Getting Off Statin Drug Stories - Dach

Getting Off Statin Drug Stories by Jeffrey Dach MD

Left Image: courtesy of Uffe Ravnskov, MD Fat and Cholesterol are Good for You.Book Cover

Just Ask Judith Walsh MD in JAMA

 

 

Getting Off Statin Drug Stories
by Jeffrey Dach MD
Case Number One, Martha
Martha is 55 years old, healthy and no history of heart disease.  Nonetheless, Martha has been taking a statin drug for “high cholesterol” under the care of “the top cardiologist” in South Florida for the past five years.  Martha has also been under my care taking a bioidentical hormone program for menopausal symptoms, and doing very well.  Every six months, we run a lab panel which always shows  low cholesterol of 170, courtesy of her statin anti-cholesterol drug.


 And, every time Martha comes into the office to review her lab results, I print out a 2004 JAMA article by Judith Walsh, MD who reviewed thirteen statin drug clinical trials from 1966 to 2003.(1)  Dr. Judth Walsh concludes that cholesterol lowering drugs provide no health benefit for women.  I give her this article and, at the same time, explain to her that no woman should be on a statin drug.  Lowering cholesterol with a statin drug has no health benefit for women, that’s a fact, and public information readily available.

Playing Games With Statins

Every six months I recommend to Martha stopping the statin drug, and every six month, her cardiologist puts her back on the statin drug.  This has been going on for three years now.

Finally Success At Convincing Martha to Stop the Statin Drug

Finally this last time, Martha seems more receptive to idea that the statin drug is harming her and not helping her.  She is sitting in my office recounting multiple health problems for which she sees numerous doctors: back pain, asthma, sinus infections, skin problems, and allergies.  I suggested to Martha the possibility that many of her health problems are  caused by the low cholesterol from the statin drug.  Martha finally sees the light, goes home and tosses the bottle of pills into the garbage can.

Feeling Better

About a week later, Martha called me and reported, “I feel so much better off that statin drug, thank you so much! “.  Apparently, the statin drug was causing adverse health effects, and Martha was now feeling much better.

Believing in the Propaganda
This case illustrates the difficulty in convincing patients to stop their statin drug.  It is difficult to counter the drug company propaganda, and convince these patients they are harming their health with the statin drugs. Many continue to believe in the myth that cholesterol causes heart disease, and they go on to become statin drug medical victims.  I see them every day.  When we have a success like Martha who finally gets off her statin drug, this is a cause for celebration.


Left Image: Ignore the Awkward.: How the Cholesterol Myths Are Kept Aliveby Uffe Ravnskov MD

Case Number Two – Roger
Roger is a seventy one year old retired executive, and an avid tennis player.  He has no history of coronary artery disease and has always been healthy. Two years ago, his cardiologist said his cholesterol of 210 was “too high”, and prescribed a statin anti-cholesterol drug.  A year later, Roger’s tennis game deteriorated, he found his timing and balance was off, and he lost every game to players who could never beat him before.

Adverse Effects of the Statin Drug

I suggested to Roger that the decline in his tennis game was most likely an adverse effect of the statin drug on his muscle and nerve function.  He was losing his balance and coordination. 

I recommended stopping the statin anti-cholesterol drug.  At first, Roger resisted and said his wife wanted him to take the statin drug because she thought it was ”good medical care”, and she (mistakenly) believed that a lower cholesterol was somehow preventive of heart disease.

How to Counter the Propaganda: A Book For You
In order to counter the drug company cholesterol propaganda, I gave Roger a copy of the book, Fat and Cholesterol are Good for You, by Uffe Ravnskov MD PhD. This book reviews the medical studies which supposedly show that cholesterol is the cause of heart disease, and reveals that they do no such thing. This is a medical myth.  Neither cholesterol consumption nor cholesterol blood levels cause heart disease.  Similarly, many medical studies demonstrate that anti-cholesterol drugs work very well to reduce blood cholesterol levels, however, this treatment does not prolong life and makes most people sick with adverse side effects.

Roger was amazed and his eyes practically popped out out of his head when he “saw the light”.  The statin drugs were turning him another medical victim.  Once Roger learned the truth about the ”cholesterol causes heart disease” myth,  he took his statin drug bottle and threw it into the garbage can.  Two weeks later, off the statin drug,  Roger was back to his old self, prancing about the tennis court like a gazelle, and winning every game with ease.


Left Image : The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease by Uffe Ravnskov MD
 Are You Still a Believer in Anti-Cholesterol Drugs?

If you are still a believer in Statin Drugs, take a look at this primary prevention study published July 2010 in the Archives of Internal Medicine by Dr. Ray.(3)  He reviewed 11 statin drug clinical trials with 65,229 participants followed for approximately 244,000 person-years.  The astounding results showed the statin drug group all-cause mortality was THE SAME as the placebo group ! (3)  There was no benefit from the statin drugs !!!  This article was published in the mainstream medical literature !!


If cholesterol was truly the cause of heart attacks, then one would expect heart attack victims to reveal the high cholesterol causing their heart attack.   They found the opposite.  Heart attack victims have low cholesterol.  A study  analyzed 137,000 heart attack patients from 541 US hospitals and found mean cholesterol was only 174.  This is low, not high. (4)

In addition, if high cholesterol was truely the cause of heart attacks, one would expect heart attack victims with the highest cholesterol to have the worst prognosis, and lowest cholesterol to have the best prognosis.  They don’t.  A study from Henry Ford Hospital in Detroit showed that three years after a heart attack, the patients with lowest cholesterol had the highest mortality (14% vs. 7 %) (5).

Conclusion:

The cholesterol theory of heart disease is a myth maintained by drug company propaganda to support massive profits from cholesterol lowering drugs.  These drugs provide no health benefit in terms of prolonging life, and at the same time produce harm from adverse side effects.  Avoid becoming a victim of the statin drug propaganda machine.

Articles with related interest:
Heart Disease Vitamin C and Linus Pauling
Getting Off Statin Drug Stories
How to Reverse Heart Disease with the Coronary Calcium Score
Cholesterol Lowering Drugs for the Elderly, Bad Idea
Cholesterol Lowering Statin Drugs for Women Just Say No
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Heart Disease Part Two – Atherosclerosis: How Does it Happen?Preventing and Reversing Heart Disease Part Three by Jeffrey Dach MDHeart Disease, Ascorbate, Lysine and Linus Pauling by Jeffrey Dach MDA Choirboy for Cholesterol Turns Disbeliever by Jeffrey Dach MD
Links and References
(1) http://jama.ama-assn.org/content/291/18/2243
JAMA. 2004;291(18):2243-2252. Drug Treatment of Hyperlipidemia in Women
Judith M. E. Walsh, MD, MPH; Michael Pignone, MD, MPH
(2) Fat and Cholesterol are Good for You, Uffe Ravnskov GB Publishing (January 26, 2009)
(3) http://archinte.ama-assn.org/cgi/content/abstract/170/12/1024
Statins and All-Cause Mortality in High-Risk Primary Prevention A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants. Kausik K. Ray, MD, MPhil, FACC, FESC; Sreenivasa Rao Kondapally Seshasai, MD, MPhil; Sebhat Erqou, MD, MPhil, PhD; Peter Sever, PhD, FRCP, FESC; J. Wouter Jukema, MD, PhD; Ian Ford, PhD; Naveed Sattar, FRCPath. Arch Intern Med. 2010;170(12):1024-1031.
Background  Statins have been shown to reduce the risk of all-cause mortality among individuals with clinical history of coronary heart disease. However, it remains uncertain whether statins have similar mortality benefit in a high-risk primary prevention setting. Notably, all systematic reviews to date included trials that in part incorporated participants with prior cardiovascular disease (CVD) at baseline. Our objective was to reliably determine if statin therapy reduces all-cause mortality among intermediate to high-risk individuals without a history of CVD.
Data Sources  Trials were identified through computerized literature searches of MEDLINE and Cochrane databases (January 1970-May 2009) using terms related to statins, clinical trials, and cardiovascular end points and through bibliographies of retrieved studies.
Study Selection  Prospective, randomized controlled trials of statin therapy performed in individuals free from CVD at baseline and that reported details, or could supply data, on all-cause mortality.
Data Extraction  Relevant data including the number of patients randomized, mean duration of follow-up, and the number of incident deaths were obtained from the principal publication or by correspondence with the investigators.
Data Synthesis  Data were combined from 11 studies and effect estimates were pooled using a random-effects model meta-analysis, with heterogeneity assessed with the I2 statistic. Data were available on 65 229 participants followed for approximately 244 000 person-years, during which 2793 deaths occurred.
The use of statins in this high-risk primary prevention setting was not associated with a statistically significant reduction (risk ratio, 0.91; 95% confidence interval, 0.83-1.01) in the risk of all-cause mortality. There was no statistical evidence of heterogeneity among studies (I2 = 23%; 95% confidence interval, 0%-61% [P = .23]).
Conclusion  This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.
(4) http://www.ahjonline.com/article/S0002-8703(08)00717-5/abstract
AHJ Volume 157, Issue 1, Pages 111-117.e2 (January 2009)
Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines. Amit Sachdeva, MDa, Christopher P. Cannon, MDb, Prakash C. Deedwania, MDc, Kenneth A. LaBresh, MDd, Sidney C. Smith Jr, MDe, David Dai, MSf, Adrian Hernandez, MDf, Gregg C. Fonarow, MDa, on behalf of the GWTG Steering Committee and Hospitals
(5) http://www.ncbi.nlm.nih.gov/pubmed/19437396
Cardiol J. 2009;16(3):227-33. Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction. Al-Mallah MH, Hatahet H, Cavalcante JL, Khanal S.
Abstract
BACKGROUND: The relationship between admission low-density lipoprotein (LDL) levels and long-term outcomes has not been established in patients with acute coronary syndrome. We tested the hypothesis that patients who develop non-ST segment elevation myocardial infarction (NSTEMI) despite low LDL have a worse cardiovascular outcome in the long term.
METHODS: Patients admitted with NSTEMI between 1 January 1997 and 31 December 2000 and with fasting lipid profiles measured within 24 hours of admission were selected for analysis. Baseline characteristics and 3-year all-cause mortality were compared between the patients with LDL above and below the median. Multivariate analysis was used to determine the predictors of all-cause mortality, and adjusted survival was analyzed using the Cox proportional hazard model.
RESULTS: Of the total of 517 patients, 264 had LDL dL and 253 had LDL > 105 mg/dL. There was no difference in age, gender, severity of coronary artery disease, and left ventricular ejection fraction between the 2 groups. Thirty-six percent of patients with LDL 105 mg/dL were on lipid-lowering therapy on admission.
After 3 years, patients with admission LDL dL had higher all-cause mortality rate compared to patients with LDL > 105 mg/dL (14.8% vs. 7.1%, p = 0.005). The higher all-cause mortality persisted (OR 1.8, 95% CI 1.0-3.5, p = 0.05) even after adjustment for confounding variables.

CONCLUSIONS: In our cohort, lower LDL-cholesterol at admission was associated with decreased 3-year survival in patients with NSTEMI.

Jeffrey Dach MD
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Another large study is linking statin use to the development of cataracts - Wood

Statins linked to cataracts in large, retrospective study

September 19, 2013 Shelley Wood

            

 

 

 

 

 

 

 

 

 

 

 

San Antonio, TX - Another large study is linking statin use to the development of cataracts [1]. The latest, following on a Canadian analysis last year, is a propensity score-matched analysis of over 45 000 subjects in a military healthcare system, published this week in JAMA Ophthalmology.

 

As Dr Jessica Leuschen (Wilford Hall Ambulatory Surgery Center, San Antonio, TX) and colleagues point out, observational studies of statins have been conflicting, with some suggesting an increased risk of cataracts with statin use while others appear to show a beneficial effect of statins on cataract risk. At the recent European Society of Cardiology (ESC) 2013 Congress, Dr John B Kostis (Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ) presented the results of a random-effects meta-analysis, showing a 20% lower rate of cataracts with statin use compared with no statin use, with a more pronounced benefit seen when statins were started in younger patients. 

 

The meta-analysis published today, however, found the opposite. It matched 6972 statin users with nonusers within the San Antonio Military Multi-Market Area health system using propensity scores based on variables that increased the likelihood of receiving statins and increased the risk of developing cataracts. Statin users had to have been on the drugs for more than 90 days; simvastatin was prescribed in almost three-quarters of the patients.

 

They found that statin users in the propensity-matched analysis had a 9% increase in cataracts. In secondary analyses that looked at all patients with no comorbidities (based on the Charlson index) at baseline, the risk of developing cataracts was 29% higher in the statin users. Results were consistent regardless of whether patients had been taking statins for two, four, or six years, authors note.

 

The study is the first to use propensity matching to try to eliminate baseline confounding—making it a key contribution to the relatively recent research into this potential interaction. To heartwire, senior author Dr Ishak Mansi (VA North Texas Health Care System, Dallas) noted that there are a number of ways in which statins could be a marker for important confounders, including accessible healthcare and health insurance, as well as underlying risk factors such as smoking, diabetes, and older age—all of which are also risk factors for cataract.

 

That kind of confounding may have been a factor in the Kostis et al meta-analysis at ESC, Mansi commented, when asked about the divergent findings, adding that since the paper is not yet published, he hasn't had a chance to review its methodology.

 

"Without knowing the specifics of the paper . . . I can generally say the following: During the mid-1990s and early 2000s, there were many papers that associated statin use with improved outcomes of many diseases such as cataract, fracture, infection, dementia, etc; however, recently, it was realized that statin use was associated with 'healthy-user bias.' That is to say, individuals who are health-conscious are more likely to take statins, and better outcomes may be secondary for their health consciousness and not due to the statin itself. . . . Therefore, if this meta-analysis included large-volume studies that date back to this period of time, their results may be affected by these biases of these studies."

 

Cardiologists have had plenty of experience with seemingly contradictory studies, he added. "Historically, we have been through these controversies on several topics, such as the use of hormonal-replacement therapy, treatment of chronic systolic heart failures with antiarrhythmic drugs, etc. We will have to study and search for our best capabilities until we reach an answer."

 

"Statins are very effective medications; therefore, side effects are expected. Healthcare providers should make sure that there is justifiable indication to prescribe statins according to guidelines and that the potential benefits outweigh the potential risks of side effects for individual patients. These medications should not be prescribed lightly."

 

For the public, however, the message is slightly different. "For some patients, these medications have been a main tool in treatment of heart disease and should not be stopped because of a small higher risk of association with other diseases," Mansi said. All effective medications can be expected to have side effects, he continued. "It is much better to do your best to lower your own risk of cardiovascular disease (if feasible) by stopping smoking and keeping physically active than to take a pill to lower your risk of heart disease."

 

Source

1. Leuschen J, Mortensen EM, Frel CR, et al. JAMA Ophthalmol 2013; DOI:10.1001/.jamainternmed.2013.4575. Available at: http://archopht.jamanetwork.com/journal.aspx.

Related links

• Statins linked with development of cataracts
  [Lipid/Metabolic > Lipid/Metabolic; Aug 13, 2012]
• Genetic marker may identify risk for statin-induced myopathy
  [Clinical Conditions > Lipid/Metabolic; Sep 06, 2013]
• Treat risk and not LDL-cholesterol targets, new perspective argues
  [Lipid/Metabolic > Lipid/Metabolic; Jan 19, 2012]

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Read the complete article here.http://www.theheart.org/article/1584825.do

 

Why Women Should Stop Their Cholesterol Lowering Medication - Hyman

Why Women Should Stop Their Cholesterol Lowering Medication

by Dr Mark Hyman   January 19th, 2012

If you are a post-menopausal women with high cholesterol, your doctor will almost certainly recommend cholesterol lowering medication or statins. And it just might kill you. A new study in the Archives of Internal Medicine found that statins increase the risk of getting diabetes by 71 percent in post-menopausal women.

Since diabetes is a major cause of heart disease, this study calls into question current recommendations and guidelines from most professional medical associations and physicians. The recommendation for women to take statins to prevent heart attacks (called primary prevention) may do more harm than good.

Statins have been proven to prevent second heart attacks, but not first heart attacks.

Take it if you already have had one, but beware if your doctor recommends it for you if have never had a heart attack.

This current study adds to an increasing body of literature questioning the benefits of statins, while highlighting their potential risks.

New Study Shows 48 Percent Risk of Diabetes in Women Who Take Statins

This study examined the data from the large government sponsored study called the Women’s Health Initiative, the same study that disabused us of the idea that Premarin prevented heart attacks in postmenopausal women.

In fact, based on this randomized controlled trial, estrogen replacement therapy, once considered the gold standard of medical care for the prevention of heart disease, was relegated to the trash bin of history joining medicine’s many other fallen heroes including DES, Thalidomide, Vioxx, Avandia, and more.

In this new study researchers reviewed the effect of statin prescriptions in a group of 153,840 women without diabetes and with an average age of 63.2 years. About 7 percent of women reported taking statin medication between 1993 and 1996. Today there are many, many more women taking statin medications, thus many more are at risk from harm from statins.

During the 3-year period of the study, 10,242 new cases were reported – a whopping 71 percent increase in risk from women who didn’t take statins. This association stayed strong at a 48 percent increased risk of getting diabetes, even after taking into account age, race/ethnicity, and weight or body mass index. These increases in disease risk were consistent for all statins on the market.
This effect also occurred in those with and without heart disease. Surprisingly disease risk was worse in thin women. Minority women were also disproportionately affected. The risk of diabetes was 49 percent for white women, 57 percent for Hispanic women, and 78 percent for Asian women.
But in a typical “my mind’s made up, don’t confuse me with the facts” statement by the medical establishment, the researchers said we should not change our guidelines for statin use for the primary prevention of heart disease.

In a large meta-analysis published in the Lancet last year, scientists found that statins increased the risk of diabetes by 9 percent. If current guidelines were followed for those who should take statins, and people actually took them (thank God only 50 percent of prescriptions are ever filled by patients), there would be 3 million more diabetics in America. Oops.

Other studies have recently called into question the belief that high cholesterol levels increase your risk of heart disease as you get older. For those over 85 it turns out having high cholesterol will protect you from dying from a heart attack, and, in fact, from death from any cause.

Low Cholesterol May Kill You

A recent study showed that in healthy older persons, high cholesterol levels were associated with lower non-cardiovascular-related mortality. This is extremely concerning because millions of prescriptions are written every day to lower cholesterol in the older population, yet no association has been found between higher cholesterol and heart disease deaths for those aged 55 to 84; and for those over 85, the association seems to be inverse — higher cholesterol predicts lower risk of death from heart disease.

The pharmaceutical industry, medical associations, and academic researchers whose budgets are provided by grants from the pharmaceutical industry continue to preach the wonders of statins, but studies like these should have us look good and hard at our current practices. Are we doing more harm than good?

Cardiologists recommend putting statins in the water and giving them out at fast food restaurants and having them available over the counter. They believe in driving cholesterol as low as possible. Statin prescriptions are handed out with religious fervor, but do they work to prevent heart attacks and death if you haven’t had a heart attack already?

Bottom line: NO! If you want to learn why this is true, read on.

Statins Don’t Work to Prevent First Heart Attacks

Recently, the Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death. In addition, many other studies support this and point out the frequent and significant side effects that come with taking these drugs. (i) If scientists found that drinking two glasses of water in the morning prevented heart attacks, even if the evidence was weak, we would jump on board. Big up side, no down side.

But this is not the case with statins. These drugs frequently cause muscle damage, muscle cramps, muscle weakness, muscle aches, exercise intolerance (ii) (even in the absence of pain and elevated CPK – a muscle enzyme), sexual dysfunction, liver and nerve damage and other problems in 10-15 percent of patients who take them. (iii) They can also cause significant cellular, muscle, and nerve injury as well as cell death in the ABSENCE of symptoms. (iv)

There is no lack of research calling into question the benefits of statins. Unfortunately, that research doesn’t get the benefit of billions of dollars of marketing and advertising that statins do. One big trial was touted as proving statins work to prevent heart attacks, but the devil is in the details.

It was the JUPITER (v) trial that showed that lowering LDL (or bad cholesterol) without a reduction in inflammation (measured by C-reactive protein) didn’t prevent heart attacks or death. (vi) Statins happen to reduce inflammation so the study has been touted as proof of the effectiveness of these medications.

Mind you it wasn’t lowering the cholesterol that helped (which is the intended purpose of statins), but the fact that they lower inflammation. What is ignored by people who use this study to “prove” that statins work is the fact that there are so many better ways to lower inflammation than taking these drugs.

Yet other studies have shown no proven benefit for statins in healthy women (vii) with high cholesterol or in anyone over 69 years old. (viii) Some studies even show that aggressive lowering of cholesterol can cause MORE heart disease. The ENHANCE trial showed that aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone, but led to more arterial plaque and no fewer heart attacks. (ix)

Other research calls into question our focus on LDL or the bad cholesterol. We focus on it because we have good drugs to lower it, but it may not be the real problem. The real problem is low HDL that is caused by insulin resistance (diabesity).

In fact studies show that if you lower the bad (LDL) cholesterol in people with low HDL (good cholesterol) that is a marker of diabesity – the continuum of obesity, prediabetes and diabetes – there’s no benefit. (x)

Most people simply ignore the fact that 50-75 percent of people who have heart attacks have normal cholesterol. (xi) The Honolulu Heart Study showed older patients with lower cholesterol have higher risks of death than those with higher cholesterol. (xii)

Some patients with multiple risk factors, or who have had previous heart attacks do benefit, but when you look closely the results are underwhelming. It’s all in how you spin the numbers. For high-risk males (those who are overweight and have high blood pressure, diabetes, and/or a family history of heart attacks) and are younger than 69 there is some evidence of benefit, but one hundred men would need to be treated to prevent just one heart attack.

That means that 99/100 men who take the drug receive no benefit. Drug ads say the risk is reduced by 33 percent. Sounds good, but that just means the risk of getting a heart attack goes down from 3 percent to 2 percent.

Despite the extensive data showing that statins are a questionable therapy at best, they are still the number one selling drug in the US. What isn’t so well known is that 75 percent of statin prescriptions are written for people who will receive no proven benefit. The cost of these prescriptions? Over $20 billion a year.

Yet somehow the 2004 National Cholesterol Education Program guidelines expanded the previous guidelines to recommend that even more people without heart disease take statins (from 13 million to 40 million) (xiii) What are we thinking?

Why would respected scientists go against the overwhelming research that statins don’t prevent heart disease in people who haven’t already had a heart attack?

You can find the answer if you follow the money. Eight of the nine experts on the panel who developed these guidelines had financial ties to the drug industry. Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak.

What Should Women Do?
It is time to push the sacred cow of statins overboard.
But first let me say this. If you have had a heart attack, or have heart disease, the evidence shows they do in fact help protect against a second heart attack, so keep taking them. However, you should be aware that most prescriptions for statins are given to healthy people whose cholesterol is a little high. For these folks the risk clearly outweighs the benefit.

The editorial that accompanies the recent study on women taking cholesterol-lowering medication that I opened this article with was quite clear. Dr. Kirsten Johansen from the University of California, San Francisco said that the increased risk of diabetes in women without heart disease has “important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality.”

In plain English, she said that we shouldn’t be using statin drugs for women without heart disease because:

1. The evidence shows they don’t work to prevent heart attacks if you never had one.
2. They significantly increase the risk of diabetes.

Treating risk factors like high cholesterol is misguided. We must treat causes – what we eat, how much we exercise, how we handle stress, our social connections and environmental toxins are all more powerfully linked to creating health and preventing disease than any drug on the market.
Remember what you put at the end of your fork is more powerful than anything you will ever find at the bottom of a pill bottle.

My new book The Blood Sugar Solution, which comes out at the end of February, gives exact details on what you should put at the end of your fork to prevent and reverse diabesity. It provides a comprehensive solution to the health problems facing our nation today.

Now I’d like to hear from you …

What do you think of statins?

Have you taken statins? What has your experience been?

Why do you think the medical establishment prescribes drugs that research shows don’t work?
Please leave your thoughts by adding a comment below – but remember, we can’t offer personal medical advice online, so be sure to limit your comments to those about taking back our health!

To your good health,
Mark Hyman, MD

References:

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(i) Abramson J, Wright JM. Are lipid-lowering guidelines evidence-based? Lancet. 2007 Jan 20;369(9557):168-9

(ii) Sirvent P, Mercier J, Lacampagne A. New insights into mechanisms of statin-associated myotoxicity. Curr Opin Pharmacol. 2008 Jun;8(3):333-8.

(iii) Kuncl RW. Agents and mechanisms of toxic myopathy. Curr Opin Neurol. 2009 Oct;22(5):506-15. PubMed PMID: 19680127.

(iv) Tsivgoulis G, et. al, Presymptomatic Neuromuscular Disorders Disclosed Following Statin Treatment, Arch Intern Med. 2006;166:1519-1524

(v) Mora S, Ridker PM. Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)–can C-reactive protein be used to target statin therapy in primary prevention? Am J Cardiol. 2006 Jan 16;97(2A):33A-41A.

(vi) Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ; JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008 Nov 20;359(21):2195-207.

(vii)Abramson J, Wright JM. Are lipid-lowering guidelines evidence-based? Lancet. 2007 Jan 20;369(9557):168-9

(viii) IBID

(ix) Brown BG, Taylor AJ Does ENHANCE Diminish Confidence in Lowering LDL or in Ezetimibe? Engl J Med 358:1504, April 3, 2008 Editorial

(x) Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, Kastelein JJ, Bittner V, Fruchart JC; Treating to New Targets Investigators. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007 Sep 27;357(13):1301-10.

(xi) Hansson GK Inflammation, Atherosclerosis, and Coronary Artery Disease N Engl J Med 352:1685, April 21, 2005

(xii) Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet. 2001 Aug 4;358(9279):351-5.

(xiii) http://www.nhlbi.nih.gov/about/ncep/index.htm

About Dr Mark Hyman

MARK HYMAN, MD is dedicated to identifying and addressing the root causes of chronic illness through a groundbreaking whole-systems medicine approach called Functional Medicine. He is a family physician, a four-time New York Times bestselling author, and an international leader in his field. Through his private practice, education efforts, writing, research, and advocacy, he empowers others to stop managing symptoms and start treating the underlying causes of illness, thereby tackling our chronic-disease epidemic. More about Dr. Hyman or on Functional Medicine. Click here to view all Press and Media Releases

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Coronary artery calcium scoring

Jan 31, 2011 @ 1:30AM (i.e. middle of the night while sleeping) I was in Brooke's Point Palawan, I had my sixth heart attack (they say practice makes perfect and so I'm working on it).

At least I'm here to blog about it.
This one was unique in a couple of ways:

1. It was painful. None of the other 5 were in that category.

2. I was quite a ways from real help. The hospital had an ECG/EKG that did make a chart which they said looked abnormal. Wanted to put me on heparin but said otherwise they could only observe me if I accepted their recommendation to be checked in. It was a 120 mile (almost 4 hour ride) north to the airport, then a one hour plane ride, then a 45min drive to my now favorite hospital St Lukes Medical Center where they were capable of acute care.

Well, I made it. Underwent an ECG, Troponin T blood enzime lab test, catheterization exam, etc. etc. etc.

Where to go from here???????

I think I've got a plan.

While in the hospital this time I accidently discovered that this relatively new hospital had facilities to perform a Cardiac Calcium Scoring procedure that uses computed tomography (CT) scan. I had read of this and had been lurking about a source on the web touting it as an effective tool to actually measure plaque buildup not just crystal balling CVD using factors which hadn't worked worth beans in my case in the past - yeah you guessed it basic old cholesterol!

Doesn't sound like that exciting of a find since I know I have cardiovascular disease and therefore plaque buildup. Well it is exciting given the following. If you can quantify it (the calcium score does that) and identify causes you should be able to take steps to slow down, stop, or (stop the presses) even shrink plaque growth - that is begin healing the disease - WOW!

So here's the plan.

1. Get a calcium score. [DONE] (I'm in the 59th percentile by my score, age and gender and I've heard of much worse results than mine).

2. Begin evaluating causes of my CVD by measuring quantifyable and controllable factors. [PARTIALLY DONE].
Have yet to undergo Lipoprotein Analysis using Nuclear Magnetic Resonance (NMR).
Had a VAP Cholesterol test some years back but my cardiologist hadn't a clue what to do with all those 'new' numbers. But the VAP is more complete and actual measured values as opposed to the Friedewald calculated, but not measured, LDL cholesterol approximation most often used today.

3.  Take steps to bring into line those specific factors that have been shown to reduce the growth or even actually reduce the quantity of cardiovascular plaque. [ONGOING]

4. Check interim progress (maybe even using some old Friedewald calculated LDL - since it's cheaper) then eventually have another calcium scoring CT scan to measure artery plaque and compare with the score I got today and make adjustments to the process. [FUTURE]

So that's the plan. Won't be a quick fix or even a magic bullet or likely much more than a more educated attempt at reducing the risk of number 7.

I think I like this approach better than the previous approach that gave me sleep robbing muscle aches, low enough "C" numbers to make the cardiologists pat themselves on the back and smile like Cheshire Cats thinking they had saved another doomed soul (oh and according to some clinical trials, may have had something to do with the cancerous intestinal tumor discovered after almost 20 years on statins).

Stay tuned. I'm determined and committed.

If you are interested more in what I'm doing check here and/or here.

Depression, Statins and Cardiologists

Cardiologists know that treating depression likely will benefit patients complaining of cardiovascular problems, but likely are completely unaware statin drugs may be a major contributing factor.


According to a report from a National Heart, Lung and Blood Institute (NHLBI) Working Group, and published simultaneously in Annals of Behavioral Medicine and Psychosomatic Medicine, up to 20 percent of patients with heart disease meet the American Psychiatric Association's criteria for major depression, and identifying better treatments for depression in this population could lead to improved medical, financial and psychosocial outcomes.

At almost the same time Goldstein and others of the Department of Physiology, The Hebrew University-Hadassah Medical School, Jerusalem, Israel, report in Biol Psychiatry 60(5): 491-9 on the involvement of endogenous digitalis-like compounds in depressive disorders. Cholesterol is the major precursor of these endogenous digitalis-like compounds synthesized in our adrenals.

We might have predicted the effect of this new substance in something like heart failure because of the word digitalis but who would have predicted its impact on bipolar disorder and other forms of depressive reactions?

These pleotrophic effects are due to the fact that the cellular effect of this class of drugs is on the sodium, potassium and ATPase cell wall channels in such a way as to induce calcium retention within the cells leading to altered response.

In a brain cell, mania can result from increased membrane excitability and depression from decreased transmitter release and these are only a few of the effects of these endogenous digitalis-like compounds synthesized from cholesterol.

What of the statin drugs with their ability to reduce natural cholesterol levels to values far below normal for the individual? Is there any real doubt that we now have another reason for the association of statin use with depression?

The drug industry proudly hails the ability of Lipitor®, Crestor® and Vytorin® and others to lower blood cholesterol some 40-50%. We already know what this does to the cognitive ability of many people and the erectile function of many others. And now we find another major body system completely dependent upon adequate cholesterol levels.

In addition to this mechanism for altered emotional status we also have others and all are tied to cholesterol availability. The first of these is dolichol associated glycoprotein process for neurohormone synthesis. Every emotion and mood we have are governed by the makeup of sugars and protein fragments, linked like popcorn on a string, to make up our neurohormones.

The second involves our glial cell mediated production of "on-demand" cholesterol synthesis for memory synapses, critical to the development of psychological manifestations. The third has to do with G-protein coupled receptors responsible for neurotransmitter coupling and felt to be the most important mechanism for perception of environmental factor cells.

All three of these are cholesterol dependent and therefore sensitive to statin use. The effects can be so subtle as to be hardly noticeable or so severe as to support the diagnosis of psychotic illness.

How could the designers of lucrative statin drugs two decades ago know of these effects? They obviously could not and now after 20 years of use have some very real economic reasons for not wanting to hear this. One might say that the research community is now documenting adverse reactions to statin drug use that should have been defined and warned of long before marketing.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Updated December 2010

The True Cause of Heart Disease

The True Cause of Heart Disease - Part One of Two

via Total Health Breakthroughs by Ian Robinson on 7/14/10

Conventional wisdom tells us that high cholesterol is the cause of heart disease. But Dr. Dwight Lundell is fighting to expose this dangerous mainstream myth.

Dr. Lundell is a pioneer and leading expert in this field. He has enjoyed a long and a distinguished career, leading his peers to new breakthroughs.. He spent 25 years as a cardiovascular surgeon and performed over 5,000 heart surgeries.

His experience in cardiovascular and thoracic surgery includes certification by the American Board of Surgery, the American Board of Thoracic Surgery, and the Society of Thoracic Surgeons. He was a pioneer in “Off-Pump” heart surgery, reducing surgical complications and recovery times. He’s in the “Beating Heart Hall of Fame” and has been listed in Phoenix Magazine’s “Top Doctors” for 10 years.

He has been recognized by his peers as a leader and has served as Chief resident at the University of Arizona and Yale University Hospitals. He later served as Chief of Staff and Chief of Surgery.

He was also one of the founding partners of the Lutheran Heart Hospital which became the second largest heart hospital in the U.S.

Dr. Lundell recently agreed to grant us an in-depth and revealing interview about the pioneering work he is currently conducting. It’s our privilege and pleasure to share part one of that exclusive interview with you today.

THB: You are the author of a controversial heart-health book called The Great Cholesterol Lie. The book challenges conventional wisdom and accepted medical theories. What’s been the response to this book?

Dr. Lundell: The response to the book has been overwhelming. I regularly correspond with people from around the world who are enjoying better health from the new understandings they gained from learning about inflammation and heart disease.

THB: That’s good to hear. It’s a seminal book that charts your professional journey as a cardiac surgeon. And, more importantly, reveals your gradual discovery of the true cause of heart disease.

If you could go back in time to when you were a young cardiac surgeon… what would you tell yourself and would you take a different path?

Dr. Lundell: I was dedicated to treating heart disease and passionate about saving lives. It was my responsibility to provide patients with a second chance.

As a young cardiac surgeon in the 1980s coronary bypass operation was the only effective treatment for people afflicted with severe coronary artery disease. So, as you can imagine, this was a very exciting time. Our ability to help people increased and the risks of surgery decreased as techniques and technology improved.

The scientific consensus at that time was elevated cholesterol levels in the blood cause a gradual deposition of cholesterol in the lumen of the blood vessel so two treatment forces were obvious: lower the levels of cholesterol in the blood or do an operation to detour the blood around the accumulated plaque thus restoring flow and heart function.

Rather than looking at more effective ways to lower blood cholesterol, there was relatively little research going on as to what was causing plaque. Everyone settled on the idea that it was as simple as controlling fat and cholesterol.

Then new research was in part driven by industry and not basic science. As balloon angioplasty emerged as an alternative to open heart surgery, the companies that produce the balloons became concerned by high rates of re-stenosis. They began funding studies to understand exactly what was happening biologically to cause the re-stenosis. (Re-stenosis means a re-narrowing of the artery after angioplasty or a stent has been inserted.)

This stimulated a lot of research and culminated in the seminal article published in 1999 in the New England Journal of Medicine announcing that “atherosclerosis [is] an inflammatory disease.”

THB: How did you discover that the true cause of heart disease was inflammation?

Dr. Lundell: I was excited to understand this new research because in the operating room I had observed the classic signs of inflammation around the coronary artery and was very disappointed that surgery, although effective at relieving symptoms and extending life, was not a cure for heart disease.

Many brilliant scientists and university centers continued to do more research that confirmed the basis for coronary disease was chronic inflammation. Sadly the attention was all directed at finding a therapy rather than looking at the cause of chronic inflammation.

Research is hugely expensive and was largely funded by drug companies who were making billions of dollars from the prescriptions for statin drugs.

One of the many side effects of statin drugs is that they seem to have a mild anti- inflammatory effect. Because of the size of the industry and how entrenched the cholesterol theory had become, the focus continues to be on treating everyone with statin drugs rather than understanding the cause and the ability to control chronic inflammation.

The makers of statin drugs have been so skillful at influencing science and controlling public policy that prescribing statins is the standard of care. Anyone questioning or disagreeing with these policies is labeled as a heretic and disregarded.

THB: Why were you so convinced inflammation was the culprit? You were so convinced that you made a major life – and career – change based on that conviction.

Dr. Lundell: I knew that I did not have enough influence to change any of the policies or practices from inside mainstream medicine. Taking a lesson from the drug makers with their direct to consumer advertising I decided to write the book and hopefully people would learn and make the changes needed to truly prevent and cure heart disease.

THB: You describe inflammation very powerfully in your book as a battleground. Can you give our readers an overview of what inflammation is?

Dr. Lundell: Inflammation truly is a battleground. For most of human history we died because of infection and trauma. Our immune system and our inflammatory systems are designed to aggressively respond to these two challenges.

If we get invaded by bacteria or injured in some way, our immune system recognizes the challenge and marshals all of the body’s resources to respond to defeat the invader and heal the wound.

We all have experienced the classic signs of inflammation: warmth, swelling, redness, and pain. Acute inflammation is the response to acute injuries. Chronic inflammation is the response to chronic smaller injuries and so we do not always get the four classic signs.

THB: You’ve taken the bold step to speak out against statin medications. But playing devil’s advocate for a moment… surely there are some situations when statin medications are effective?

Dr. Lundell: Statin medications have proven to be somewhat beneficial to a small group of people; that is a middle aged man with a previous heart attack. They have never been documented to benefit any woman of any age with any condition. They have not been documented to help people who have not had a previous heart attack of any age or gender.

There may be some people who would take great offense at the previous paragraph – especially the makers of Crestor and cardiologists who support treating almost everyone with statin drugs.

They might quote the Jupiter study which was touted as proving Crestor would reduce heart attack rates by almost 50% in otherwise healthy people. Happily, this month in The Archives of Internal Medicine, four peer reviewed articles gave a scathing rebuke to the Jupiter study – the methodology, the conflict of interest by most of the authors, the early termination of the study which almost always provides false results, and the conclusion that statin drugs were beneficial in this population of patients. At last I am getting reinforcements!

THB: That’s a good point to make - and you make it well. So, if statin meds aren’t effective, why are they so dangerous?

Dr. Lundell: Statin drugs are dangerous not necessarily because of the side effects which can be disabling or fatal, but because they divert our attention from understanding and preventing heart disease and merely treat it with statins, allowing us to think that this is beneficial.

Even some of the foremost cardiologists in the country who have written extensively about inflammation as the true cause of heart disease offer no solutions except taking statin drugs. $30,000,000,000 in worldwide sales of statin drugs has a lot to do with it.

In part two of our revealing interview, Dr. Lundell tells us why inflammation is the true cause of heart disease and offers critical solutions to prevent it. We also discover the four most common lifestyle factors that injure heart health and get expert guidance on how to improve it. All this and more in next Wednesday’s edition of Undercover.

About Dr. Lundell: Dr. Dwight Lundell is the past Chief of Staff and Chief of Surgery at Banner Heart Hospital, Mesa, AZ. He is the founder of Healthy Humans Foundation and Chief Medical Advisor for Asantae. In 2003, Dr. Lundell made the most difficult decision of his 25 year surgical career. As traditional medicine continued to chase the cholesterol theory of heart disease, Dr. Lundell closed his surgical practice. He then devoted the rest of his life to speaking the truth that inflammation causes heart disease. By lowering inflammation, heart disease has a cure.

Dr. Lundell is the author of the world-wide bestselling book, The Great Cholesterol Lie. This book is a revealing look at heart disease and the faulty theories of low-fat diets and cholesterol. He also reveals his clinically-tested recommendations for lowering inflammation that can prevent and reverse heart disease.

To your health,

Ian Robinson,
Managing Editor, Total Health Breakthroughs

Are They Above Reproach?

USA Today reports the following
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"By Rita Rubin, USA TODAY
Virtually all doctors in a national survey of six specialties reported some sort of relationship — from free lunches to payments for consulting and lecturing — with medically related industries such as those for drugs or medical devices, a report says today.
Researchers mailed surveys and a $20 check to a random sample of 3,167 practicing anesthesiologists, cardiologists, family practitioners, general surgeons, internists and pediatricians in late 2003 and early 2004. Slightly more than half responded. Among the findings, reported in The New England Journal of Medicine:
•Cardiologists were more than twice as likely as family practitioners to receive payments from industry.
•On average, family practitioners reported meeting 16 times a month with industry reps — the most of any specialty surveyed."
http://www.usatoday.com/news/health/2007-04-25-docinfluence_N.htm?csp=34
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No real surprise there. This has been known for sometime. My question is "Can they make an unbiased and purely scientific or medical decision/recommendation under these circumstances?" Ask yourself that and ask your health professional that same question. See the full article in The New England Journal of Medicine at http://content.nejm.org/cgi/content/full/356/17/1742 "A National Survey of Physician–Industry Relationships".