Dr Malcolm Kendrick has done great work in the cause of exploding the cholesterol fearmongering. Our arteries are NOT sewer pipes, and cholesterol is not grease. See https://drmalcolmkendrick.org/ and read Dr Kendrick’s superb, accessible, and entertaining books: “The Great Cholesterol Con” and “The Clot Thickens”.
I am very interested in the topic of heart disease and statins and I was prescribed statins by my physician 5 years ago. I implored her to guide me how to lower it with lifestyle changes to which she stated, “it’s in your genes and you can’t change that with diet and exercise”. I decided to still give it another chance and examined my diet which was laden with loads of sugar all day long. I have successfully decreased my LDL from very high to just borderline and my HDL is always above 75.
I am not an expert but i often question why more than 80% of my family members are either deceased or suffering from cardiovascular problems in spite of statins being the first meds given to them as most of them crossed 40 years of age and their health continued to decline with the addition of diabetes. I wish the medical industry would put more emphasis on patient education and lifestyle changes rather then bandaid solutions.
I was interested until you said a SBP of 135 is not ideal. It used to be back when people were healthy that we would not start a anti-hypertensive until SBP was >150. We need pressure in our arteries to pump oxygenated blood to our vital organs and if the recommended SBP is less the 120, couldn’t that be attributing to all the orthostatic hypotension and dementia? We need oxygen as well as cholesterol for good brain function. Also, if cholesterol is what is clogging arteries then why is the CT coronary calcium scan being widely used to date to determine if coronary arteries are clogged? There are multiple things that clog arteries. Inflammation which I’m seeing a ton of in people who received the Covid vaccine, calcium, and yes lipids. K2 is a great supplement that pulls the calcium out of the arteries and puts it back in the bone, and it doesn’t have side effects. Why isn’t that being promoted? Oh, because it’s not a prescription?
Best explanation I’ve read. I see similar arguments about BMI by people that don’t understand it’s one of several risk factors.
I have also read high Lp(a) contributes to early heart attacks but is still not included in most risk assessments. The treatment of course is to treat LDL and blood pressure but more aggressively than the general population.
Yeah this makes sense. another thing people get confused is what should be the ideal cholesterol number and which matters the most.....LDL,HDL, Triglycerides ,Total cholesterol or some other marker. Got a lot of debate about that especially here in US about this. Thanks for sharing 👍
Interesting, the JAMA article tells us the absolute risk reduction is far less than the relative risk reduction. This seems counter intuitive to your arguments. Are there any study's of the use of statins long term? I don't know if you are using mendelian randomization as the basis for the 40 year projections, but I've heard of this as a mathematical model projection not an actual RCT. This seems like the most likely explanation of your 40 year projection. What is the cholesterol we are measuring? We measure total and then HDL but the LDL is a calculation. Why is it we are measuring and treating the taxis of cholesterol? If we think HDL is the "good" cholesterol and we want this elevated, why use a statin as it will lower both of the taxis- LDL and HDL. It is plausible statins are decent at secondary reduction, primary prevention according to the JAMA article is a different story all together. Isn't it also possible they work by reducing inflammation rather than lowering the cholesterol transportation system?
I appreciate this article and in-depth explanations. I do intend to read more of your articles – and re-read this one even.
I was Rx’d statins a while back, but I declined to take them, per my ‘informed consent’. At the time, and now, I’m ridding veg/seed oils and following an Atkins-Keto-ish diet.
I’ve read 7+ books about CHOL. (A Statin Free Life, by Malhotra – The Lies I Taught in Medical School, by Lufkin – The Great CHOL Myth, by Sinatra – and others like the ones by Kendrick referenced in another comment)
In the books there are ratios to consider, so even though my total CHOL was 284, my CHOL:HDL = 3.8 – “less than 4 is desirable”; and my TRI:HDL = 1.25 – “a ratio of 2 or less is ‘wonderful’”.
Next lipid panel I will request ApoB, as I read that ApoB correlates to Heart Attack 70% of the time, where CHOL correlates 40% of the time.
I don’t want to lower my CHOL (with Statins) because: 1) I want my brain to have all the CHOL it needs, 2) IMO, sugar, veg/seed oils, trash carbs (and diabetes) are probably more negative impacts, 3) I don’t think my body puts excess CHOL into plaque as a method to rid any excess – rather, plaque is repairing vascular damage or inflammation, so I prefer to invest in my vascular health, 4) with Statins very widely Rx’d for more than 3 decades, (to the tune of $20 billion annually) nary a dent has been made in CAD, and 5) journal article, The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-known Unknowns, Sultan, Hynes – Open J of Endocrine and Metabolic Disease, 2013, 3, 179-185. https://www.scirp.org/journal/PaperInformation?PaperID=34065
IMO, Ancel B. Keys took us down a wrong turn – some 50 years ago. (Ref ‘The Big FAT Surprise’, by Nina Teicholz)
I am continuing to read – Dr Jason Fung – The Diabetes Code – and work with supplements, diet, exercise, etc.
Thank you for this. Since your example is for a man, are women's heart risk factors and treatments similar? I keep seeing menopause focused creators (who are MDs) on social media state that statins do not work for women but they are still prescribed.
After menopause, there is usually a rise in LDL and a small decrease in HDL, roughly 10-15%. Add a little weight gain and a subsequent increase in glucose resistance and cardiac risk factors go up. However, the statement that "statins don’t work for women" is mostly originating from the small group of contrarian cholesterol deniers. Statins work just fine for women.
Dr Malcolm Kendrick has done great work in the cause of exploding the cholesterol fearmongering. Our arteries are NOT sewer pipes, and cholesterol is not grease. See https://drmalcolmkendrick.org/ and read Dr Kendrick’s superb, accessible, and entertaining books: “The Great Cholesterol Con” and “The Clot Thickens”.
I am very interested in the topic of heart disease and statins and I was prescribed statins by my physician 5 years ago. I implored her to guide me how to lower it with lifestyle changes to which she stated, “it’s in your genes and you can’t change that with diet and exercise”. I decided to still give it another chance and examined my diet which was laden with loads of sugar all day long. I have successfully decreased my LDL from very high to just borderline and my HDL is always above 75.
I am not an expert but i often question why more than 80% of my family members are either deceased or suffering from cardiovascular problems in spite of statins being the first meds given to them as most of them crossed 40 years of age and their health continued to decline with the addition of diabetes. I wish the medical industry would put more emphasis on patient education and lifestyle changes rather then bandaid solutions.
I was interested until you said a SBP of 135 is not ideal. It used to be back when people were healthy that we would not start a anti-hypertensive until SBP was >150. We need pressure in our arteries to pump oxygenated blood to our vital organs and if the recommended SBP is less the 120, couldn’t that be attributing to all the orthostatic hypotension and dementia? We need oxygen as well as cholesterol for good brain function. Also, if cholesterol is what is clogging arteries then why is the CT coronary calcium scan being widely used to date to determine if coronary arteries are clogged? There are multiple things that clog arteries. Inflammation which I’m seeing a ton of in people who received the Covid vaccine, calcium, and yes lipids. K2 is a great supplement that pulls the calcium out of the arteries and puts it back in the bone, and it doesn’t have side effects. Why isn’t that being promoted? Oh, because it’s not a prescription?
Doktar what does it mean to have apolipoprotein B is low and LDL is high ? Former said to be better independent marker of heard disease.
Best explanation I’ve read. I see similar arguments about BMI by people that don’t understand it’s one of several risk factors.
I have also read high Lp(a) contributes to early heart attacks but is still not included in most risk assessments. The treatment of course is to treat LDL and blood pressure but more aggressively than the general population.
Yeah this makes sense. another thing people get confused is what should be the ideal cholesterol number and which matters the most.....LDL,HDL, Triglycerides ,Total cholesterol or some other marker. Got a lot of debate about that especially here in US about this. Thanks for sharing 👍
Interesting, the JAMA article tells us the absolute risk reduction is far less than the relative risk reduction. This seems counter intuitive to your arguments. Are there any study's of the use of statins long term? I don't know if you are using mendelian randomization as the basis for the 40 year projections, but I've heard of this as a mathematical model projection not an actual RCT. This seems like the most likely explanation of your 40 year projection. What is the cholesterol we are measuring? We measure total and then HDL but the LDL is a calculation. Why is it we are measuring and treating the taxis of cholesterol? If we think HDL is the "good" cholesterol and we want this elevated, why use a statin as it will lower both of the taxis- LDL and HDL. It is plausible statins are decent at secondary reduction, primary prevention according to the JAMA article is a different story all together. Isn't it also possible they work by reducing inflammation rather than lowering the cholesterol transportation system?
I appreciate this article and in-depth explanations. I do intend to read more of your articles – and re-read this one even.
I was Rx’d statins a while back, but I declined to take them, per my ‘informed consent’. At the time, and now, I’m ridding veg/seed oils and following an Atkins-Keto-ish diet.
I’ve read 7+ books about CHOL. (A Statin Free Life, by Malhotra – The Lies I Taught in Medical School, by Lufkin – The Great CHOL Myth, by Sinatra – and others like the ones by Kendrick referenced in another comment)
In the books there are ratios to consider, so even though my total CHOL was 284, my CHOL:HDL = 3.8 – “less than 4 is desirable”; and my TRI:HDL = 1.25 – “a ratio of 2 or less is ‘wonderful’”.
Next lipid panel I will request ApoB, as I read that ApoB correlates to Heart Attack 70% of the time, where CHOL correlates 40% of the time.
I don’t want to lower my CHOL (with Statins) because: 1) I want my brain to have all the CHOL it needs, 2) IMO, sugar, veg/seed oils, trash carbs (and diabetes) are probably more negative impacts, 3) I don’t think my body puts excess CHOL into plaque as a method to rid any excess – rather, plaque is repairing vascular damage or inflammation, so I prefer to invest in my vascular health, 4) with Statins very widely Rx’d for more than 3 decades, (to the tune of $20 billion annually) nary a dent has been made in CAD, and 5) journal article, The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-known Unknowns, Sultan, Hynes – Open J of Endocrine and Metabolic Disease, 2013, 3, 179-185. https://www.scirp.org/journal/PaperInformation?PaperID=34065
IMO, Ancel B. Keys took us down a wrong turn – some 50 years ago. (Ref ‘The Big FAT Surprise’, by Nina Teicholz)
I am continuing to read – Dr Jason Fung – The Diabetes Code – and work with supplements, diet, exercise, etc.
YMMV
Very helpful framework . Has me reconsidering statin .
This is fantastic. It directly contradicts disinformation I’ve seen on YouTube. Thank you again.
Dr B… a wonderful article. I have this chat with Dr Google patients regularly.
This is excellent. I have a hard time explaining / relaying this info effectively to my patients. Thanks for a great and succinct article !
Good stuff, Maynard!
A holistic approach to heart health needs to be prioritized. The medical model needs to be replaced with preventative medicine.
Thanks for shedding light on this, Dr. Barrett.
Thank you as always for your well thought out analysis.
Can you share the risk calculator you used in the example?
http://www.lpaclinicalguidance.com/
Thank you for this. Since your example is for a man, are women's heart risk factors and treatments similar? I keep seeing menopause focused creators (who are MDs) on social media state that statins do not work for women but they are still prescribed.
After menopause, there is usually a rise in LDL and a small decrease in HDL, roughly 10-15%. Add a little weight gain and a subsequent increase in glucose resistance and cardiac risk factors go up. However, the statement that "statins don’t work for women" is mostly originating from the small group of contrarian cholesterol deniers. Statins work just fine for women.
thank you for your detailed reply