Drugs To Lower Cholesterol

Cholesterol Lowering Drugs and Nerve Damage

April 2, 2015 by James Bogash

statins and nerve damage — decade3d / Dollar Photo Club

Ok. I’ll admit it. I am completely stumped as to why drugs to lower cholesterol are among the most successful drugs that drug companies manufacture.

The evidence for their effectiveness pretty much sucks. Out of 100 people who are prescribed statins over the course of 5 years, only a single person will actually benefit. Not quite as rare as winning the lottery, but very few people have side effects from buying a lottery ticket.

Not so with statins. The list of side effects in far longer than you probably realize. At the top of the known list is muscle problems. From microscopic damage all the way up to fatal reactions from muscles literally melting (fatal rhabdomyolysis). It would not be unreasonable to say that almost everyone who takes a statin drug to lower cholesterol will suffer some type of muscle damage, even if it’s only on the microscopic level.

But what about your nervous system? Could your brain and the nerves going into your feet and hands be affected just as much as the muscles? And if so, why didn’t your doctor mention this side effect potential?

Here’s a little tidbit. When it comes to clinical studies on statins, the odds are stacked against you and your doctor for finding out just how common many of the side effects are. In both the muscle and nervous system lists of side effects, there are some 10-11 separate categories. So, when the reports of a study done on drugs that lower cholesterol are released, the risks are deemed “uncommon.” However, if you grouped all of the “nervous system” or “muscle” side effects into a single category, the rates of these side effects for EACH CATEGORY approached that 10% or higher level.

Considering that only 1 in 100 will benefit from the drug, 1 in 10 having significant side effects is a BIG deal.

As for just how common nerve damage may be, I’d like to point out this particular study. Normally, I review current research that has been published in the past month or so, but this one of those “oldie but a goody” studies from 2002. It is even more important in the context of recent recommendations to give practically every living being over 5 years of age who knew someone who had chest pains or lived in the same zip code as someone with heart disease a statin.

These researchers looked at cases of nerve damage (polyneuropathy) to see how likely statin use was related to the nerve damage. Because of the way that the data was retrieved, the diagnosis of polyneuropathy was limited to definitive, probable or possible. (Definitive = tested for all previously listed exclusion diagnoses and conditions, and where no apparent cause for the neuropathy had been established. Probable = only sufficient information existed to rule out alcohol over-use, diabetes, and renal insufficiency. Possible = information available was not sufficient to ascertain the presence or absence of any of the above-mentioned exclusion criteria.)

Here’s the specifics of this study:

Overall, statin users had a 370% higher risk of suffering from polyneuropathy.
However, for those who had definitive nerve damage, this risk skyrocketed to 1,420%.
When looking at current statin users, these were 460% for any diagnosis of polyneuropathy and 1610% for the definite cases.
If patients had been taking statins for 2+ years the risk of a diagnosis of definite idiopathic polyneuropathy topped the charts at 2,640%.

These aren’t exactly small relationships. If the drug manufacturers get their way and there is a massive increase in prescriptions for statin drugs, the number of cases of permanent nerve damage caused by statins are going to go through the roof.

And for what? So a single patient out of a hundred suffer one less heart attack?

Cholesterol Lowering Drugs and Diabetes: Just How Bad is It?

February 28, 2015 by James Bogash

aspirin to protect your heart — Sergey Yarochkin/Dollar Photo Club

It is now clear that cholesterol lowering drugs cause diabetes. But the proponents have clearly stated that the risk was in those already at risk.

Ironically, pretty much everyone with cholesterol issues is, to some degree, already on his or her way to developing diabetes. Giving a drug that is now proven to push patients along this pathway faster just seems a wee bit on the crazy side.

This article is not about the fact that statins suck at preventing heart disease. Because they do. Across the board statins pretty much lower your risk of having a heart attack by a paltry, sad 1%. High cholesterol, low cholesterol high CRP….doesn’t matter. One percent is the magic number. Your protection from heart disease will really not go above this level of protection.

Patients will respond by saying that the cholesterol drug he or she is taking lowered his or her cholesterol. Big deal. Do you REALLY care what your cholesterol is??? No. You just don’t want to have a heart attack or stroke. Well guess what—your cholesterol level dropping has very little to do with whether or not you are going to have a heart attack.

THAT is the big problem with statins. This delusional idea that artificially lowering your cholesterol with a drug (as opposed to lifestyle changes) will protect the heart is dangerous.

For those of you who would like to know more, I elaborate quite a bit in my Cholesterol Lowering eBook that can be found on Amazon by clicking here.

Back to this particular study. In it, researchers looked at the statin / diabetes link in greater detail. They looked at 4,645 patients who already had vascular disease but no diabetes. Of this group, 3,057 of them were taking statins at the beginning of the study, and 1,608 of these were on high-doses (intensive statin therapy–statin therapy theoretically lowering LDL cholesterol more than 40%).

Here’s what they found:

Statin use increased the risk of developing diabetes by 63%.
Those on intensive statin therapy had an even higher 22% risk of developing diabetes.
Here’s the shocker: the increase in risk had NO relationship to whether or not the statin user was already at risk for diabetes or not.
As a matter of fact, the greatest risk was in those patients who were LESS likely to on their way to diabetes (baseline glucose levels less than <120 mg/dl or 5.6 mmol/L).

Less just review this a second. People with elevated cholesterol are, in almost all cases, already on the way to developing diabetes. These patients are then put on drugs to lower cholesterol levels but do almost nothing to actually prevent a heart attack or stroke (which, BTW, is the main reason that diabetics leave this planet).

These drugs will then, paradoxically, further increase the risk of diabetes that the patient already had.

But, if you’re one of the luckier ones who was NOT on your way to diabetes but had high cholesterol, the drug you are put on will now pretty much ensure that you ARE on your way to diabetes.

Umm…am I the only one who seems to think this is a problem? Especially considering that the new ACC/AHA guidelines will drastically increase the number of patients who will be given prescriptions for statins.

No wonder heart disease is still the #1 killer in the industrialized world.

Cholesterol Lowering Drugs & Your Good Cholesterol–Bad News

February 20, 2015 by James Bogash

Despite all the less-than-stellar research on cholesterol lowering drugs, the powers-that-be want us to take even more of it.

The latest “cholesterol guidelines” released late in 2013 have drastically increased the number of patients who would potentially be given a statin. They have finally dropped the fallacy that total cholesterol has any value (you know–total cholesterol–that lab value that you were taught to pay attention to so doctors would know when to put you on a cholesterol lowering medication..) and basically state that you should be given a statin if your doctor THINKS you might be at risk for a heart attack.

I have certainly been a vocal opponent of the statin class of drugs because the numbers just don’t make any sense. Treat 1,000 people for 5 years to prevent 11 heart attacks (instead of 22 people who would’ve had heart attackes without the drugs), while at the same time causing diabetes in 8 more. A net gain of 3. Out of a thousand. In 5 years.

That just sucks in my book.

And “they” think we should use it more on more patients. None of this takes into account the very long list of side effects from this class of drugs (other then the already mentioned increased risk of diabetes).

And, as we treat more and more patients with cholesterol lowering drugs, the amount of people experiencing side effects is just going to skyrocket. But at least they are not going to have a heart attack because of the statin drugs.

Right?

I guess that all depends.

This particular study looks at one of those little-known secrets about drugs to lower cholesterol. While they all lower cholesterol levels (for whatever that is worth), in some individuals the drugs also lower HDL (the “good”) cholesterol. This is generally not a good thing. Specifically, researchers looked at 724 patients who had just started treatment with statins after having a heart attack and followed for 6 to 9 months.

Eighty-six percent (620) of these patients had his or her HDL-C level increase during the course of the study, while 14% (104) of patients had his or her HDL cholesterol go down. Here’s what the researchers found when they looked closer at the group that had HDL levels drop:

Both groups had their LDL cholesterol levels drop below 100 mg/dl.
Adverse cardiovascular events (including death from all causes, heart attacks and stroke) happened more frequently in the decreased HDL group.
To be precise, this lower HDL group had these events at over TWICE the rate (15.4% vs 7.1%).
Overall, those who had lowered HDL as a result of the statin drugs (to protect the heart, I might add) were 95% more likely to have a cardiac event.

Let’s get this straight. A drug given to lower cholesterol levels actually lowered good cholesterol levels in 14% of those patients taking them. In this 14%, they were 95% MORE likely to have a cardiac event??

THIS is the wonder drug that seemingly all of medicine is hanging their hats on to save the world from heart disease? I‘ll take lifestyle changes, thank you.

The New Statin Guidelines: Surprisingly Inferior Compared to this

November 5, 2014 by James Bogash

No one has ever accused me of being a friend of the statin class of drugs to lower cholesterol.

An entire eBook devoted to the side effects of statins and natural ways to lower cholesterol that do not involve statins pretty much cinches that.

Despite all the continued evidence that statin drugs are only minimally effective at saving lives, the powers-that-be are perpetually trying to jam more of them down our throats. The latest guidelines, if interpreted loosely enough, could lead to millions more patients being eligible for statin prescriptions.

What a windfall for the drug companies at the expense of unsuspecting patients.

I will be the first to admit that statin drugs are effective at lowering cholesterol. Quite frankly, NO ONE cares what his or her cholesterol is; we just don’t want to have a heart attack or stroke. And we’ve been brainwashed to believe that lowering cholesterol with drugs is the way to get this done.

But it’s just not true and we’ve seen it time and time again. At the bottom line, for the average patient, you have to treat 1,000 patients for 5 years to prevent a measly 11 heart attacks. Eight of these unfortunate souls will develop diabetes (and will then die of a heart attack or stroke from the diabetes).

It took years for the drug companies to realize this. Or maybe, it just took years for them to let the unsuspecting patients know that they knew that statins sucked at saving lives. Regardless, this leaves them with a conundrum. A multi-billion dollar engine that needs to be fed before the world wakes up to the fact that you have to treat 100 patients to prevent a single heart attack (leaving the other 99 with side effects and costs).

What would you do if you had a product that would soon have no use?

You got it—re-purpose it.

Just think if the guy who created the pet rock later marketed it as a paperweight. He’d own a small island by now. Or if the VHS cassette tape people could’ve later marketed the tapes as mini-storage device to hide money and valuables in bookcases… You get the idea.

So, the latest attempt to prove value to drugs to lower cholesterol is to see if they can reverse plaguing in the arteries of your heart. Sounds like a good idea, right? Less plaque in your arteries would be a good indicator that the statin drugs were doing something positive for your cardiovascular health.

That’s what researchers did in this particular study. They looked across multiple studies to see if high dose statin therapy could lead to shrinking of the plaque in the arteries of the heart regardless of what your cholesterol levels were or how much inflammation you had (as measured by CRP). And they looked at high dosages because the side effects and costs are going to be greater so they need a stronger justification for the use of these drugs.

In other words, they are looking for a rationale to treat patients carte blanche without needing to worry about pesky reasons like high cholesterol or high inflammation. They want to create a rationale to treat patients with high dose statins because it protects the heart, NOT because you have a risk factor that has been shown to be lowered with statins (since we saw how poorly that worked out using just total cholesterol).

They found 8 studies in all that included 1,881 who maintained or switched to 18- to 24 months of high-intensity statin therapy (rosuvastatin 40 mg or atorvastatin 80 mg) and were evaluated using coronary intravascular ultrasound to look at the plaque in the arteries of the heart.

As expected, lipids levels changed for the better. Here’s where it gets exciting:

The plaque in the heart arteries dropped by 0.7%.
The total volume of the plaque dropped by 8.2 mm3.

For the icing on the cake, the effect was seen regardless of what the cholesterol or CRP levels were.

BUT…

Before we pop the cork on the champagne bottle, let’s saunter on over across the hall to this particular study published in the same issue of the same journal.

In this much smaller study (because hundreds of billions of dollars were not at stake), researchers looked at the effects aerobic exercise on this same parameter—plaque regression.

They compared aerobic interval training (my favorite) to moderate continuous training in 36 patients who had significant coronary artery disease who were already optimal medical treatment (i.e. “fully drugged up”).

The interval training used intervals at 90% of peak heart rate and the moderate continuous training used 70% of peak heart rate) 3 times a week for 12 weeks after they had a cardiac procedure to put a stent in. Here’s what they found:

The necrotic core inside the plaque (that nasty, dead tissue just waiting to break off and cause a heart attack) shrunk in both exercise groups by 3.2% with the interval and 2.7% with the continuous.
Overall plaque was reduced by a respectable 10.7% in both groups.

Now compare the two. Which would prefer—0.7% or 10.7% less plague ready to explode in the blood vessels of your heart? And one was done in 3 months instead of 2 years.

While you can’t make an exact direct comparison, it is clear that exercise is far more effective in a shorter period of time, with NO side effects and no cost (outside the cost of the study).

And yet, when the time comes for your doctor to give you your options, which do you think he was told about? The one that is going to make the drug companies untold billions but has a small effect on your blood vessels, or the more powerful one that no one is making a buck off of?

Take Drugs to Lower Cholesterol? Odds Are You Do This

July 5, 2014 by James Bogash

drugs to lower cholesterol and exercise — Photo courtesy of http://www.freeimages.com/profile/mjimages

It’s been awhile since I’ve written about how much statins suck, so I thought I’d throw another article about the side effects of statins out there.

Basically, I just can’t figure out why we still use this class of drugs. At preventing a first heart attack (referred to as primary prevention) you have to treat 1000 people for 5 years to prevent 11 heart attacks. During this time, another 8 out of the 1000 will develop diabetes. Another huge chunk of this group will experience a long list of other side effects like muscle pains, muscle damage and liver problems just to name a few. With all of this taken into account, many in the cardiology community think we should be giving MORE patients statin drugs.
[Read more…] about Take Drugs to Lower Cholesterol? Odds Are You Do This

Surprising Fact on Users of Statin Drugs to Lower Cholesterol–

April 30, 2014 by James Bogash

drugs to lower cholesterol and weight gain — Photo courtesy of http://www.freeimages.com/profile/julosstock

Society has been brainwashed into thinking that drugs to lower cholesterol are required to prevent heart disease if you have high cholesterol. Money thrown at a consistent marketing message can do that.

It is not uncommon for me to hear a patient speak defiantly in a phrase like, “I do NOT want to go on those cholesterol drugs.” It is stated in the same tone as someone saying he or she does not want to have a leg amputated due to a severed artery bleeding like an Uma Thurman opponent or gangrene you can smell from down the hall. This is how serious much of the American public thinks the issue of taking or not taking a statin is. They are under the mistaken belief that statin drugs will actually do a lot to protect him or her from a heart attack.

I think these patients fear that the doctor will recommend (key word here is “recommend,” not “force”) statins when the misguided lifestyle advice doesn’t work. If the lifestyle changes didn’t work, then taking a drug to lower cholesterol is now a requirement, not an option. If only the general public really knew (If that statement does not mean anything to you, it might be a good time to spend some time with my Cholesterol eBook that can be found on Amazon by clicking here).

But this article is not about beating up on how ineffective the statins are at actually preventing a heart attack or the long list of side effects associated with their use. Rather, this article is about a much, much bigger issue.

It is about the public’s view of medicine and the subsequent responsibility we have for our own health. Just yesterday I had a conversation with a patient whose wife is an obese diabetic with a desire for sweets that she just won’t kick. Her, and many other diabetics just like her, are under the delusion that everything is ok because they are on drugs to “control” the condition.

But what would’ve happened if we didn’t have drugs that we give to diabetics? We would have to sit this patient down, have a direct face-to-face conversation about what is going to happen to her if she doesn’t make changes. Not MIGHT, but WILL happen. Replay this scenario with pretty much every other chronic disease, especially in the early stages of the disease. In this scenario, the responsibility is smack dab in the patient’s lap where it should be.

Medications, however, remove the responsibility from the patient. There is no worse ideology than one that eliminates a lack of personal responsibility when it comes to the prevention and management of chronic disease. None.

This particular study says it all and makes it more real that patients who are given drugs to “control” their chronic disease or, even worse, drugs to control merely the RISK FACTOR for a chronic disease, (like cholesterol) have let go of personal responsibility.

In it, researchers compared two groups of 27,886 US adults, from 1999 through 2010; one group who took statins and the other group that did not use statins to lower cholesterol. Here’s what they found:

Over the time frames measured, the calorie intake of statins users climbed (2009-2010 was 9.6% higher than that in the 1999-2000 period).
The non-statin group calorie intake, however, was unchanged during the same study period.
Over the time frames, the fat intake of statin users jumped 14.4%.
Non-statin users’ fat intake? Unchanged.
BMI increased more among statin users (+1.3) than among nonusers (+0.4).

In a group who had an obvious concern over cardiac health, enough so to take a medication designed to lower cholesterol to lower the risk of a heart attack, the concern extended no further than a number on a lab test. If that number got better using a drug to lower cholesterol, there was no need to control anything else in the lifestyle.

Unless we return the true responsibility for health back where it belongs (with the patient) the health of our culture will continue to decline, with the doctors frustrated and their time bled dry and the drug companies raking in massive profits.

The NEW Statin Guidelines: This is the Best We Got?

December 7, 2013 by James Bogash

I keep thinking that I’m missing something here. Some magical number that makes these drugs to lower cholesterol worth the hype.

I’ve read all the studies and I’ve seen the numbers, but I don’t read ALL of the medical literature that gets published on statins. So maybe I missed the one that showed that statins are worth all the hype and the new recommendations.

There has been much pushback on the newly released 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on reducing atherosclerotic cardiovascular disease risk. The arguments include conflict of interest (8/15 panelists had financial ties) and overzealous interpretation of the data. Here are the scenarios when moderate to high dose statins should be used:

Anyone with low-density lipoprotein (LDL) cholesterol levels >190 mg/dL.
Anyone from 40 to 75 years or age with type 1 or 2 diabetes.
Anyone aged 40 to 75 years with LDL cholesterol levels between 70 and 189 mg/dL and 7.5% or higher estimated 10-year risk of atherosclerotic cardiovascular disease.
Moderate-dose statin treatment in anyone with an estimated 10-year risk between 5% and 7.5%.

This pretty much covers everyone.

But this aren’t the problem. Or rather, the problems.

First, the queen of all twisting of the data has to do with cholesterol. If you remember how this all started years ago, it was all about total cholesterol. Everyone needed their total cholesterol checked so that we could see whether or not they needed drugs. The entire, laser-like focus on preventing heart disease kept total cholesterol in the crosshairs. We did this, spending mass amounts of money on “educating” doctors and patients that total cholesterol = heart disease = statins.

It got embedded deep. Really deep.

It was not until 10 years later that anyone asked whether lower total cholesterol with drugs was preventing heart attacks and deaths. Turns out they didn’t work really well. Actually, they sucked. So much that these new guidelines do not even take total cholesterol into account. Basically, the suggestions were that we don’t need to look at markers anymore, but we just treat for the sake of treating because the research shows that these drugs help to reduce deaths.

Which brings us to the second problem. They suck at preventing death.

And they did not hide this in the recommendations, as you can see in this review article on the subject. The numbers are given as “NNT,” or number needed to treat over 5 years to see a benefit. This number helps us to understand how many patients need to be treated to benefit a single patient. As an example, using steroids in an acute asthma attack will save 1 person from going to the hospital for every 8 treated, so a NNT of 8. This is considered pretty darn good. Acid blocking drugs in a bleeding stomach ulcer to prevent another episode of bleeding? 15. Probiotics for preventing C. diff infections? 25.

You get the idea.

So what about the use of statins? Here’s the numbers:

Dying from all causes NNT 138
Having a cardiac event NNT 49
Dying from cardiac causes NNT 88
Having a stroke NNT 155
Developing diabetes NNT 98

The saddest part about all of this is that society and medicine has degenerated to the point where we are willing to accept a treatment that is so poor that we have to treat 88 people for 5 years to prevent a single death. And the costs to prevent that single heart attack are staggering (think about the costs of 5,280 months of statin drugs).

With these recommendations, we have given up on the hope that the American public can and will make the necessary lifestyle changes to protect their hearts and have instead leaned more heavily on the use of drugs for “prevention” of heart disease.

That is the saddest part of all of these recommendations.

Statins Have Shocking Benefits in Diabetics

March 11, 2013 by James Bogash

Back to my favorite topic. The statin class of drugs to lower cholesterol and prevent heart attacks. Regular readers of the Rantings will know how I feel about this class of drugs.

To sum it up, they suck at preventing a first heart attack. Without going into detail here, you can read an overview by clicking on a previous blog article here.

For those of you who have been living in a cave, the statin class of drugs (think Lipitor, Crestor) was designed and promoted to lower cholesterol. By lowering cholesterol, we made a big jump in assuming that your risk of heart disease would also go down. After years of the drugs being given out like candy, we realized that the statins just weren’t that good at preventing heart attacks.

Then the studies came out that found that total cholesterol really wasn’t all that great of a risk factor for heart disease anyway. This left the statins in a huge vacuum.

Luckily, some creative researchers were able to create the idea that statins had “pleiotropic” effects–meaning that their benefit on heart disease was due to other factors besides cholesterol lowering. The race was on to determine what these additional benefits might be. Make sense, right? We have a drug making billions of dollars, so we should find out what they’re good for, right?

First came inflammation as measured by CRP. Trials (the biggest being the Jupiter trial) were done that looked at whether statins could lower inflammation as measured by CRP. And it seems like statins were able to lower CRP levels. Great, so now we have an expensive medication with a long list of side effects that lowers CRP. The problem? So does:

Overall, when you compare lifestyle changes to statins in preventing heart disease and lowering CRP levels, there is no comparison.

So, scratch the possibility that we should look at statins and CRP levels and hang our prescription hat on this.

Which brings us to this particular study. Researchers looked at 26 patients with type 2 diabetes taking either simvastatin 40 mg (Zocor) or atorvastatin 10 mg (Lipitor). Here are the jaw dropping conclusions:

Both lowered cholesterol levels about the same.
Vitamin D levels were increased more in the atorvastatin group.
While inflammation (CRP) and markers of oxidative stress (MDA) were lower, it was because of the higher vitamin D levels.

Sooooo..

Atorvastatin increases vitamin D levels.

A long list of side effects, $200 / month and really sucks at preventing heart attacks. Why not just take vitamin D?