Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid?

J Eval Clin Pract. 2012 Feb;18(1):159-68. doi: 10.1111/j.1365-2753.2011.01767.x. Epub 2011 Sep 25.

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study.

Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TI, Getz L.

Source

Research Unit of General Practice, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. halfdanpe@gmail.com

Abstract

RATIONALE, AIMS AND OBJECTIVES:

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline.

METHODS:

We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total).

RESULTS:

Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) . Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern.

CONCLUSION:

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.
© 2011 Blackwell Publishing Ltd.

Comment in

• J Eval Clin Pract. 2012 Feb;18(1):169; author reply 170-1.

PMID:

21951982

[PubMed - in process]

PMCID:

PMC3303886

==========================================================

Read the article here.

Slicing The Salami (and calling it steak).

Not about heart disease, cholesterol or statins but excellent excoriation of the ?study? published in Archives of Internal Medicine. Thanks blackdog!
=============================================================

Slicing The Salami (and calling it steak).

I am taking a brief respite from the 'Loss of Innocence' saga, to excoriate about the publicity for the study about the intake of meats causing Cancer. Much was made of this in the print and broadcast media with precious little criticism or adverse comment from, well anyone. But in truth it was like most of these proselytising studies, that attempt to steer us from the path of our demise by feeding us the results from 'scientific' research that is not really scientific at all.

The study, published in the Archives of Internal Medicine is an observational study, which means it is not presenting any evidence, merely drawing conclusions from data provided by food frequency questionnaire's filled in by the cohort every four years! I can't even remember what I had for dinner last Tuesday, except to know it would have had meat in it, probably lots of it. These epidemiological type studies are really the starting point of a hypothesis to test it's credibility. They are not the end point, merely the beginning of a journey that should encompass all of the checks and balances that science should pursue to ensure that any statement made about anything should at least be founded in proven fact. So, is it likely that the cohort from whom the data was drawn, reported the facts of their diet without telling a few little lies? I really think not, but that's a side issue really.

Let us then look a little deeper. Firstly we see that all meat, processed or otherwise so long as it's red, is alarmingly 'lumped' together, although they

.

.

.

.

 So eating preserved meats does have a mechanism that could be causative of some cancers, because it does actually exist, but frankly you would have to eat really large amounts, on a regular basis. And, the bun surrounding the 'unprocessed' burger meat (sic) is likely to be more harmful. And what country is renowned for it's consumption of burgers and barbecued meats? Might that be the country of origin of the cohort of this study, the USA? Always remember, long suffering reader, that observation (and correlation) does not prove causation.
================================================================

Read the full article by BLACKDOG here.

 

And I learned a new word - excoriate: to denounce vehemently; censure severely.

Vitamin D deficiency was associated with several cardiovascular-related diseases, including hypertension, coronary artery disease, cardiomyopathy, and diabetes

From the American Journal of Cardiology on 3 Feb 2012.Vitamin D and CVD - AJC Feb 2012.pdf

Vitamin D Deficiency and Supplementation and Relation to Cardiovascular Health

It is very interesting in that, whilst it was an observational study, it looked not only at serum Vitamin D levels, but also at the relationship of D3 supplementation to CVD. It suggests a strong association between supplementation and reduced CVD, particularly among those who were deficient at the baseline.

See abstract and discussion below:

"Recent evidence supports an association between vitamin D deficiency and hypertension, peripheral vascular disease, diabetes mellitus, metabolic syndrome, coronary artery disease, and heart failure. The effect of vitamin D supplementation, however, has not been well studied. We examined the associations between vitamin D deficiency, vitamin D supplementation, and patient outcomes in a large cohort. Serum vitamin D measurements for 5 years and 8 months from a large academic institution were matched to patient demographic, physiologic, and disease variables. The vitamin D levels were analyzed as a continuous variable and as normal (≥30 ng/ml) or deficient (<30 ng/ml). Descriptive statistics, univariate analysis, multivariate analysis, survival analysis, and Cox proportional hazard modeling were performed. Of 10,899 patients, the mean age was 58 ± 15 years, 71% were women (n = 7,758), and the average body mass index was 30 ± 8 kg/m². The mean serum vitamin D level was 24.1 ± 13.6 ng/ml. Of the 10,899 patients, 3,294 (29.7%) were in the normal vitamin D range and 7,665 (70.3%) were deficient. Vitamin D deficiency was associated with several cardiovascular-related diseases, including hypertension, coronary artery disease, cardiomyopathy, and diabetes (all p <0.05). Vitamin D deficiency was a strong independent predictor of all-cause death (odds ratios 2.64, 95% confidence interval 1.901 to 3.662, p <0.0001) after adjusting for multiple clinical variables. Vitamin D supplementation conferred substantial survival benefit (odds ratio for death 0.39, 95% confidence interval 0.277 to 0.534, p <0.0001). In conclusion, vitamin D deficiency was associated with a significant risk of cardiovascular disease and reduced survival. Vitamin D supplementation was significantly associated with better survival, specifically in patients with documented deficiency."

Discussion

Vitamin D has important physiologic functions beyond bone and calcium metabolism. Because vitamin D receptors are involved in the expression of nearly 3,000 human genes, a deficiency could potentially affect numerous disease processes.  Cardiovascular, oncologic, and immunologic disorders have been associated with vitamin D deficiency. Our study showed an association between vitamin D deficiency and many cardiovascular disease states, including hypertension, coronary artery disease, cardiomyopathy, and cardiovascular risk factors, such as hypertension, diabetes mellitus, and hyperlipidemia.

Numerous studies and meta-analyses have suggested that vitamin D deficiency has a negative association with survival; however, the effect of vitamin D supplementation on overall mortality has not been studied. Our findings are consistent with these previous studies, suggesting poorer patient outcomes for patients with vitamin D deficiency. In addition, our data further extend these findings by demonstrating better survival with vitamin D supplementation. The benefits of vitamin D supplementation on survival were significant for those patients with a documented deficiency. This benefit was independent of the concomitant use of other cardioprotective drugs such as aspirin or statins.

These findings could have clinical implications for the usual recommended daily allowance for vitamin D. The regular intake of the recommended 400 IU/day might be adequate to avoid deficiency in many people, and supplementation of _1,000 IU/day might be required to achieve optimal levels.

When included in survival and hazard models with several disease states, vitamin D deficiency is a strong independent predictor of all-cause death. Several studies have reported on the association between obesity and low vitamin D levels, which we also observed in our study cohort. Because the prevalence of obesity is increasing in the United States, as well as in many other developed and emerging nations, vitamin D deficiency could be increasingly common in the future. In addition, our study showed an association between vitamin D deficiency and unfavorable serum lipid values.

Because vitamin D deficiency is widespread, strategies directed at population-based supplementation programs could prove beneficial. To date, however, prospective studies evaluating vitamin D supplementation are few and have not consistently shown benefit. It is possible that the lack of benefit in these studies resulted from suboptimal levels of vitamin D supplementation or other unknown factors. Many previous studies of vitamin D supplementation have used doses of 400 to 800 IU, which might not be adequate to ensure optimal serum levels, with more appropriate daily supplement doses suggested as 1,000 to 2,000 IU. Nevertheless, the growing body of observational data demonstrating relatively high rates of low vitamin D serum levels warrant additional welldesigned studies to investigate the relation between vitamin D and cardiovascular health.

Additional investigation with long-term prospective studies of various vitamin D dosage levels in both healthy and diseased populations are indicated to firmly establish the role of vitamin D supplementation on overall outcomes and mortality. Our study suggests a significant association of vitamin D supplement use and improved survival in deficient subjects, supporting the potential benefit of this intervention. Recent guidelines for the evaluation and treatment of vitamin D deficiency have been published that can help the clinician with patient treatment.

 This was a retrospective, observational study with a selected population, introducing possible selection bias. The study population was derived from patients who had had their vitamin D levels measured at a hospital laboratory and who were patients in a cardiovascular practice and included in its electronic medical records. Extrapolation to other populations might not be appropriate. Also, isolated vitamin D measurement might not reflect long-term levels. We made an arbitrary decision to use the lowest vitamin D measurement for analysis because this value was thought to most likely represent the subjects’ baseline nonsupplemented level. We were unable to accurately associate the timing of vitamin D measurement and supplement initiation. The dose and duration of vitamin D supplementation were not analyzed, and patient compliance was not measured. Inclusion of vitamin D in multivitamin supplements was not considered.

=================================================================

See Am J Cardiol 2012;109:359–363

Professional athletes...rarely tolerate statin treatment because of muscular problems

Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems

Abstract

 

Aims

Muscular problems are the major group of side-effects during statin treatment. They are known to occur much more frequently during and after exercise.

 

Methods and results

For the last 8 years we have monitored 22 professional athletes in whom, because of familial hypercholesterolaemia, treatment with different statins was attempted. Only six out of the 22 finally tolerated at least one member of this family of drugs. In three of these six the first statin prescribed allowed training performance without any limitation. Changing the drug demonstrated that only two tolerated all the four or five statins examined (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin). Cerivastatin was not among the statins prescribed.

 

Conclusions

These findings indicate that in top sports performers only about 20% tolerate statin treatment without side-effects. Clinical decision making as to lipid lowering therapy thus becomes a critical issue in this small subgroup of patients.

===================================================================

 Read the full article here.

Doctors Say Vitamins are Safe and Effective

Doctors Say Vitamins are Safe and Effective

(OMNS, March 13, 2012) The news media proclaim that taking vitamin supplements is of no value and, somehow, actually dangerous. You have heard an earful from reporters. Now let's hear from doctors.

Michael Janson, M.D.:

The standard American diet does not provide even the RDA. Two-thirds of all meals are eaten outside the home, and nearly half of them are in fast food joints. You can't expect this to provide all the necessary nutrients, and many studies show that it does not. A large number of people admitted to hospitals are found to have deficiencies, and the problems worsen in the hospital. Those given supplements have a lower rate of complications, faster discharge from the hospital and fewer deaths. Vitamin companies do not send doctors on expense paid vacations or "seminars," as do the drug companies for prescribing their drugs, and vitamins are safe and cheap. But surely this does not influence pharmaceutical-advertising-paid-for media!

Vitamin E in high doses (800 IU) enhances immunity in healthy elderly subjects. Vitamin C in doses (2,000 mg) far above the RDA (90 mg) significantly reduces allergic rhinitis and asthma and speeds the recovery from airway constriction induced by histamine. Vitamin B1 (thiamine) was used successfully to treat trigeminal neuralgia, as described in an article published in the Journal of the American Medical Association way back in 1940.

Many people are losing their faith in the medical profession because many doctors are unwilling to accept what is becoming common knowledge: nutrition and nutrient therapies are safer, cheaper and more effective than most other medical treatment. It is clear that most media reporters do not know the current nutrition literature, they do not know the old literature, and they do not know the middle-aged literature. If they do not know the literature, they should not be writing articles.

Martin Gallagher, M.D., D.C.:

I have been a practicing physician for 37 years. During that time, I have directly treated and supervised over 12,000 patient encounters per year. With each patient, I have prescribed a variety of vitamins, minerals, homeopathic medicines, and herbs. I have to date not encountered a single complication, anaphylactic reaction or death. The doses have been well above the RDA's for vitamins and minerals. In fact, the IV treatments include doses of ascorbate (vitamin C) that vary from 10,000 to over 100,000 mg per treatment session.

At a time when the leading cause of death in the US is correctly prescribed medication, we need to embrace, not chastise, nutritional supplements.

Robert G. Smith, Ph.D.:

Most people in modern societies have vitamin and mineral deficiencies because these nutrients are removed by industrial food processing. Vitamin and mineral supplements are effective in preventing deficiencies that cause major illness such as heart disease, cancer, diabetes, arthritis, osteoporosis, dementia, and many others. Supplements of vitamins and minerals, when taken in proper doses large enough to work (For example: vitamin C for an adult at 3,000 - 6,000 mg/day, and much more when stressed or sick), are safe and effective -- and far less expensive than taking prescribed drugs overblown by the medical profession and media.

Michael J. Gonzalez, Ph.D.:

Research in Europe has shown that long-term users of antioxidant vitamin supplements have a 48% reduced risk of cancer mortality and 42% lower all-cause mortality. [1] The media did not bother to mention it. There is in fact overwhelming clinical evidence to justify the use of nutritional supplements for the prevention of disease and the support of optimal health. The Lewin Group estimated a $24 billion savings over 5 years if a few basic nutritional supplements were used in the elderly. [2] On the other hand, prescription medication kills over 100,000 people a year. [3]

Thomas Levy, M.D.:

There are more politics in modern medicine than in modern politics itself. Today's average physician deserves even less trust than today's average politician, as doctors continue their refusal to allow the scientific data on the profound benefits of vitamins and other antioxidant supplements to reach their eyes and brains. And the staunch support of a press, which collectively no longer has a shred of journalistic or scientific integrity, completes the framing of today's colossal medical fraud. Money always rules the day: properly-dosed vitamins would eliminate far too much of the profit of prescription-based medicine.

William B. Grant, Ph.D.:

Modern lifestyles including wearing clothes and sunscreen and working and living largely indoors have led to widespread vitamin D deficiencies. Numerous ecological and observational studies have found correlations between higher solar UVB doses and vitamin D concentrations and reduced risk of many types of cancer, cardiovascular disease, diabetes mellitus, bacterial and viral infectious diseases, autoimmune diseases, falls and fractures, cognitive impairment, and many more types of disease. To compensate for lack of sun exposure, 1,000-5,000 IU per day of vitamin D3 should be taken to raise serum 25-hydroxyvitamin D concentrations to at least 30-40 ng/ml (75-100 nmol/L). These amounts are safe for all but those with granulomatous diseases, who can develop hypercalcemia. 1,000 to 5,000 IU/day of vitamin D is effective in reducing risk of many types of diseases, as shown in a number of randomized controlled trials, such as cancer, falls and fractures, type A influenza, and pneumonia.

W. Todd Penberthy, Ph.D.:

Niacin in particular has been shown to provide exceptional benefit in treating cardiovascular disease in clinical trial after clinical trial [4]. By comparison, the popular diabetes drug Avandia was recently found to cause a 43% increase in heart attacks in diabetics. [5] This came out only after Avandia had already become the most popular diabetes drug in the world! Never underestimate the power of market-driven forces to sell drugs, and books, such as The End of Illness by Dr. Agus, instead of proper information regarding what actually works best.

People are amazed how quickly simply taking supplemental niacin corrects high cholesterol, high triglycerides, low HDL (the good cholesterol) and VLDL. All of these parameters are pushed in the healthier direction because niacin ultimately functions inside the body in over 450 reactions. There is a reason niacin continues as a preferred therapy for doctors in the know, using niacin therapy for over 50 years now. Niacin works better than any drug to correct dyslipidemia.

One thing to always remember is this. You can "prove" that any drug or vitamin does not work if you are not using high enough doses to achieve the correct concentration of the molecule. Furthermore, all biochemical pathways rely on more than one molecule to function properly, so generally one drug/vitamin is not enough for optimal health. Our bodies rely on vitamins, not drugs, to routinely stave off illness by means we often take for granted. Sometimes we need much more of these essential molecules. This is common sense, and it is known as orthomolecular medicine.

James A. Jackson, Ph.D.:

For over twenty years, I was the laboratory director of a federally approved clinical reference laboratory. We accepted samples from all the United States and foreign countries. We measured all the fat soluble and water soluble vitamins in blood and urine. It was common to find vitamin deficiencies in both males and females, whether children or adults. The most common vitamin deficiencies were vitamin C and vitamin D3. The clinic's physicians treated the patients with the appropriate vitamins and were monitored by our laboratory. Many were helped by the vitamin replacement treatment, including those with complaints such as headache, joint and muscle pain, chronic fatigue syndrome, and ADHD. We published many of these cases in the Journal of Orthomolecular Medicine. (http://orthomolecular.org/library/jom/index.shtml)

Ian Brighthope, M.D.:

Over 70% of Australians consume vitamins on a regular basis. A search of the department of health's database reveals no serious adverse reactions or deaths have occurred in the Australian population over the past ten years from the use of complementary medicines. There is an extreme bias against very low to extremely low risk products by government regulators and health professionals working within and outside the establishment institutions.

Robert Jenkins, D.C., M.S.:

I have been in practice for 52 years and have treated thousands of patients with diet and nutritional supplements for numerous health conditions ranging from hypertension, diabetes, hypercholesterolemia, metabolic syndrome, irritable bowel syndrome, and many others. I have yet to experience adverse patient reactions from taking nutritional supplements. I have lectured second year medical students at two medical schools in the Philadelphia, PA area. When I asked those students how much nutritional training they had received, they all held up their hands with the sign of zero. The pharmaceutical industry makes sure medical students are trained in how to prescribe their drugs, while no positive mention is made of nutritional supplements. Why would anyone think that our modern medical doctors are to be considered authorities on nutritional supplementation for health conditions when they are not trained to do so? When this lack of nutritional education is combined with the news media's ignorance of supplements and their benefits, we have "the blind leading the blind."

Gert Schuitemaker, Ph.D.:

In the Netherlands, a report of the Dutch Health Council states that less than 2% of the population is eating according to official dietary guidelines. [6] Moreover, the authorities state that, even if a person is eating according to the dietary guidelines, he is not getting enough vitamin A, D, folic acid, iron, selenium and zinc. [7] Research in a Dutch hospital showed that 40% of patients at the time of admission were malnourished.[8] So, dietary supplements are necessary. Usually, chronic diseases, developing with increasing age, are treated with medicines, inevitably accompanied with the risk of severe side effects and unnecessary deaths. While the basis of many chronic diseases is a metabolic disturbance and nutritional deficiencies, the best treatment approach is good nutrition, including the use of dietary supplements. The "danger" of vitamins and minerals lies in chronic deficiencies,not in alleged toxic effects. Following the scientific literature on a daily basis, in 30 years, I have not seen any harmful effect from supplements.

Damien Downing, M.D.:

The more toxins you are exposed to, the more nutrients you will use up in dealing with them. Every year, we are exposed to more and more toxins, and our DNA has had no time to adapt. Heavy metals such as lead, mercury, fluorine; pesticides including the newer ones like glyphosate ("Roundup"); flame retardants that are even contaminating the Arctic; and hundreds of thousands of other new-to-nature molecules that every human has to deal with. And like it or not, pharmaceutical medications are mostly toxins too.

At the same time, intensive farming, soil depletion and poor diets (often foisted on us for spurious reasons such as fear of cholesterol) mean that it's normal to be deficient now. We are deficient in vitamins, minerals, and other nutrients as well.

What chance does a human have? A much better one if she doesn't buy the hype from big companies, the dogma from pharma-paid scientists, and the bullying from governments. Take your vitamins.

Steve Hickey, Ph.D.:

Over the past three centuries, the frequency of deficiency and infectious diseases has been reduced, through improved nutrition and better hygiene. Throughout this time, however, the role of nutrition has been belittled by the authorities. These same authorities now reject the idea that nutritional supplements can prevent our current chronic diseases. Thus, as a result of such authoritarian medicine, we may have replaced the horrors of pellagra, scurvy, and rickets with those of dementia, heart disease, and cancer. If so, it is likely that people in the future will look back with similar dismay on the current and needless destruction of health. How will we answer them, when they ask how could we have allowed this to happen?

Dean Elledge, D.D.S., M.S.:

The high-carbohydrate, nutrient-poor diet is a primary contributing factor in dental diseases. [9] Vitamin D and vitamin C are safe to use in dentistry to help the patient recover from dental diseases. Vitamins in general help reduce inflammation, and antioxidant vitamins reduce the inflammation in periodontal disease. Vitamin supplements improve antioxidant reserves.

Michael Ellis, M.D.:

I see so many patients in conventional general practice who are deficient in vitamins. I had one patient who had ended up in a hospital neurosurgical unit only to be found to have severe B12 deficiency. The foods that most people eat are high in sugar, processed, and denatured of essential nutrients. All patients need, at the very least, daily multivitamins.

Ralph Campbell, M.D.:

We have had lots of talk of the alleged "toxicity" of vitamins over the decades I have been in pediatric practice. I remain leery of the validity of such accusations. Most are just uninformed regurgitation of poorly designed studies. If alert, a clinician can easily detect vitamin deficiencies, and with experience, quickly spot suboptimal vitamin levels. The medical establishment seems to be increasingly aware of vitamin D, B12 and folic acid deficiency. What is taking the media so long?

Karin Munsterhjelm-Ahumada, M.D.:

I have been a physician for 35 years. For the last 20 years, I have worked with combining general medicine with nutritional (orthomolecular) medicine, the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body, principally vitamins and minerals. I have had good opportunity to compare the results of my work as a GP from the time before I got knowledge of vitamins and minerals as therapeutic substances with the time after I had learned to integrate them in my work with patients. I can today certify that I have seen a great number of very positive results after beginning to integrate vitamins in my clinical work. The results have been particularly fine in neurologic and psychiatric conditions, including schizophrenia, and in hormonal and infectious diseases. During these last 20 years I have not seen severe side effects of orthomolecular substances. On the contrary, I have often been able to decrease the dosage of strong pharmaceutical drugs that carry severe side effects. This has led to a completely new and better quality of life for my patients, and for myself as a doctor.

Conclusion:

The old saying remains true: the person who says it can't be done should not interrupt the person successfully doing it. Progressive doctors prescribe vitamins because they work. If your doctor doesn't "believe" in vitamins, maybe it is time for him or her to change such an antiquated belief system in favor of the true clinical evidence.

For further reading:

How to Learn More about Nutritional Medicine: Information Archive and Locating a Practitioner http://orthomolecular.org/resources/omns/v06n09.shtml

How Doctors Use (Or Should Use) Vitamin Therapy http://orthomolecular.org/resources/omns/v06n25.shtml

A Guide to Free, Peer-Reviewed Nutritional Medicine Information Online http://orthomolecular.org/resources/omns/v07n08.shtml

Intravenous Vitamin C as Cancer Therapy: Free Access to Twenty-One Expert Video Lectures Online http://orthomolecular.org/resources/omns/v07n03.shtml

Additional Resources on Nutritional Therapeutics http://orthomolecular.org/resources/omns/v06n27.shtml

References:

1. Li K, Kaaks R, Linseisen J, Rohrmann S. Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg). Eur J Nutr. 2011 Jul 22.

2. Suh DC , Woodall BS, Shin SK , Hermes-De Santis ER. Clinical and economic impact of adverse drug reactions in hospitalized patients. Ann Pharmacother . 2000;34(12):1373-9.

3. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA . 1998 15;279(15):1200-5.

4. Carlson LA: Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review. J Intern Med, 2005; 258: 94-114.

5. Nissen SE, and Wolski K: Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med, 2007; 356: 2457-2471.

6. Significant trends in food consumption in the Netherlands. The Hague: Health Council of the Netherlands, 2002; publication no. 2002/12.

7. Voedingscentrum. Richtlijnen goede voedselkeuze. [The Netherlands Nutrition Centre. Guidelines Good Nutritional Choice] 2011.

8. Naber TH, Schermer T, de Bree A et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr. 1997 Nov; 66(5):1232-9.

9. Elledge DA. Effective hemostasis and tissue management. Dentistry Today, Oct 2010, p150.

=====================================================================================

Read the full article here.

Genetic studies lay the foundations for anti-inflammatory drugs to prevent heart disease

Interleukin-6 receptor pathways in coronary heart disease: a collaborative meta-analysis of 82 studies

Original Text

IL6R Genetics Consortium Emerging Risk Factors Collaboration

Summary

Background

Persistent inflammation has been proposed to contribute to various stages in the pathogenesis of cardiovascular disease. Interleukin-6 receptor (IL6R) signalling propagates downstream inflammation cascades. To assess whether this pathway is causally relevant to coronary heart disease, we studied a functional genetic variant known to affect IL6R signalling.

Methods

In a collaborative meta-analysis, we studied Asp358Ala (rs2228145) in IL6R in relation to a panel of conventional risk factors and inflammation biomarkers in 125 222 participants. We also compared the frequency of Asp358Ala in 51 441 patients with coronary heart disease and in 136 226 controls. To gain insight into possible mechanisms, we assessed Asp358Ala in relation to localised gene expression and to postlipopolysaccharide stimulation of interleukin 6.

Findings

The minor allele frequency of Asp358Ala was 39%. Asp358Ala was not associated with lipid concentrations, blood pressure, adiposity, dysglycaemia, or smoking (p value for association per minor allele ≥0·04 for each). By contrast, for every copy of 358Ala inherited, mean concentration of IL6R increased by 34·3% (95% CI 30·4—38·2) and of interleukin 6 by 14·6% (10·7—18·4), and mean concentration of C-reactive protein was reduced by 7·5% (5·9—9·1) and of fibrinogen by 1·0% (0·7—1·3). For every copy of 358Ala inherited, risk of coronary heart disease was reduced by 3·4% (1·8—5·0). Asp358Ala was not related to IL6R mRNA levels or interleukin-6 production in monocytes.

Interpretation

Large-scale human genetic and biomarker data are consistent with a causal association between IL6R-related pathways and coronary heart disease.

Funding

British Heart Foundation; UK Medical Research Council; UK National Institute of Health Research, Cambridge Biomedical Research Centre; BUPA Foundation.

==================================================================

View the article here.
See also this article in theheart.org.

Putting The Myth To Rest: There Is No Such Thing As Bad Cholesterol

Putting The Myth To Rest: There Is No Such Thing As Bad Cholesterol

by PreventDisease.com

Perhaps one of the biggest health myths propagated in western culture and certainly in the United States, is the correlation between elevated cholesterol and cardiovascular disease (CVD). Unfortunately, despite dozens of studies, cholesterol has not been shown to actually cause CVD. To the contrary, cholesterol is vital to our survival, and trying to artificially lower it can have detrimental effects, particularly as we age.

Cholesterol seems to be one of those things that strikes fear into the hearts of many, so to speak. We have become obsessed with eating foods low in cholesterol and fat. Ask almost anyone, and they can tell you their cholesterol levels.

What is certain is that the ‘little knowledge’ that the media often imparts means many folks assume cholesterol is simply a ‘bad’ thing. Alternately, a good number of us may have heard the terms ‘good’ cholesterol and ‘bad’ cholesterol bandied about without knowing much about what this really means. In fact it is a fairly safe bet that if you asked anyone on the street for his or her instinctive response, if asked about cholesterol, they would probably say that we simply need to ‘reduce it’.

The ‘noddy-science’ offered by marketing men to a generally scientifically-naive public has led many people to believe that we should replace certain food choices with specially developed products that can help ‘reduce cholesterol’. Naturally this comes at a price and requires those who can afford it to pay maybe four or five times what a ‘typical ordinary’ product might cost. But is this apparent ‘blanket need’ to strive towards lowering our cholesterol justified? And, indeed, is it healthy?

For anyone who has had the official diagnosis of ‘high cholesterol’ in their bloodstream, they may even have embarked upon a program of medicinal intervention. In fact it is quite likely that they may have joined the legions of long-term pill-poppers who are already lining the pockets of the profit-oriented pharmaceutical giants.

But let’s take a moment, now, to review some of the facts and fallacies about the much-maligned substance: cholesterol.

Cholesterol is needed to make hormones. Without it we would not produce estrogen, progesterone or testosterone. It is vital for the functioning of nerve synapses and provides the structural integrity for our cell membranes. Cholesterol is used by the skin to help prevent water evaporation and to make our skin waterproof. Vitamin D is synthesized from cholesterol. And bile, used for fat digestion, consists mostly of cholesterol. The liver produces about 90 percent of the cholesterol in our bodies; only 10 percent comes from diet. If we eat too much cholesterol, the liver decreases the output of cholesterol.

Cholesterol is a naturally occurring lipid. This means it is a type of fat or oil and it is in fact an essential component in creating and sustaining the membranes of the cells of all bodily tissues. So this alone means we need cholesterol to survive! Most of the cholesterol that is found in our bodies is actually naturally manufactured within our own cells. However there is also an additional contribution that we get from external ‘nutritional’ sources – the foods we consume. In a typical diet providing around 400mg of cholesterol per day from food sources, about half to two-thirds of this amount is actually absorbed through the process of digestion. The body will normally secrete about a gram (1000mg) of cholesterol per day into the bile via the ducts, and approximately three-fifths of this is then re-absorbed.

Where our tissues or organs are a particularly dense complex of cells, which have closely packed cell membranes, there will naturally be higher levels of cholesterol. The key organs that need, and contain, these higher amounts of cholesterol include the liver, the brain and the spinal cord – none of which would work well if we reduced cholesterol too much!

In effect cholesterol plays an essential role in the development and maintenance of healthy cell walls. It is also a critical factor in the synthesizing of steroid hormones, which are a key factor in our natural physical development.

Being a lipid, cholesterol is fat-soluble, but it is not soluble in blood. However it needs to be transported around the body to the places where it can be utilized. This is why, in order to be moved around, it must become ‘associated’ with certain lipoproteins which feature a water-soluble (therefore ‘blood transportable’) coat of proteins. There are two key types of lipoproteins that transport cholesterol around the body: low-density and high-density variants. The essential cellular function of cholesterol requires that sufficient amounts are manufactured by specialized sub-systems (or organelles) within the body’s cells called the endoplasmic reticulum. Alternatively, the cholesterol we need must be derived from our diet. During the process of ‘digestion and assimilation’ of foods, it is the low-density lipoprotein (LDL) that carries dietary cholesterol from the liver to various parts of the body.

When there is sufficient cholesterol for cellular needs, the other key transport mechanism in this amazing ‘logistics system’ – high-density lipoprotein (HDL) – can take cholesterol back to the liver from where any unnecessary excess can be processed for excretion.

The ‘noddy-science’ of the so-called ‘functional food’ manufacturers would have us believe that there is such a thing as ‘bad’ cholesterol and ‘good’ cholesterol. This is, in fact, totally untrue. The cholesterol itself, whether being transported by LDL or HDL, is exactly the same. Cholesterol is simply a necessary ingredient that is required to be regularly delivered around the body for the efficient healthy development, maintenance and functioning of our cells. The difference is in the ‘transporters’ (the lipoproteins HDL and LDL) and both types are essential for the human body’s delivery logistics to work effectively.

Problems can occur, however, when the LDL particles are both small and their carrying capacity outweighs the transportation potential of available HDL. This can lead to more cholesterol being ‘delivered’ around the body with lower resources for returning excess capacity to the liver.

LDL can vary in its structure and occur in particles of varying size. It is the smaller LDL particle sizes that can easily become ‘trapped’ in the arteries by proteoglycans, which is, itself, a kind of ‘filler’ found between the cells in all animal and human bodies. This can then cause the cholesterol the LDL carries to contribute to the formation of fatty deposits called ‘plaques’ (a process known as atherogenesis). As these deposits build up, they restrict the arteries’ width and flexibility. This causes an increase in blood pressure and can also lead to other cardiovascular problems such as heart attacks or strokes.

The LDL itself is consequently sometimes referred to as ‘bad cholesterol’, but you can now appreciate the fact that this is simply incorrect. In fact LDL, HDL and cholesterol are all essential to our health. However, it seems that it has become common for humans to have a preponderance of ‘unhealthily’ small LDL particles, which can become a precursor to heart and arterial disease due to the mechanisms described. It is apparently healthier to have a smaller number of larger LDL particles carrying the same quantity of cholesterol than a large number of small LDL particles might transport, but for some reason this is less common. This is an interesting area that demands more research.

When LDL becomes retained by the glycol-proteins in the arteries it is subject to being oxidized by ‘free radicals’. This is when the process can become health threatening. It has therefore been suggested that increasing the amount of antioxidants in our diet might effectively ‘mop up’ free radicals, and consequently reduce this harmful oxidation. Although the idea of consuming foods rich in antioxidants, or even using supplements, is now widely promoted, the scientific evidence for their efficacy still remains to be fully established.

Another point to consider is the occurrence of substances called ‘very-low-density-lipids’ or VLDL, also known as triglycerides. VLDL is converted to LDL in the bloodstream and therefore contributes towards increased levels of LDL and to subsequent potential cholesterol-related health problems. This is why triglycerides are usually measured when a cholesterol test of your blood is undertaken.

The production of VLDL in the liver – which amounts to a combination of cholesterol and low-density apolipoprotein – is exacerbated by the intake of fructose. Fructose is the type of sugar found in many fruits, it is also a component of sucrose and of the widely used food ingredient high-fructose corn syrup. This implies that anyone whose LDL or triglyceride levels are unduly high should cut back on those sweet sugary snacks, and even on the sweeter, fructose laden fruits; not simply reduce their intake of fatty foods!

Vitamin B3, otherwise known as niacin, on the other hand, actually lowers the amount of VLDL, and therefore also LDL. In addition, niacin helps to stimulate the production of helpful HDL, the lipoprotein that carries excess cholesterol back to the liver for excretion. However, in keeping with the best traditions of consuming ‘all things in moderation’, currently recommended upper limits for daily intake of niacin is 35mg, given that it can have toxic effects in larger amounts. Even so, medical professionals have been known to prescribe niacin in doses as high as 2g, up to three times a day, for treatment of those with dangerously high blood cholesterol levels. Naturally you should never self-medicate with high doses of niacin without taking appropriate medical advice.

Niacin in the diet is typically derived from high protein foods including liver and other meats, as well as significant amounts being found in certain nuts and whole grains.

However one of the fashionable types of pharmaceutical drugs of recent times, introduced to treat the apparently increasing incidence of high cholesterol levels particularly in the West, are Statins. Most likely you have a friend or relative taking these useless drugs (Lipitor, Mevecor, Crestor, etc.) to lower cholesterol. Statin medications are the number-one-selling drugs in the world. They work by interfering with the liver function and reducing the production of LDL. But Statins are a questionable innovation on at least a couple of accounts. Firstly they are not without side-effects: they can, for example, lead to the breakdown of major muscular material, which can ultimately overwhelm the kidneys and even cause acute renal failure.

Statins also appear to reduce the body’s natural levels of the vitamin-like, cellular protection agent known as Co-enzyme Q10. This benzoquinone plays an important role in cellular energy release, particularly in hard worked areas like the lungs, liver and heart. CoQ10 (as it is sometimes called) has also been shown to protect the brain against neurological degeneration. But perhaps most interestingly, with respect to cholesterol, CoQ10 also acts as an antioxidant, particularly active in protecting the system against LDL oxidation and the potential problems associated with this as described above. So whilst Statins might provide a reduction in LDL per se, they might also be causing more problems in the long-term. Naturally, as with many modern drugs, they generally have to be taken for the long-term by anyone who has been prescribed them.

What is particularly disturbing about Statins is, perhaps, the fact that they may be seen as a ‘quick fix’ for unhealthily high LDL, and consequently cholesterol levels throughout the body. They need to be taken over a long period – which makes them very profitable for drugs manufacturers. But they may also be prescribed without the over-arching message that in order to address any cholesterol problem ‘naturally’, the sufferer must change their lifestyle and diet. Statins can seem an easy option but may indeed merely be the beginning of a process where the ‘negative health pay-off’ is simply delayed rather than actively defused! That is not to say that in extreme cases of high blood cholesterol, or hypercholesterolemia, there may not be a useful role for Statin therapy when natural strategies fail or do not prove effective, or feasible.

In truth, and in summary, cholesterol is an important and essential substance that we need for health at a cellular level. It is most likely that any imbalance in our cholesterol transport system comes down to long-term poor dietary and exercise habits. Ensuring that we consume some extra anti-oxidant foods, along with including niacin rich foods, might well be of benefit. But it is perhaps most important to recognize that deliberate and continued levels of activity and the consumption of a healthful diet is a better solution than questionable quick-fix drugs, if we ever are diagnosed with levels of cholesterol and triglycerides that might give cause for concern.

====================================================================

Read the complete article here.

Dairy: food of the Gods or neolithic agent of disease?

February 8, 2011 in Food & Nutrition by Chris Kresser

One of the most contentious issues in the Paleo nutrition community is whether dairy products are health-promoting or disease-causing.

On one end of the spectrum you have Loren Cordain and his group, who claim that dairy is not fit for human consumption for two reasons: 1) because it’s a neolithic food and not part of our evolutionary heritage, and 2) because of proposed physiological mechanisms by which dairy causes harm when consumed. On the other end of the spectrum you’ve got folks like Kurt Harris, Stephan Guyenet, Chris Masterjohn and the Weston A. Price Foundation who have pointed out the many health benefits of dairy and are generally in favor of its consumption.

My answer to the question of whether dairy is healthy are harmful is, in short: it depends. But before we get into the factors I think the answer depends on, I want to briefly address why I don’t take the evidence against dairy very seriously at this point.

Paleo re-enactment isn’t the goal

I agree with Dr. Kurt Harris on this one. We can look to the Paleo era to determine what was evolutionarily normal for humans, but it doesn’t follow that anything that falls outside of that norm is automatically harmful. The argument that we shouldn’t eat dairy now because we didn’t eat it 2 million years ago – without supporting clinical evidence – is not convincing.

There’s also the inconvenient (for the anti-dairy set) matter of people like the Masai and Loetschental Swiss that Weston A. Price studied, who were free of modern, degenerative disease despite receiving a large percentage of calories from dairy products.

Human evidence is more convincing than proposed mechanisms

Cordain’s group has published and reviewed several papers proposing various physiological mechanisms by which dairy causes harm. One recent example is a paper by Melnik called Milk Signalling in the Pathogenesis of Type 2 Diabetes. The theory presented is that milk consumption beyond the weaning period may overstimulate pancreatic beta-cells and promote beta-cell apoptosis. Since proliferation and apoptosis of beta-cells are hallmarks of type 2 diabetes (T2DM), it follows that milk consumption must contribute to T2DM.

Or does it?

If that theory were true, we might expect to see increased rates of T2DM in people consuming dairy products. But in fact we see just the opposite.

This study looked at serum levels of trans-palmitoleic acid, a fatty acid found in milk, cheese, yogurt and butter, and correlated them with risk factors for diabetes. Here’s what they found:

At baseline, higher circulating levels of trans-palmitoleic acid were associated with healthier levels of blood cholesterol, inflammatory markers, insulin levels, and insulin sensitivity, after adjustment for other risk factors. During follow-up, individuals with higher circulating levels of trans-palmitoleic acid had a much lower risk of developing diabetes, with about a 60% lower risk among participants in the highest quintile (fifth) of trans-palmitoleic acid levels, compared to individuals in the lowest quintile.

Translation: people with the highest trans-palmitoleate levels had 1/3 the risk of developing diabetes over the three years volunteers were followed. Not only that, after adjusting for confounding factors trans-palmitoleate levels were associated with smaller waist circumfrence, lower triglycerides, higher HDL and lower C-reactive protein.

Since trans-palmitoleic acid is a fatty acid found in the – you guessed it – fat of milk, the study also supports the idea that full-fat, whole dairy products are beneficial. This directly contradicts the low-fat hysteria we’ve been brainwashed with for so many years. But I digress.

Stephan Guyenet blogged about this study and re-wrote the authors’ conclusion in more straightforward terms:

Our findings support eating as much butter as possible****. Don’t waste your money on low-fat cream, either (half-n-half). We’re sorry that public health authorities have spent 30 years telling you to eat low-fat dairy when most studies are actually more consistent with the idea that dairy fat reduces the risk obesity and chronic disease.

Since this was an observational study, it doesn’t prove that dairy fat reduces the risk of T2DM. But it does suggest that the converse isn’t true.

Another study found that people with the highest levels of milk fat biomarkers, suggesting they consumed the most dairy fat, were actually at lower risk of heart attack; for women, the risk was reduced by 26 percent, while for men risk was 9 percent lower.

Another study showed that people who ate the most full-fat dairy had a 69% lower risk of cardiovascular death than those who ate the least.

Finally, this literature review of 10 studies found that milk drinking is associated with a small but significant reduction in heart disease and stroke risk.

I could go on, but I think you get the point. Which is this: evidence of what happens when people actually consume dairy products is a lot more convincing to me than proposed mechanisms of how dairy may effect humans.

The problem with isolating certain effects of a nutrient or food, and then making predictions based on those effects, is that we might miss some other quality about that food that negates the proposed effect. That’s a mouthful, so let me explain.

T. Colin Campbell is (in)famous for his research linking casein, a protein in dairy products, with cancer. He then made the huge and unsupportable leap to concluding that all animal proteins cause cancer and should be avoided. Most of you know the rest of that story.

However, what Campbell neglected to notice, or mention, is that whey, another protein found in dairy, has anti-cancer effects that completely cancel out the cancer-promoting effects of casein. Oops! This is why it’s so important to study whole foods, not just nutrients.

So let me finish this section by saying that I believe the weight of the evidence on dairy consumption suggests that it is not only not harmful, but quite beneficial.

When dairy may not be beneficial

However, as in most things, there are exceptions. Many of you reading this are probably sensitive to dairy and don’t tolerate it well. I certainly have patients that this is true for, and it’s not at all uncommon.

What’s the deal? Why does it seem to benefit some, but cause problems for others? In my opinion the answer boils down to the health of the gut. If someone has compromised intestinal permeability, or “leaky gut”, it’s more likely that their immune system will respond to potentially allergenic components in milk such as alpha- and beta-casein, casomorphin and butyrophillin.

This is especially true for people who are gluten intolerant, because it has been shown that milk proteins commonly cross-react with gluten. Put another way, if you react to gluten, it’s more likely that you’ll also react to milk.

Along these same lines, people with small intestine bacterial overgrowth (SIBO) – which is one of the major causes of irritable bowel syndrome (IBS) – may be more likely to react to milk because the bacteria in their small intestine aggressively ferments lactose, the sugar in milk, causing gas, bloating and other G.I. symptoms.

Not all milk is created equal

Something that irritates me is that raw and pasteurized dairy is often discussed as if it’s the same thing. It’s not. Raw dairy is a whole food, and pasteurized dairy is a processed food.

While it’s true that some people (described above) react to the proteins in milk, most who are sensitive are reacting to the sugar in milk: lactose. The enzyme lactase must be present to hydrolyze lactose into its constituent compounds, glucose and galactose. Somewhere between 1% – 95% of people don’t produce lactase on their own, depending on race and ethnicity.

In a sign of nature’s wisdom, raw milk contains lactase, the enzyme needed to digest lactose. Pasteurization, however, kills lactase. So if you don’t produce your own lactase, you’ll have a hard time digesting pasteurized milk. But that doesn’t mean you can’t tolerate raw milk. I can’t tolerate pasteurized dairy myself, but I don’t seem to have any problems with raw dairy.

So the answer to the question I posed in the title of this article isn’t so simple, and it depends on several factors:

• The status of your gut barrier
• Whether or not you have SIBO or IBS
• Whether or not you’re gluten intolerant
• Whether you’re eating raw or pasteurized dairy

If you’re not sure where you stand with dairy, the best approach is to remove it for 30 days and then reintroduce and see what happens. Elimination/reintroduction is still the gold-standard for determining sensitivity to a particular food.

But if you tolerate it well, I haven’t seen any evidence in the literature that convinces me you shouldn’t be eating liberal amounts of full-fat dairy.
============================================================
Read Chris Kresser's full article here.

So what’s wrong with low-carbohydrate diets?

Dr. John Bariffa just posted an article on his blog titled What’s wrong with the dietary advice Diabetes UK dishes out to diabetics? Now this blog (Credible Evidence) is not ususlly about diabetes, rather (you guessed it - this blog is primarily about heart disease) but there is a strong connection between the two diseases.

I have reproduced part of Dr. Briffa's article because he makes several strong statements regarding heart disease and I thought it appropriate to post them here. I encourage you to follow the link to his site to read the full article and to check out the references he provided.

=======================================================================
"            So what’s wrong with low-carbohydrate diets?
The usual accusation that such diets are high in fat, including ‘saturated’ fat that can cause heart disease (that diabetics are prone to). Actually, there is good evidence that when carbohydrate is cut from the diet, while the percentage of fat increases in the diet, the absolute amount of fat in the diet stays about the same (in other words, those switching to low-carb eating don’t generally eat more fat as a result).

This issue is a moot point, because there really is no evidence that saturated fat causes heart disease anyway. There have been several recent major reviews of the evidence regarding role that saturated fat, or fat in general, has in heart disease.

One such review conducted by researchers from McMaster University in Canada found that epidemiological evidence simply does not support a link between saturated fat and heart disease. Another recent study out of Oakland Research Institute in California, USA – this one, a meta-analysis (adding together of several similar studies) found saturated fat consumption has no links with heart disease risk.

Yet another comprehensive review of the relevant literature was performed as part of an ‘Expert Consultation’ held jointly by the World Health Organization (WHO) and Food and Agriculture Organization (FAO) of the US. Again, no association was found between saturated fat and heart disease. This review also included a meta-analysis of intervention studies in which the effects of low-fat diets (these usually target saturated fat specifically) were assessed. Lower fat diets were not found to reduce the risk of either heart attack or risk of death due to heart disease.

The most recent review of the evidence was a 2011 meta-analysis, in which the results of 48 studies were pooled together. Each of these studies tested the effect of reducing fat and/or modifying its nature in the diet. In general, the study subjects reduced saturated fat intake and/or replaced it at least partially with so-called ‘polyunsaturated’ fats (e.g. vegetable oils). The results of this review showed that these interventions did nothing to reduce the risk death due to cardiovascular disease nor overall risk of death. In studies in which lowering and/or modification of fat was the only intervention, risk of cardiovascular events such as heart disease and stroke was not reduced either."
=====================================================================
Read the complete article by Dr John Bariffa here.

The Statin Scam - Dr Lundell

The Statin Scam

by Dwight C. Lundell M.D.
For 25 years as a thoracic surgeon, my life was passionately dedicated to treating heart disease; I gave many thousands of patients a second chance at life.

Then a few years ago I made the most difficult decision of my medical career. I left the surgery that I loved to have the freedom necessary to speak the truth about heart disease, inflammation, statin medications, and the current methods of treating heart disease.

It was an exciting time to be a young cardiac surgeon in the eighties. A new surgical technique, coronary bypass, was the only effective treatment for people afflicted with severe coronary artery disease. Our ability to save lives increased and the risks of surgery decreased as techniques and technology improved.

Desperately sick and diseased patients could be restored and rehabilitated with relatively low risk, it was an exciting challenge. During my career as a surgeon I performed over 5000 coronary bypass operations.
The consensus at that time was that elevated cholesterol in the blood caused a gradual deposition of cholesterol in the channel of the blood vessel. We had two obvious treatment choices; lower the levels of cholesterol in the blood or do an operation to detour the blood around the accumulated plaque in the artery thus restoring blood flow and function to the heart muscle.

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

Statin drugs, the ones your Doctor insists that you take if your cholesterol is slightly elevated and Bernie Madoff ( the now infamous financial fraudster ) have both left in their wake many innocent victims, and many sincere but misled supporters. Both are huge frauds perpetrated on the unsuspecting.

Mr. Madoff, over 30 years swindled people out of about $50 billion. Statins have a worldwide market of over $30 billion annually and have had for many years. In addition, the testing for and treating elevated cholesterol costs about $100 billion annually with no noticeable benefit to the victims, I mean patients.

I'm not sure if Mr. Madoff intended to swindle when he started out, but reading the reports it seems things got out of hand and he had to continue to tell a false story in order to keep the money flowing into his coffers to support his and his supporters' lavish lifestyles, and perpetuate the fraud.

I'm not sure that the statin makers intended to swindle in the beginning but they also were not about to give up on a $30 billion annual market easily. There are many sincere, well intentioned and deeply convinced physicians that will continue to support the theory that dietary cholesterol and saturated fats cause heart disease.

They will continue to believe that cholesterol lowering medications will successfully treat and prevent heart disease in spite of the fact that a study published in The American Heart Journal ( January 2009 ) analyzing 137,000 patients admitted to hospitals in the United States with a heart attack demonstrated that almost 75% had "normal" cholesterol levels.

This fact continued to bother me during my surgical career. The idea that a normal substance, namely cholesterol, would cause heart disease never resonated with me. I would see patients coming back for second coronary bypass operations a few years after their first, having had normal cholesterol levels the entire time. In the operating room I had made the observation that there seemed to be inflammation around the coronary arteries that I was bypassing.

Through brilliant and massive marketing the makers of statin drugs have skillfully influenced science and controlled public policy so that prescribing statin drugs has become the standard of care. Anyone questioning or disagreeing with these policies is labeled as a heretic, disregarded and ridiculed.

The U.S. Food and Drug Administration ( FDA ), The National Cholesterol Education Program, The American Heart Association and many academic centers are led and influenced by physicians who receive direct or indirect benefit from the makers of statin drugs.

Their influence is so pervasive that recently the FDA approved Crestor®, a statin, to treat patients with normal cholesterol. Some of these academics have called for treating children with statin drugs. Marketing has truly triumphed over medicine.

Treating or attempting to prevent heart disease with statin drugs is dangerous and fraudulent for two reasons:

1.) Serious, deadly and disabling side effects which are largely ignored by the medical profession and suppressed by the statin makers. These side effects have been brilliantly documented by Dr. Duane Graveline and other brave doctors who dare to speak out against the official religion of cholesterol and saturated fat.

2.) Continued focus on this ineffective treatment diverts attention from truly understanding and controlling heart disease, and gives patients a false sense of security that prevents them from making the lifestyle changes that would truly prevent and reverse heart disease.

Consider also the following:
1.) Statins have not been proven to help any woman of any age!
2.) Statins have not been proven to help anyone over the age of 65!
3.) The only group of patients who may, and I emphasize "may" get any benefit, are middle aged men who have had a previous heart attack.

It is amazing to see all the medical literature that is funded by the statin makers and delivered to doctors' offices by enthusiastic young drug reps that purport to prove that statins are beneficial.

The very best statistical manipulation shows that one must treat at least 10 people for several years for 1 to have possible benefit. I'll bet that when your doctor told you to take statins you were not told that under the most favorable statistical slant on the data there is only 1 chance in 10 that you will benefit.

The much publicized JUPITER study which led the FDA to approve Crestor® for people with normal cholesterol showed that treating 100 people for 3 years with Crestor® "may" have prevented one heart attack.

Yet the approval was granted and millions of people were exposed to the risks of statins with no possible benefit except to the maker of Crestor®. Do you think the process is pure and clean and free of improper influence?

Just as a point of reference, if I had treated 100 people with the correct antibiotic for an infection 99 would have been cured. This is why I call statin treatment a scam that is bigger and more harmful than anything Bernie Madoff pulled off, at least his victims only lost money, not their health.

In spite of being Chief of Staff and Chief of Surgery at a large specialty heart hospital I found that I could not change Medicine no matter how much I preached and pleaded, no matter how much scientific evidence I gathered that cholesterol was not a problem and that treating cholesterol with medications was counter productive.

So I made that difficult decision and left my successful surgical practice in order to have the freedom to speak, write and teach the truth about heart disease. I wrote a book The Cure for Heart Disease, which explains that the real cause of heart disease is low grade inflammation. For without inflammation cholesterol would never accumulate in the wall of the blood vessel and cause plaque with its eventual consequence of heart attack and death.

Dwight C. Lundell M.D.
www.thecureforheartdisease.net
Chief Medical Consultant, Asantae Inc.
Chief Medical Consultant at www.realweight.com

Dr. Lundell's experience in Cardiovascular & Thoracic Surgery over the last 25 years includes certification by the American Board of Surgery, the American Board of Thoracic Surgery, and the Society of Thoracic Surgeons.
Dr. Lundell was a pioneer in off-pump coronary artery bypass or "beating heart" surgery reducing surgical complications and recovery times.
He has served as Chief resident at the University of Arizona and Yale University Hospitals and later served as Chief of Staff and Chief of Surgery.
He was one of the founding partners of the Lutheran Heart Hospital which became the second largest Heart hospital in the U.S.

January, 2011
======================================================
http://www.spacedoc.com/statin_scam