View Full Version : The Cholesterol "Controversy"
In quotes as it's really not as controversial as some may believe. While CVD is a multi factorial process that's more complex than simple cholesterol levels, denying cholesterol is a major contributor is poor science. While it's still somewhat of a moving target as to what all the aspects, sub fractions, of cholesterol play in the etiology of CVD, ignore anyone who claims cholesterol levels have no effects on CVD and it's all conspiracy of statin producing companies, etc. This is an excellent review of the topic:
A recent article in The Guardian raised an interesting question. Is cholesterol denialism a valid form of skepticism or pseudoscience? Is there valid debate surrounding the benefit of cholesterol medication or is the evidence and the scientific consensus clearly on one side of the issue?
It is true that we argue about cholesterol far more than the other cardiovascular risk factors. It is hard today to find anyone who doubts the harmful effects of smoking, diabetes, hypertension or the lack of exercise. So why is there a cholesterol controversy but unanimity on other risk factors?
First off, we should acknowledge that there in fact has been a controversy on almost all these issues at some point. Ronald A. Fisher was famously resistant to the idea that cigarette smoking was harmful. Also, up until fairly recently, high blood pressure was seen as necessary to push blood through the narrowed arteries of people with atherosclerosis. Some of the more amusing quotes regarding high blood pressure are worth quoting verbatim:
Get it out of your heads, if possible, that high pressure is…the feature to treat.
– William Osler, 1912 address to Glasgow Southern Medical Society
Hypertension may be an important compensatory mechanism which should not be tampered with, even were it certain that we could control it.
– Dr. Paul Dudley White, 1937
The greatest danger to a man with high blood pressure lies in its discovery, because then some fool is certain to try and reduce it.
– JH Hay, British Medical Journal 1931
The fact is that controversies are not new. We simply tend to forget that they happened.
Cont:
https://sciencebasedmedicine.org/the-cholesterol-controversy/
Doc Safari
05-29-19, 13:51
I will say one thing and it's anecdotal to be sure. My mom was on a statin drug and her mental state was deteriorating rapidly. I am convinced the statin was partially to blame for her dementia because her mind improved as soon as she stopped taking it. I had been steered to a couple of studies of the harm that statins can do and that sort of cinched my decision. I'll try to look for them on the internet, but they were printouts I was given and not links to websites so I don't know how much luck I'll have.
I will say one thing and it's anecdotal to be sure. My mom was on a statin drug and her mental state was deteriorating rapidly. I am convinced the statin was partially to blame for her dementia because her mind improved as soon as she stopped taking it. I had been steered to a couple of studies of the harm that statins can do and that sort of cinched my decision. I'll try to look for them on the internet, but they were printouts I was given and not links to websites so I don't know how much luck I'll have.
Statins can cause "brain fog". It's not a rare side effect, either.
There are more medications now for cholesterol and cholesterol related disease than ever before, and finding one that works and is it safe for you it's really not that hard.
That said, medication should not be first line for anything. Lifestyle choices, exercise, diet, smoking, alcohol and sugar consumption, all these should be modified before going straight to a medication. Even if none of those affect you, you still may end up on medication. But in as much as you can, modify the behaviors that make you at risk before going on any pill.
What about the HDL? That is supposedly the "good" cholesterol. Mine is 83, which is fairly high (of course I work out regularly too). I take a statin plus zetia for high cholesterol.
Total cholesterol 196
LDL 105
HDL 83
Triglycerides 40
What about the HDL? That is supposedly the "good" cholesterol. Mine is 83, which is fairly high (of course I work out regularly too). I take a statin plus zetia for high cholesterol.
Total cholesterol 196
LDL 105
HDL 83
Triglycerides 40
What were your numbers before you were on medication? I have numbers similar to yours without taking meds, and my doc isn't even concerned.
What were your numbers before you were on medication? I have numbers similar to yours without taking meds, and my doc isn't even concerned.
I don't recall the specifics but the total was 230+. Your doc shouldn't be concerned if you have numbers like mine are now. Remember, HDL is the "good" cholesterol and is supposed to offset the LDL.
I'm only taking 20 of Simvastatin/10 of Zetia. The Zetia (generic Ezitimibe) isn't cheap but I figure that keeps me from needing a higher statin dose, which I want to avoid.
I don't recall the specifics but the total was 230+. Your doc shouldn't be concerned if you have numbers like mine are now. Remember, HDL is the "good" cholesterol and is supposed to offset the LDL.
I'm only taking 20 of Simvastatin/10 of Zetia. The Zetia (generic Ezitimibe) isn't cheap but I figure that keeps me from needing a higher statin dose, which I want to avoid.
Copy. I'm only 50. So far I've dodge blood pressure and cholesterol meds and I sure hope to stay that way. Getting mine checked again tomorrow since I've lost 50 lbs since my last blood test.
What about the HDL? That is supposedly the "good" cholesterol. Mine is 83, which is fairly high (of course I work out regularly too). I take a statin plus zetia for high cholesterol.
Total cholesterol 196
LDL 105
HDL 83
Triglycerides 40
Medical community stopped, or should have stopped, looking at the lipid fractions levels alone to decide "it is OK" in 2013, with the new lipid guidelines. Download the ASCVD risk calculator and figure out what your risk was on a basis pre-treatment numbers. We shoot for 30 to 50% LDL reduction with statins, the higher the baseline risk, the better reduction we want.
Non-HDL cholesterol is felt to be more predictive than LDL and with your HDL being that high, your non HDL is decent. That said, your LDL is over 100 and if you're already on a statin, I see zero logic in not driving LDL as low as we can by modulating the dose or changing to a more aggressive statin. Note that more aggressive doesn't mean more side effects. Choice of zetia over higher dose of statin is a wrong decision. Learn what we're trying to achieve with lipid lowering agents and why we choose statins over everything else.
In regards to earlier posts re dementia: yes, that can happen and been described. It is a risk to benefit discussion. I would be careful if someone already had dementia but the worse things that I've seen was when children of older people with dementia refused statins only because their parents couldn't tolerate them and then came in with massive heart attacks.
Medical community stopped, or should have stopped, looking at the lipid fractions levels alone to decide "it is OK" in 2013, with the new lipid guidelines. Download the ASCVD risk calculator and figure out what your risk was on a basis pre-treatment numbers. We shoot for 30 to 50% LDL reduction with statins, the higher the baseline risk, the better reduction we want.
Non-HDL cholesterol is felt to be more predictive than LDL and with your HDL being that high, your non HDL is decent. That said, your LDL is over 100 and if you're already on a statin, I see zero logic in not driving LDL as low as we can by modulating the dose or changing to a more aggressive statin. Note that more aggressive doesn't mean more side effects. Choice of zetia over higher dose of statin is a wrong decision. Learn what we're trying to achieve with lipid lowering agents and why we choose statins over everything else.
In regards to earlier posts re dementia: yes, that can happen and been described. It is a risk to benefit discussion. I would be careful if someone already had dementia but the worse things that I've seen was when children of older people with dementia refused statins only because their parents couldn't tolerate them and then came in with massive heart attacks.
So the HDL of 83 is a good thing, correct? Is it hereditary or due to a consistent exercise regimen (or a combination of both)?
Is a statin dose of 20mg associated with dementia or is it with higher does? (I guess the next step would be 40mg, or twice the dose, correct?)
83 is probably driven by genetics. You can raise HDL with exercise and diet but not that high, in my experience. Yes, high HDL is better but it doesn't fully negate the risk if risk is otherwise high because of other factors. Also not all HDL is made equal. HDL has subfractions and same total numbers with different subfraction breakdown carry different protective effects.
There is no knowledge that dose dependency with dementia exists, although there is dose dependency with other side effects. Admittedly, when I prescribe statins to people with preexisting cognitive issues, I tend to use lower doses but that's really not based on anything other than my personal feelings. There is actually no hard knowledge that there is even a cause-effect, although some studies showed increased prevalence with statin use. Personally, I do not like simvastatin, not actively dislike but prefer not to use it, and I'd use 20 mg of atorvastatin or rosuvastatin instead. That doesn't constitute formal medical advice, check with your MD, but that's what I do.
I'm 55 now and have always been very active either in the gym 5-6 days a week since the mid 70's, sports all through grade school and even into my 20's, marital arts and even now I'm doing 6-8 workouts a week. I don't eat fast food and stay away from simple carbs and sugars. I have never had high blood pressure or high cholesterol. We don't have a family history of cardiac problems either. 5 years ago I ended up having some issues and was finally referred to a cardiologist. Turns out I had 3, 95% blockages and one at 60%. Thankfully they were able to stint the 3 blockages. They left the 60% blockage alone. My cardiologist initially put me on a high blood pressure med, Plavix, 325mg of aspirin and 20mg of Lipitor. After the procedure I asked him when could I get back in the gym and he said give it 10 days and then no restrictions. I came off of the Plavix a year later and never started the blood pressure meds. I asked him why he prescribed them if I didnt have high blood pressure. He said to give my heart a break. I never took them. Right now it's still just the Lipitor and 325mg of aspirin. Last year I asked him about the 60% blockage and if the Lipitor would reduce the blockage or keep it from becoming even more blocked. His answer was "In theory......." I stopped him and said. We are not talking theory here what is reality? He said the studies were not conclusive that cholesterol meds could keep blockages from increasing.
I'm still taking the Lipitor/atorvastatin and the 325mg of aspirin. I still eat clean and if I'm not in the gym I'm very active in one way or another. Resting for me is sitting in a deer stand or a duck blind or sleeping at night. Blows my mind though that without a family history, no high blood pressure or cholesterol I still end up with 3 stints and very easily could have had a major heart attack.
Blows my mind though that without a family history, no high blood pressure or cholesterol I still end up with 3 stints and very easily could have had a major heart attack.
As a medical professional, it is people like you I'm most concerned about. The people with the risk factors, the family history, smokers, a lot of weight, those are easy to identify and control for. It's the people with none of those that end up coming dead on a stretcher into the ED.
I have a buddy from the Navy, younger than me by about 2 or 3 years (I'm 50), is a marathon runner and an Ironman triathlete. No history, no family history, no nothing. He was on a training run and had chest pain, called EMS, was having a big heart attack. You just never know.
As a medical professional, it is people like you I'm most concerned about. The people with the risk factors, the family history, smokers, a lot of weight, those are easy to identify and control for. It's the people with none of those that end up coming dead on a stretcher into the ED.
I have a buddy from the Navy, younger than me by about 2 or 3 years (I'm 50), is a marathon runner and an Ironman triathlete. No history, no family history, no nothing. He was on a training run and had chest pain, called EMS, was having a big heart attack. You just never know.
Symptoms were not normal for me. This happened during that hunting season. In September of 2014. I would walk to my treestand, nice easy 4-500 yard walk and have to stop 5-6 times. I would get a burning sensation in the middle of my chest and it would go up to my throat. Felt just like acid reflux. This happened almost every time I went into the woods. I was also running field trials with my lab at this time and if we were going to the line to begin our series of retrieves I would feel the same thing. I'd have to calm myself down. However after hunting for example I could fill up my feeder with 50lb bags of corn and the heavy lifting wouldn't cause any pains at all. I'd shoot a deer and get excited and feel the pain but dragging it to the trail wouldn't feel a thing. Sometimes at night in bed I'd feel the same thing. I went to my family doctor and he referred me to an Gastro specialist and at that appointment the gastro guy said it was a cardio issue. He referred me to a friend of mine who is a cardiologist and 10 days after that appointment I was having a catheterization done. Thankfully they were able to stint the blockages!! Overall I got lucky.
P2Vaircrewman
06-21-19, 08:40
I had a triple bypass 20 years ago when I was 54. At that time I was 150 # 5'10" and my TC was 195 and I had been a runner all my life. Running was my early warning when I started to have angina about 1/4 mile into my daily 3 mile run. I was put on a beta blocker and niacin after the surgery and and got my TC down to 175 then the AMA lowered the cholesterol guidelines and I was put on Lovastatin. It almost drove me to suicide, muscle and joint pain, loss of strength from loss of muscle tissue. It took 18 months for the effects of it to finally go away and I feel I have some permanent muscle damage from it.
Because I refused to take a another statin my cardiologist put me on Repatha, a twice a month injection 4 years ago. My TC is now below 100. Unfortunately I started have angina again during my workouts last January. Time had caught up with me and two stents were installed in my left circumflex artery.
I do 10 minutes of cardio on an elliptical machine at 8 mets and an hour and a half of lifting twice a week. I feel good and have no side effects from the Repatha. There is some evidence Repatha can remove plaque but it accumulated over a life time and it may take another lifetime to remove it.
I still take a beta blocker and an ACE inhibitor along with Plavix for a year because of the stents.
When a doctor was asked how to prevent heart disease his answer was to chose your parents wisely.
I'm 55 now and have always been very active either in the gym 5-6 days a week since the mid 70's, sports all through grade school and even into my 20's, marital arts and even now I'm doing 6-8 workouts a week. I don't eat fast food and stay away from simple carbs and sugars. I have never had high blood pressure or high cholesterol. We don't have a family history of cardiac problems either. 5 years ago I ended up having some issues and was finally referred to a cardiologist. Turns out I had 3, 95% blockages and one at 60%. Thankfully they were able to stint the 3 blockages. They left the 60% blockage alone. My cardiologist initially put me on a high blood pressure med, Plavix, 325mg of aspirin and 20mg of Lipitor. After the procedure I asked him when could I get back in the gym and he said give it 10 days and then no restrictions. I came off of the Plavix a year later and never started the blood pressure meds. I asked him why he prescribed them if I didnt have high blood pressure. He said to give my heart a break. I never took them. Right now it's still just the Lipitor and 325mg of aspirin. Last year I asked him about the 60% blockage and if the Lipitor would reduce the blockage or keep it from becoming even more blocked. His answer was "In theory......." I stopped him and said. We are not talking theory here what is reality? He said the studies were not conclusive that cholesterol meds could keep blockages from increasing.
I'm still taking the Lipitor/atorvastatin and the 325mg of aspirin. I still eat clean and if I'm not in the gym I'm very active in one way or another. Resting for me is sitting in a deer stand or a duck blind or sleeping at night. Blows my mind though that without a family history, no high blood pressure or cholesterol I still end up with 3 stints and very easily could have had a major heart attack.
Your experience demonstrates it's much more complicated than simple cholesterol levels, and some of it is still a moving target. If you want to get deep into the sauce on the topic, see also:
https://brinkzone.com/why-you-need-to-look-beyond-your-ldl-bad-cholesterol-level/
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