Re: Statins
- From: Robert1 <Goldentouchman@xxxxxxxxx>
- Date: Sat, 08 Sep 2007 11:04:45 -0700
On Sep 8, 10:13 am, Mark & Steven Bornfeld
<bornfeldm...@xxxxxxxxxxxxxxx> wrote:
Someone close to me has seen her total cholesterol gradually climb to
just north of 240 (I don't have the lab report in front of me--her LDL
is elevated slightly, but her HDL is good--164, I think).
She is by inclination averse to taking meds, and her trusted internist
wants her to go on a statin.
I am caught between my general inclination to do what the good doctor
tells me to, and my increasing apprehension about the news coming out
every day--about docs getting perks from pharma companies, about NIH
study groups packed with doctors who have a financial interest in the
drugs they are recommending (etc, etc.--I tell you this not to stir up
trouble--I've been on the receiving end of the assault by alternative
groups beating me up on amalgam, root canals, x-rays, etc.).
Most of what I've gathered on the web indicates to me that the serious
risks (hepatotoxicity, rhabdomyolysis) are pretty small. What I really
want to know is whether statins aren't being over-recommended.
Specifically, I am thrown by stats I see that while women with elevated
cholesterol put on statins suffer lower incidence of cardiovascular and
cerebrovascular events, but that the overall death rate is not
decreased. The other snippet I see (sorry, I don't have the source in
front of me) is that HDL levels have a far greater predictive
significance in development of cardiovascular disease than do either
total blood cholesterol or LDL levels.
Can someone parse these issues out for me?
TIA,
Steve
--
Mark & Steven Bornfeld DDShttp://www.dentaltwins.com
Brooklyn, NY
718-258-5001
Complicated issue. Yes they are over prescribed based on
recommendations and the reason for that is a composite of pharm
pushing the drug along with medical evidence showing it helps a select
portion. They can't pin-point more precisely what segment of that
population with high cholesterol is helps the most and so the shot-gun
approach is taken. Who is treated is based on family history, HP,
diabetes, renal disease, and people with other health conditions known
to be at risk for CAD. If the person doesn't have any known clinical
risk factors then simply having a high cholesterol is not an
indication for statins.
If I remember correctly for women non-LDL levels, HDL , is a
significant predictor of risk. As more information comes out and we
progress with our knowledge base then things are tweaked at bit.
Our understandings concerning high HDL is changing and is being
thought of not a protective in some cases and actually the opposite
depending on whether one has heart disease.
Here's a good article about HDL http://www.healthday.com/Article.asp?AID=607463
"With LDL cholesterol it's simple -- the lower the better," Heinecke
said. "With HDL, it's much more complicated. The protein composition
of people with and without heart disease is different."
So, measuring blood levels of LDL and HDL cholesterol is not as
predictive of cardiac risk, as has been assumed, Heinecke stressed.
"Protein composition [in HDL cholesterol] may be a better handle on
whether someone is at risk," he added.
Animal studies have found "dysfunctional" HDL cholesterol, which works
against coronary health, Heinecke said. "It is proposed that the same
thing is going on in humans," he noted."
Also this article concerning that.
http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=477172&in_page_id=1774
.
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