Low Cholesterol Levels Associated With Increased Mortality - Again!

It's never bad to get a Second Opinion especially when it comes to cholesterol with the hype and mis-information surrounding the topic. Barry Grover helps with this article. Please read the complete article here.

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]


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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.