Watch Dr Meade interview Dr Duane Graveline on statin drugs and Cholesterol

Watch part one and part two of this video on Inside Medicine titled Myths on Cholesterol wherein Dr Meade an orthopedic surgeon interviews the SpaceDoc - Dr Duane Graveline.

Dr John Briffa on ezetimibe (Zetia)

More bad news for the makers (and takers) of cholesterol-reducing drug ezetimibe (Zetia) http://www.drbriffa.com

Posted By Dr John Briffa On November 16, 2009

Previously, I have written about the drug combination of simvastatin and ezetimibe (sold as Vytorin in the US). Both of these drugs reduce cholesterol, but through different mechanisms. Taken together, these drugs do do a good job of reducing cholesterol levels And we all know that the lower we get the cholesterol levels down the better, right? Well, actually, results show that Vytorin [1] did not work to halt the progression of the ‘plaques’ that gum up arteries and can precipitate heart attacks and strokes.

And then another thing is that giving people simvastatin and ezetimibe is associated with an increased risk of [2] death due to cancer. This finding was inexplicably waved away by scientists as a [3] chance finding (even though the statistics showed that the finding was very unlikely to be due to chance).

Anyway, this week sees more bad news for the manufacturers of Vytorin and also those who take it. The New England Journal of Medicine has just published a study in which individuals on a statin were additionally treated with ezetimibe or niacin (vitamin B3) over 14 months [1]. All of the individuals in the trial had either been diagnosed with heart disease or were deemed to be at high risk of this condition.

The researchers measured a number of parameters including:

LDL-cholesterol (a form of cholesterol said to be associated with a higher risk of cardiovascular disease)

HDL-cholesterol (a form of cholesterol said to be associated with a lower risk of cardiovascular disease)

Triglyceride levels (a form of blood fat said to be associated with higher risk of cardiovascular disease)

Carotid artery intima thickness (the thickness of the wall of the major blood vessel supplying blood to the head – increased thickness is generally taken as a sign of worsening cardiovascular disease risk)

In the group taking a statin and ezetimibe, LDL, HDL and triglyceride levels went down.

In the group taking a statin and niacin, LDL and triglyceride levels went down, and HDL levels went up.

On paper, at this point, the group taking the niacin and statin fared better. However, more important than these results were those relating to the carotid artery intima thickness. Guess what? The group taking the niacin did better than the group taking ezetimibe on this score too.

One other outcome the researchers kept tabs on was ‘major cardiovascular events’ such as heart attacks and strokes. Here again, the niacin group fared better – 1 per cent of them had such an event compared to 5 per cent in the group taking ezetimibe.

The New York Times reports [4] here that Dr Peter Kim, the president of Merck Research Laboratories (makers of ezetimibe) claimed that the study was limited because it did not compare the groups of patients taking a statin and a second drug to a placebo group. He also claims that a drug’s ability to improve artery-wall thickness has not been proved to automatically correlate with a reduction in heart attacks. Moreover he stated that ezetimibe lowers bad cholesterol and lowering bad cholesterol is a “known good”.

Ezetimibe has been licenced on the basis of its ability to reduce LDL-cholesterol – something that is referred to as a ‘surrogate marker’. So, Merck it seems that Merck is happy for its drug to be sold and promoted on the basis of one surrogate marker (reduced cholesterol), but none-too-keen for its drug to be criticised on the basis of another surrogate measure (carotid artery intima thickness).

Dr Kim also describes a reduction in bad (LDL) cholesterol as a “known good”. However, the new England Journal of Medicine study found that lower levels of LDL cholesterol were actually associated with an increase in carotid artery intima thickness. And never mind this, do we really think that just because something reduces LDL cholesterol levels, that has to be a good thing. I mean, if arsenic and cyanide were found to reduce LDL cholesterol levels, would that mean we should all be taking arsenic and cyanide every day?

The New York Times article also quotes Dr James Stein, professor at the University of Wisconsin medical school, who points out that as far as ezetimibe is concerned, “there is not a shred of evidence that it does anything good for blood vessels or heart disease.”

References:

1. Taylor AJ, et al. Extended-Release Niacin or Ezetimibe and Carotid Intima–Media Thickness NEJM 15th November 2009 [epub ahead of print]


--------------------------------------------------------------------------------

Article printed from Dr Briffa’s Blog: http://www.drbriffa.com

URL to article: http://www.drbriffa.com/blog/2009/11/16/more-bad-news-for-the-makers-and-takers-of-cholesterol-reducing-drug-ezetimibe-zetia/

URLs in this post:
[1] did not work: http://www.drbriffa.com/blog/2008/01/28/trial-results-forced-out-of-drug-company-support-the-concept
-that-cholesterol-may-not-cause-cardiovascular-disease/

[2] death due to cancer: http://www.drbriffa.com/blog/2008/07/23/cholesterol-lowering-combination-found-to-have-limited-benef
it-again-and-now-is-linked-with-increased-risk-of-cancer/

[3] chance finding: http://www.drbriffa.com/blog/2008/09/03/is-it-right-for-scientists-to-put-the-links-between-choleste
rol-reducing-medication-and-cancer-down-to-chance/

[4] here: http://www.nytimes.com/2009/11/16/health/research/16heart.html

Statin Drugs and Mitochondrial Damage

Duane Graveline, the Spacedoc, introduces the topic of statin drug side effects this way...

"Tens of thousands of statin users have complained to their doctors of weakness, instability, easy fatigue, muscle aches and pains, burning of their extremities, depression, personality change and faulty memory, ... "

Any of those sound familiar as symptoms you have seen or heard of in someone that you know who is on the statin drug or have you experienced them yourself as a user. I did for much too long. Yet the prescribed drugs did not do what they were touted to do - prevent cardiovascular disease or heart attack in my case. I will admit they did reduce my cholesterol. Enough so that my cardiologists were tickled pink. I felt I was doing more to prevent them from having a coronary than myself. With 'dumb, fat, and happy' low cholesterol I had five heart attacks and intestinal cancer (an increased risk side effect of statin usage). Don't know how the cardiologists and GPs who prescribed them, and were so entheusiastically promoting their benefits and likely taking the miracle drug themselves are doing. Hopefully they are faring better than I did.

Read Dr Gravline's full series of articles on Statin Drugs and Mitochondrial Damage here.

Dr. Davis on Vitamin D

Addessing the question "What is a healthy vitamin D blood level?" Dr Davis makes some valuable points.

A previous post here from Dr Davis, "Another reason not to get sick in a hospital", also addresses vitamin D but with a different focus.


Vitamin D is so important for so many reasons that I recommend reading both of his articles in full. Please click on the links above.

Horrible Hiney(H1n1) - Mortality in perspective

I just spent a week in Calgary where it was much cooler than my body is accustom to but the H1N1 panic was heated up to a fever pitch which was hard to explain in my mind.


My son emailed me a link to Michael Paukner's flickr site that has a chart that helps put the magnitude of the threat in perspective.

Go to this link to see it with better detail.

Note the H1N1 entry in red near the middle of the chart. Kind of dwarfs other health risks such as cardiovascular disease and cancer - right? I wonder where deaths due to water born diseases would lie on the chart. That's one we could actually do something significant on and reduce mortality especially among the young and most vulnerable. I'm convinced that H1N1 is a scare of the affluent.

Another reason not to get sick in a hospital

Hello, this is William Davis (I usually go by Bill) blogging.
Why does that matter? Well because on the not-so-coincidental article by Dr. William Davis on his Heart Scan Blog that I am going to quote and link here on my health related blog. I find it contains some excellent information on Vitamin D and hospitals.



Hospitals are a hell of a place to get sick
via The Heart Scan Blog by Dr. William Davis on 10/28/09

I answered a page from a hospital nurse recently one evening while having dinner with the family.

RN: "This is Lonnie. I'm a nurse at _____ Hospital. I've got one of your patients here, Mrs. Carole Simpson. She's here for a knee replacement with Dr. Johnson. She says she's taking 12,000 units of vitamin D every day. That can't be right! So I'm calling to verify."

WD: "That's right. We gauge patients' vitamin D needs by blood levels of vitamin D. Carole has had perfect levels of vitamin D on that dose."

RN: "The pharmacist says he can replace it with a 50,000 unit tablet."

WD: "Well, go ahead while Carole's in the hospital. I'll just put her back on the real stuff when she leaves."

RN: "But the pharmacist says this is better and she won't have to take so many capsules. She takes six 2,000 unit capsules a day."

WD: "The 50,000 units you and the pharmacist are talking about is vitamin D2, or ergocalciferol, a non-human form. Carole is taking vitamin D3, or cholecalciferol, the human form. The last time I checked, Carole was human."

RN: (Long pause.) Can we just give her the 50,000 unit tablet?

WD: "Yes, you can. But you actually don't need to. In fact, it probably won't hurt anything to just hold the vitamin D altogether for the 3 days she's in the hospital, since the half-life of vitamin D is about 8 weeks. Her blood level will barely change by just holding it for 3 days, then resuming when she's discharged."

RN: (Another long pause.) Uh, okay. Can we just give her the 50,000 units?"

WD: "Yes, you can. No harm will be done. It's simply a less effective form. To be honest, once Carole leaves the hospital, I will just put her back on the vitamin D that she was taking."

RN: "Dr. Johnson was worried that it might make her bleed during surgery. Shouldn't we just stop it?"

WD: "No. Vitamin D has no effect on blood coagulation. So there's no concern about perioperative bleeding."

RN: "The pharmacist said the 50,000 unit tablet was better, also, because it's the prescription form, not an over-the-counter form."

WD: "I can only tell you that Carole has had perfect blood levels on the over-the-counter preparation she was taking. It works just fine."

RN: "Okay. I guess we''ll just give her the 50,000 unit tablet."

From the alarm it raises trying to administer nutritional supplements in a hospital, you'd think that Osama Bin Laden had been spotted on the premises.

I laugh about this every time it happens: A patient gets hospitalized for whatever reason and the hospital staff see the supplement list with vitamin D, fish oil at high doses, iodine, etc. and they panic. They tell the patient about bleeding, cancer, and death, issue stern warnings about how unreliable and dangerous nutritional supplements can be.

My view is the exact opposite: Nutritional supplements are a wonderful, incredibly varied, and effective array of substances that, when used properly, can provide all manner of benefits. While there are selected instances in which nutritional supplements do, indeed, have interactions with treatments provided in hospitals (e.g., Valerian root and general anesthesia), the vast majority of supplements have none.

Saturated Fat is Good for You

The newest newsletter from Dr Duane Graveline at spacedoc.net contains a three part article by Uffe Ravnskov MD a very credible doctor and researcher titled "Saturated Fat is Good for You". Dr Graveline has written books such as "Lipitor Thief of Memory", "Statin Drugs Side Effects and the Misguided War on Cholesterol", and "The Statin Damage Crisis", all excellent documentary resources on the effects and dangers of cholesterol lowering statin drugs.

Dr Graveline's guest in this newsletter, Uffe Ravnskov MD, is not new to this topic by any stretch. He has numerous papers, books, and medical journal articles about cardiovascular issues- see links here. A book that helped me tremendously when I was struggling with the cholesterol/statin issues, "The Cholesterol Myths" is now unfortunately out of print though may still be available from some sources.

All that to say I heartily recommend "Saturated Fat is Good for You" at Spacedoc.net. Read it.

The healthcare model of the future

Dr. William Davis and I are not the same person (my name is also William Davis without the Dr.) or even related. I do follow his Heart Scan Blog and Track Your Plaque website and take to heart (pun intended) what he says. He simply makes sense. If I were located where I could I would seriously consider getting more officially involved in his program.

His current blog entry (Tuesday, August 25, 2009) is titled Grasscutting, fertilizer, and healthcare sounds odd for a heart related blog but it caught my eye. I'll quote here his timely paragraph with "the healthcare model of the future." And I do recommend that you read his full blog entry.

You manage your own cholesterol issues, your own basic thyroid issues, supplement and monitor your vitamin D levels, use diet to suit your needs, order blood tests when necessary, even obtain basic imaging tests like heart scans, carotid ultrasound, bone density testing. Your doctor is a resource, near by when and if you need him or her: guidance when needed, an occasional review of what you are doing, someone to consult when you fracture an ankle.

What your doctor is NOT is a paternal, "do what I say, I'm the doctor," or a "You need these tests whether you like it or not" holder of your health fate.

What makes statins so dangerous?

In his popular newsletter, Dr. Mercola provides this analysis of the ubiquitous, cure all statin drug and the stance by the Mayo clinic.

What You Need to Know About Cholesterol in Order to Understand the Dangers of Statins

Statin drugs work by preventing the formation of cholesterol, and reduce LDL cholesterol, which is considered the "bad" cholesterol.

There is no argument that these drugs do work very well at lowering your cholesterol levels. However, was has not been proven is that they significantly lower your risk of dying from heart disease. In no way, shape or form, do they treat the cause of your problem. They are nothing more than a toxic band-aid.

So just what makes statins so dangerous, and why are they not the answer for managing your cholesterol levels?

First you need to understand the biological workings of cholesterol.

In fact, there is no such thing as “good” or “bad” cholesterol. Both HDL and LDL
cholesterol perform vital functions in your body, which is why it’s actually dangerous to bring your LDL levels down too low.

HDL (high density lipoprotein) and LDL (low density lipoprotein) are actually proteins that transport the cholesterol to and from your tissues.

Cholesterol in turn is a precursor to steroid hormones. For example, you can’t make testosterone or estrogen, cortisol, DHEA or pregnenolone, or a multitude of other steroid hormones that are necessary for health, without cholesterol.

Even more importantly, your cells cannot regenerate their membranes without it. The reason you have LDL to begin with is to transport the cholesterol to the tissues in order to make new cells and repair damaged ones.

However, there are different sizes of LDL particles and it’s the LDL particle size that is relevant, and statins do not modulate the size of the particles. Unfortunately, most people don’t know about that part, and very rarely, if ever, get tested for particle size.

The particles are sticky, so very small LDL’s can easily get stuck in different areas, and the build-up eventually causes inflammation and damage.

The only way to make sure your LDL particles are large enough to not cause damage is through your diet. In fact, it’s one of the major functions of insulin.

Conveniently enough, a healthy diet is also the answer for type 2 diabetes, so by focusing on what you eat, you’re treating both your diabetes and your cholesterol levels, and reducing your associated risk of heart disease.

If you eat properly, which is really the only known good way to regulate LDL particle size, then it does the right thing; it takes the cholesterol to your tissues, the HDL takes it back to your liver, and no plaque is formed.

The second thing you need to know is that statins work by reducing the enzyme that causes your liver to make cholesterol when it is stimulated by high insulin levels.

Again, you can achieve the same, or better, result by simply reducing your insulin levels by eliminating sugar and most grains, which is also what you need to do to successfully address type 2 diabetes.

Read the complete article here. Thank you Dr Mercols for a clear, concise explanation.

The diet–heart hypothesis: a critique

An article under VIEWPOINT AND COMMENTARY in the Journal of the American College of Cardiology (JACC) titled "The diet–heart hypothesis: a critique" by Sylvan Lee Weinberg, MD, states the following in the final paragraph. Please read the complete article here.

"A balanced appraisal of the diet–heart hypothesis must recognize the unintended and unanticipated role that the LF-HCarb diet may well have played in the current epidemic of obesity, abnormal lipid patterns, type II diabetes, and the metabolic syndrome. Defense of the LF-HCarb diet, because it conforms to current traditional dietary recommendations, by appealing to the authority of its prestigious medical and institutional sponsors or by ignoring an increasingly critical medical literature, is no longer tenable. The categoric rejection of experience and an increasingly favorable medical literature, though still not conclusive, which suggests that the much-maligned LCarb-HP diet may have a favorable impact on obesity, lipid patterns, type II diabetes, and the metabolic syndrome, is also no longer tenable."

H1ow N1ot to Get Swine Flu

H1N1 again? Yup! Again. Not a favorite of mine but certainly seems to be a media favorite and likewise a high priority of governments with a 'You need us to save you' view of their function.



That being said, I came across the blog of Mark Sisson, which I'm still evaluating, and there it was again... "H1N1". And I like his catchy title "H1ow N1ot to Get Swine Flu". I think I'm on track with much of what he says but I'm reminded that there are definitely things I need to work on. Work on not just to avoid H1N1 but for healthy living. As I read Mark's article it is not so much steps to avoid Swine flu but rather a philosophy of health that provides among its benefits a strong immune system.



What led me to Mark's Daily Apple was not even related to the topic of this blog entry, rather his excellent, well researched article on saturated fats - the boogey man of modern heart health because of it's supposed artery clogging properties. I've linked to it in my Credible Evidence list on the right column.



Read both articles and much more here.

More Bad News about Statins

Jon Barron of Baseline of Health Foundation has written an article titled "More Bad News about Statins". In the article, which I do wish he had provided a link to the source, he sites a study published in the Journal of Pathology which reported "...virtually all patients who take statins experience muscle damage, even if they don't have pain."



Please read his full article here.

Swine Flu Vaccine, Deja Vu All Over Again by Jeffrey Dach MD

Jeffrey Dach MD has a documentary on swine flu vaccine that is very interesting and a worthwhile read. I heartily recommend it to all. Read it here

Don't be fooled by the study which found lower cancer rates in vegetarians

Don't be fooled by the study which found lower cancer rates in vegetarians

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Homocysteine By Dr. Kilmer McCully, M.D.

Second in a series by Dr Kilmer McCully, M.D. at the SpaceDoc web site, this two part article covers his research into the relation between homocysteine and arteriosclerosis. Read it here.

Swine Flu (H1N1) virus

Gary Moller has written a good article on reducing the impact of the now declared pandemic flu virus on your health. See it at his web site here I found it quite good as it dispells some of the mystery of something so awful as to be called 'pandemic', 'Swine flu', or '(H1N1) virus'. Not only that but it provides some practical things you can do. All in all that makes for a dynamic duo!

Kilmer McCully, M.D. on Cholesterol

Spacedoc.net is running a two part series of articles by Dr Kilmer McCully on the topic of Cholesterol. Lots of insight there. Please read part 1 and part 2.



Dr McCully has written a book titled "The Homocysteine Revolution", And one titled "The Heart Revolution".

Dr. Malcolm Kendrick M.D. looks at Cholesterol

In Dr Graveline's Newsletter dated May 12, 2009 There is an eye opening article titled "Dr. Malcolm Kendrick M.D. looks at Cholesterol". I have read a number of articles by Dr Kendrick published at The International Network of Cholesterol Skeptics (THINCS). They are definately suggested reading. I am going to quote some parts of Dr Kendrick's article but I really recommend you read the full article here.

Quotes from "Dr. Malcolm Kendrick M.D. looks at Cholesterol".

re: Facts that are not true.

• So, the soon to be Professor, Hugh Tunstall-Pedoe looked at the French, and their diet, and came to the conclusion that the French were protected against heart disease by their high consumption of garlic, red-wine and lightly cooked vegetables (full of anti-oxidants, don't you know). Very soon after this, it became a ‘fact' that these three factors were protective against heart disease.
  One slight problem is that there never was, and still is not, the slightest evidence that any of these three factors provides any protection. I write this in the certain knowledge that many of you are absolutely convinced that garlic, red-wine and anti-oxidants truly are protective, and that many studies have proved it. To which I would say..... ‘show me the studies'.
• I have since discovered that the entire field of heart disease research is packed full of facts that do not (when you start looking properly) exist. Female sex hormones protect against heart disease. For many years this 'fact' was just known to be true. One slight problem. There never was any evidence to support it. Unlike most ‘facts' in heart disease, it was spectacularly disproved.
• To give another example of facts that aren't true. Namely, that saturated fat intake raises cholesterol levels. The Framingham study, the longest lasting, most respected study into the causes of heart disease (started in 1948) reported that ‘In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people's serum cholesterol.' Dr William Castelli - director of the Framingham study at the time - 1992.
• a major eight year long interventional study on fifty thousand women (the Woman's Health Intervention) found that a 25% reduction in saturated fat intake had no effect on LDL ‘bad cholesterol' levels, or heart disease rates.
• The cholesterol hypothesis is, perhaps, the greatest ever example of a medical hypothesis that has become too powerful to die. Too many vested interests are intertwined with it. World famous experts would look incredibly stupid if the hypothesis were to be accepted to be wrong.
• here is another quote from the Framingham study on the impact of cholesterol levels themselves. There is a direct association between falling cholesterol levels over the first 14 years of the study and mortality over the following 18 years. 11% overall and 14% CVD death rate increase per 1mg/dl per year drop in cholesterol levels In short, once your cholesterol level starts to fall, you are much more likely to die from heart disease. A 150% increase in relative risk for every 10 % fall, approximately.
• Add this to another very big study of the elderly, published in the Lancet: Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol levels, and show that long term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier that patients start to have lower cholesterol concentrations the greater the risk of death.
• Even though the ‘experts' have been made aware of it many times, they care not that this particular emperor has no clothes. Or, to be more accurate, they cannot and will not allow themselves to accept that it might be true. For to accept this would be far too humiliating for the great and the good.

Thank You Dr. Malcolm Kendrick

Again, I highly recommend you read the complete article along with other essays.

Disagreements about 'Ugly Facts"

A web site I land on frequently has a home page that starts out this way...
=============================================

"The great tragedy of Science-the slaying of a beautiful hypothesis by an ugly fact." (Thomas Huxley, 1825-1895)

"The growth of knowledge depends entirely on disagreement" (Karl R. Popper, 1902-1994)


For decades, enormous human and financial resources have been wasted on the cholesterol campaign, more promising research areas have been neglected, producers and manufacturers of animal food all over the world have suffered economically, and millions of healthy people have been frightened and badgered into eating a tedious and flavorless diet or into taking potentially dangerous drugs for the rest of their lives. As the scientific evidence in support of the cholesterol campaign is non-existent, we consider it important to stop it as soon as possible. The International Network of Cholesterol Skeptics (THINCS) is a steadily growing group of scientists, physicians, other academicians and science writers from various countries. Members of this group represent different views about the causation of atherosclerosis and cardiovascular disease, some of them are in conflict with others, but this is a normal part of science. What we all oppose is that animal fat and high cholesterol play a role. The aim with this website is to inform our colleagues and the public that this idea is not supported by scientific evidence; in fact, for many years a huge number of scientific studies have directly contradicted it.
==================================================

I appologize for stealing that text - but it is a good statement which I think is also applicable to other sciences, particularly the science (or whatever you call it) of anthropogenic climate change, that which is caused or produced by humans. I am still looking, open-mindedly I hope, for 'growth of knowledge' based on good honest disagreement, well thought out hypotheses and maybe 'ugly facts'.

Are some 'Ugly Facts' being swept under the rug? Here's one view and maybe Winston Churchill was correct when he said "that Americans always do the right thing after they’ve tried everything else,” and Arthur B. Robinson, president and professor of chemistry at the Oregon Institute of Science and Medicine speaking about consensus said “Maybe that’s what we’re going to do this time. But there will be a lot of suffering.” See article here.

Heart-protective properties in red wine

If you have scanned this blog you have likely noticed that I primarily deal with issues of the heart and cancer since they are topics of concern to me for very personal reasons. I subscribe to a newsletter Heart, Health & Nutrition A Cardiologist's Guide to Total Wellness . The latest newsletter by Dr. Stephen Sinatra is titled "The Scary Truth About Alcohol and Breast Cancer". He does mention in the article the supposed heart protective properties of red wine which I alluded to in this blog entry's title, but with this statement... "Dr. Sinatra never endorsed daily wine consumption for heart disease prevention…and thank goodness he didn’t! After doing a bit of research, I discovered that the French have the highest rate of cirrhosis of the liver in the world! That’s not a safe trade off. "

The article mainly deals with the results from an ongoing “Million Women Study” in the UK released this past winter and concluded this:

"The bottom line…Women who drank as little as one alcoholic beverage a day significantly increased their cancer risk"

If you are interested in more details I suggest you read the complete article written by Jan Sinatra, Cardiac Care Nurse, and Dr. Stephen Sinatra’s wife here.