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Thread: The Cholesterol "Controversy"

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    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...l-controversy/
    - Will

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    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.

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    Quote Originally Posted by Doc Safari View Post
    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.

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    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
    11C2P '83-'87
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    Quote Originally Posted by ABNAK View Post
    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.

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    Quote Originally Posted by AKDoug View Post
    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.
    11C2P '83-'87
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    Quote Originally Posted by ABNAK View Post
    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.

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    Quote Originally Posted by ABNAK View Post
    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.
    Last edited by YVK; 06-06-19 at 19:42.

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    Quote Originally Posted by YVK View Post
    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?)
    Last edited by ABNAK; 06-06-19 at 19:59.
    11C2P '83-'87
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    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.
    Last edited by YVK; 06-06-19 at 22:41.

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