention Assailed (http://heartdisease.about.com/b/2010/07/01/attacking-jupiter-statins-for-primary-prevention-assailed.htm)
"Ironically, the chief author of this critical paper is himself a member of a fringe medical group known as The International Network of Cholesterol Skeptics (THINCS), whose stated mission is to "oppose" the notion that high cholesterol and animal fat play a role in cardiovascular disease. Members of THINCS also take an extraordinarily strong position opposing statins for any clincal use whatsoever. The irony, of course, is that this striking bias was not disclosed in an article whose main thrust was to criticise the disclosed biases of the JUPITER investigators."

So where does this leave the patient or those of us who are trying to sort this out? It seems we're caught in the middle of a dispute: The JUPITER trial versus 4 articles published by Archives of Internal Medicine. Both sides are pointing fingers at the other. Well, that's my first impression.
I copied the article by richard N. Fogoros, M.D. and will give it a more careful reading (and more thought) later.

[ssmith]

Thanks Gracie for listening. Sorry about your hubs and daughter. I am sure it is not your cooking :mmmm:

.

[Villages PL]

If I remember correctly, the statins were used in participants who didn't necessarily have high blood fats, but did have higher levels of C-reactive protein levels...an indicator of inflammation. Statins were shown to reduced inflammation levels and they are considered safer than asprin therapy for many.

Thanks, pooh, that was very helpful. I was wondering about CRP as far as what it was indicating. For anyone who has a high level of inflammation, I think it's usually due to lifestyle. And there are books on this subject. One such book is: "The Anti-inflammation Diet".

The culpret is: "The standard American diet." It's the result of too much sugar, baked goods made with white flour, and too many processed foods in general. This lifestyle issue is something that doctors, and the makers of Crestor, are not likely to pay much attention to. Doctors don't have the time or training for this and the goal of drug companies is to sell more drugs. If the JUPITER trial has bias built in, it may stem from this unwillingness to pay attention to lifestyle issues.

[Villages PL]

One thing I found disappointing is that no mention was made of the actual number of deaths in the JUPERER trial. All we know is that there was a 20% reduction in overall mortality among those taking the drug, Crestor. That could mean there were 5 deaths in the placebo grouop and 4 deaths in the Crestor group. Likewise, a 50% reduction in strokes could mean 2 strokes in the placebo group and 1 stroke in the Crestor group.

That would mean that 9,000 people were drugged in order to prevent 1 death and 1 stroke etc.. And being that there were "other risk factors," we don't know if those who died ate poor diets or had sedentary stressful lifestyles, or whatever. Even if there were a greater number of deaths prevented, I would still want to know all the lifestyle details of those who died.

"The study was stopped after a little less than two years,...." So we don't know anything about long-term or lifelong risks. Therefore, it's possible that the positive results (from the short term trial) could reverse themselves over a much longer period of time. Who will decide to roll the dice to gamble the possible short term benefits against possible long-term adverse outcomes (i.e., liver disease, kidney disease, among many others). Most likely it will be your doctor who decides to roll the dice for you. After all, your doctor won't be the one risking organ failure or premature death for himself or herself.

[Quixote]

Thanks, pooh, that was very helpful. I was wondering about CRP as far as what it was indicating. For anyone who has a high level of inflammation, I think it's usually due to lifestyle. And there are books on this subject. One such book is: "The Anti-inflammation Diet".

The culpret is: "The standard American diet." It's the result of too much sugar, baked goods made with white flour, and too many processed foods in general. This lifestyle issue is something that doctors, and the makers of Crestor, are not likely to pay much attention to. Doctors don't have the time or training for this and the goal of drug companies is to sell more drugs. If the JUPITER trial has bias built in, it may stem from this unwillingness to pay attention to lifestyle issues.

Our world renowned MD in Boston is convinced based on his evaluation of many studies (not just those noted earlier in this thread) that statin drugs, notably Lipitor, is way overprescribed based on "bad" cholesterol numbers that, according to his research, should rise somewhat as we get older, and that this is perfectly normal. He also believes based on his research that bringing the cholesterol number down to so low is related to an increase in pancreatic cancer. A radical suggestion, perhaps, but we've been in the care of this MD for 32 years and are convinced that he knows what he's talking about.

He also "requires" all his patients and family members (even his young grandsons!) to take a full tablespoon of cod liver oil daily, at first unpalatable but you get used to it. For me, it brought down a very mildly elevated "bad" cholesterol, but more important, it raised my level of "good" cholesterol from well below normal range into the normal range. He also mentioned, for what it's worth, that the fish oil capsules are good too, but you have to take FOURTEEN of them to be the equivalent of the tablespoon of cod liver oil!

How many people know that Lipitor was NEVER tested on women before it was given permission to be released on the market? Standing in line at a local pharmacy, I couldn't help but overhear a man discussing his wife's prescription for Lipitor with the pharmacist, who supported her use of this drug. Granted it's not the place of a pharmacist to second-guess a doctor, but various studies have also shown that pharmacists are considerably more trusted than doctors! When my turn came and I asked the pharmacist if she were familiar with the lack of study of women and Lipitor, she said that, oh yes, she was well aware of it! I found the whole thing very disturbing....

A book that was recommended to me that I in turn recommend is In Defense of Food: An Eater's Manifesto by Michael Pollan. At least it is an eye-opener; at most it is a shocker....

[graciegirl]

So where does this leave the patient or those of us who are trying to sort this out? It seems we're caught in the middle of a dispute: The JUPITER trial versus 4 articles published by Archives of Internal Medicine. Both sides are pointing fingers at the other. Well, that's my first impression.
I copied the article by richard N. Fogoros, M.D. and will give it a more careful reading (and more thought) later.

Where does it leave us? We find the best physician we can afford to consult and listen to what he/she says. It is a little hard now for most of us at our age and time consuming to get a degree in medicine.

A good physician knows the interactions of drugs as does a good pharmacist. We don't have to figure this out all by ourselves. These are known factors. Known by the experts that do it every day. A good doctor.

But....we have to be open to following the directives of our doctor and not try to row our own boat in waters that we do not have charted.

Reading a bunch of articles without the background medical education AND experience just makes us full of worry and confusion.

And there are a lot of people out there selling psuedo science and their own products and they are making a LOT of money. I would rather count on the traditional medical community.

Plus...I read in The Daily Sun last week that fewer people are dying of heart related problems. I think it may have a lot to do with Statins. It takes a while to prove a medication aided longevity...

[Villages PL]

Where does it leave us? We find the best physician we can afford to consult and listen to what he/she says. It is a little hard now for most of us at our age and time consuming to get a degree in medicine.

You don't need a degree in medicine to understand your health issues. For example, if you are concerned about heart trouble, there are some good books written by very highly qualified doctors. One that comes to mind is "The Cardiovascular Cure" by by John P Cooke, M.D., PH.D., and Judith Zimmer. Another great book is: Dr. Dean Ornish's Program For Reversing Heart Disease. The qualifications of these two doctors are truly amazing and their books are written to be understood by the average person.

A good physician knows the interactions of drugs as does a good pharmacist. We don't have to figure this out all by ourselves. These are known factors. Known by the experts that do it every day. A good doctor.

No one is suggesting that you figure everything out for yourself when it comes to drug interactions. However, the patient does play a big role because only the patient knows how he/she feels. And not everyone is the same. Different people react to drugs in different ways. A drug that makes one person feel better, might make another person feel sick. So, your doctor, no matter how great she may be, can't possibly predict in advance how everyone will react to different drug combinations.

But....we have to be open to following the directives of our doctor and not try to row our own boat in waters that we do not have charted.

That's always your choice. But some of us may want to be as informed as possible.

Reading a bunch of articles without the background medical education AND experience just makes us full of worry and confusion.

No one is suggesting that you need to read a bunch of articles. I read the one that was presented on this board so as to give my opinion of it. It wasn't that complicated, in my opinion. And it didn't hurt me to stretch my mind a little to see what my understanding of it would be.

And there are a lot of people out there selling psuedo science and their own products and they are making a LOT of money. I would rather count on the traditional medical community.

Again, that's your choice. However, the two books I recommended above are not selling psuedo science. They are, or have been, practicing physicians just like your doctor. And I don't recall any products being promoted by their books.


Plus...I read in The Daily Sun last week that fewer people are dying of heart related problems. I think it may have a lot to do with Statins. It takes a while to prove a medication aided longevity...

Yes, I read that article too. I believe it has to do with angioplasty and bypass operations among other things. Sometimes they may need to take medication. But most of the these treatments could be avoided if people would stop eating the standard American diet. The sad thing is that most people are so addicted/habituated to processed foods that they can't or won't stop.

[graciegirl]

you don't need a degree in medicine to understand your health issues. For example, if you are concerned about heart trouble, there are some good books written by very highly qualified doctors. One that comes to mind is "the cardiovascular cure" by by john p cooke, m.d., ph.d., and judith zimmer. Another great book is: Dr. Dean ornish's program for reversing heart disease. The qualifications of these two doctors are truly amazing and their books are written to be understood by the average person.



No one is suggesting that you figure everything out for yourself when it comes to drug interactions. However, the patient does play a big role because only the patient knows how he/she feels. And not everyone is the same. Different people react to drugs in different ways. A drug that makes one person feel better, might make another person feel sick. So, your doctor, no matter how great she may be, can't possibly predict in advance how everyone will react to different drug combinations.



That's always your choice. But some of us may want to be as informed as possible.



No one is suggesting that you need to read a bunch of articles. I read the one that was presented on this board so as to give my opinion of it. It wasn't that complicated, in my opinion. And it didn't hurt me to stretch my mind a little to see what my understanding of it would be.



Again, that's your choice. However, the two books i recommended above are not selling psuedo science. They are, or have been, practicing physicians just like your doctor. And i don't recall any products being promoted by their books.




Yes, i read that article too. I believe it has to do with angioplasty and bypass operations among other things. Sometimes they may need to take medication. But most of the these treatments could be avoided if people would stop eating the standard american diet. The sad thing is that most people are so addicted/habituated to processed foods that they can't or won't stop.

uncle!

[JohnN]

I take 2 fish oil tabs a day (which my doc say is just fine)
and my cholesterol has gone down about 70 points in the last couple years.

[moribstatam]

A low cholesterol diet plan can certainly help to cut down cholesterol buildup, that likely leads to cardiovascular disease and other well being issues. Our body does produce cholesterol, however a surplus within the our blood is generally the end result of a diet plan full of animal foodss for instance red meat, eggs and whole fat dairy food. Switching our diet plan to low cholesterol foods such as grains, fruits and nuts can not just decrease the cholesterol intake but also actively fight existing cholesterol.

[ssmith]

""This lifestyle issue is something that doctors, and the makers of Crestor, are not likely to pay much attention to.""

OOOOPs disagree adamantly about this statement. At our practice we preach diet until we are blue in the face. We also have a dietician on staff....sadly few listen. We send copies of articles, free diet instructions and copies of the Mediteranean diet but seldom do our patients change. It may be that since most of our patients are older that they just plain like their present diet.

Yes inflammation related to diet is the underlying key. Remember though that the inflammation is what causes the plaque (build up in the arteries) to dislodge....conventional wisdom ...since most Americans won't change their diet then....try to change the plaque burden in the arteries by medication.

I love the discussion but I would never want to be responsible for someone making decisions that could harm them, knowing full well that I am not a doctor. I do think a person has the right to make their own decisions about their health but they should make informed decisions and discuss their choice thoroughly with their doctor. There is some very scary stuff out there so be careful!

It does seem to me that perhaps you have made up your mind and really just want to be heard instead of being open to the debate? Sorry if I have misunderstood your intentions.

To John N: Fish Oil caps are widely recommended at our practice!!!