Cholesterol and Statins

[bulkbiker]

If memory serves me right someone quoted on another statin thread that the surgery ( not the individual doctor) gets £1245 a year if they get enough of their patients who the nhs think should be taking a statin to take one, given surgeries now regularly have thousands of patients ...... do we really think that our doctors are prescribing statins so they can get say £1 a patient a year ?

Why wouldn't you? your surgery gets money and you may well believe that they are doing some good.

 

[bulkbiker]

Why would you ? To get your surgery a pound a patient, a year ... must cost more to issue the repeat prescriptions

Its a target of 50-90% of patients with T2 over 40 etc etc etc.
You don't get money for just one you need a large number of them.

 

[filly]

Well we know what happens if we follow their lead!
I have always refused statins. I shall have to look at my notes to see what they may have written.
I suspect it is a combination of both factors. They believe they will help but the do also get paid extra for prescribing them to you. There is a tick list as we know.

 

[pixie1]

Do you really think your doctor wants you to take a statin just because their surgery might get a few pounds added to their budget from the nhs if they get enough of their diabetic patients to take statins ? Or because the doctor thinks it might do you some good .....

You never know on the financial bit. The Dr follows an assessment tool for risk factors to see if statins are needed as a preventative measure normally. aka tick box exercise. Also Drs will prescribe meds to prevent complications developing from diabetes. Just in case meds I think.

 

[ianf0ster]

@BrianDoc Sorry if I misunderstand, but since it isn't disputed (even by statin advocates) that Statins A). Actively harm over 20% of patients and B). Do not prolong life. The question should be 'Why would a GP prescribe them for all Type 2's in the first place?
To quote Bob Seegar 'I'm not a number dammit, I'm a man!'

 

[Lupf]

I haven't commented on statins before, but as I have been reading this thread a bit, I've decided to weigh in.

Let me start by making a few observations.
1) Statins are well researched. there is lots of literature, which show that they reduce your chance of getting a heart attack or a stroke.
2) If you live in the UK and have at least one of high cholesterol, diabetes or high blood pressure you will likely be told by your GP do DN that you should take statins. There is a school of thought that everyone above a certain age should take statins.
3) Statins have side effects, e.g. muscle pains, which are documented in the medical literature, but people also report side effects, where there is no consensus.
4) The adherence rate of people taking statins is not great. Many patients stop taking it.
5) The variation of statin use varies a lot between countries. It is higher in the UK than in many other comparable countries (in Europe), but use has increased everywhere.
6) Statin is big business and one of (or the most) prescribed medication. The costs per unit have greatly reduced, though.
7) Statins are hotly debated, not only in this forum.

Let me now comment on these observations.
To be fully transparent, I am a scientist, not in medicine, but an experimental physicist. Thus I am used to interpret complex data sets, but medical research is difficult: it is often very hard to disentangle real causal effects from correlations; there is observation bias towards finding positive effects; successful drug studies is huge business; and not least there are ethical questions which sometimes prevent researchers from setting up double-blind studies with control groups. Finally, I am also a T2 diabetic who has been advised to take statins, and so far I've declined to take them All that said, I want to give statins a fair assessment.

Statins have their use. I have friends who have had a heart attack, a family history of heart problems, who are all very happy to take statins and tell me that this has and or will prolong their lives. I agree with this and would take statins if or when any of these conditions would apply to me.

Beneficial effects of statins can be overstated by quoting relative risk reductions, see the quote from

https://theconversation.com/benefits-of-statins-may-have-been-overstated-new-study-175557.

"The relative risk reduction for those taking statins compared with those who did not was 9% for deaths, 29% for heart attacks and 14% for strokes. Yet the absolute risk reduction of dying, having a heart attack or stroke was 0.8%, 1.3% and 0.4% respectively."
In other words, if you don't have a history of heart problems, ok blood pressure, controlled diabetes and only slightly elevated cholesterol, you might conclude that your risk of dying from cardiovascular diseases is low enough. This basically is why I am not taking them so far.

People are always worried about side effects, even in cases where there is no or little evidence. However, the fact that adherence rates are low must have reasons: people don't tolerate statins, i.e. side effects; statin can increase blood sugar levels, which is not something which T2s want; and, my guess, people don't perceive them necessary. What does a 1% increase of chance of dying from a heart attack in the next 10 year mean? Basically 1 in 100 people with the same conditions will die. Of course if it is you, that's tough, but you might worry about other risk factors which are higher. People also turn this risk into: it will shorten my life span by 1 months every 100 months or ~8 years, which looks low. This is not a correct interpretation, but that does not stop us. We also know that the availability of a defibrillator nearby will affect our chance of surviving a heart attack by much more.

The role of cholesterol is not as clear cut as medical establishment has seen it for years. I don't want to digress, but I also concluded that fat, eggs and cheese are wrongly blamed for heart attacks, which matters for all of us who do LCHF diet. I've learned here that a large ratio of total cholesterol to HDL might be more important. That said, I would still be worried if my cholesterol is really high and re-evaluate my decision.

People on this forum have strong opinions on statins. I hope @bulkbiker, who started this thread with almost 500 entries, you will agree with me that you are in this category. You have looked at the evidence and read several studies. Like me you have concluded that statins are not for you. You then let others in this forum know your opinion. This is of course ok. Many thanks for compiling all this information about statin and cholesterol for this thread. This is a very useful repository. However, as a scientist, I always have a slight worry, which is confirmation bias. This applies to you, myself and all other people who contrbute on this forum, We are all at risk that once that we've formed our opinion, we still look at further evidence but (subconsciously) only pick up data which fits our conclusion and disregard evidence to the contrary. At this point our conclusion turns into a prejudice. This bias is an issue in all of science. In my field we use so called blind analysis to prevent experimenters bias, i.e. we don't look at the results until all studies are done by, for example, adding a random number to a result, which is hidden from the analysts until we are ready to publish. Another case are drug studies tended to overestimate the positive effects of a drug as only positive results were published. Now there is a requirement to publish all results, independent if a positive effect has been observed or not. To address our confirmation bias we need to take a step back once in a while, study all the evidence of why statins are useful and tally these together with our existing assessment. We then should ask ourselves or even better ask another scientist or informed person to look at the evidence and tell us if our standpoint is tenable.

Money is a great distorter and while I haven't looked into the discussion that NHS surgeries benefit from prescribing statins, such effects are well known. In know that in Switzerland doctors benefit directly from prescribing more expensive drugs, and so it happens and makes health care more expensive.

Finally, while I respect everyone is entitled to their opinion, we must be careful. We all know that the person who shouts loudest is rarely fully correct. We always need to make clear that everyone who posts a question on this forum needs to decide for themselves, if they'll take their GPs advice or not when asked to take statins. All we can do is tell them our experience and how we formed an opinion. This forum is such a great place for finding information and discussion, but If we are not kind to people, who do it differently, we could end up being an insular group of only T2s who all are anti-statin and do LCHF.

This has become a long discussion. I hope it is useful.

 

[Fenn]

I admit I haven’t read more than three posts here but still I like the sound of my own opinion enough to comment lol

I refused statins for years, then I had a mini stroke.

I told the stroke consultant I had watched video xyz and didnt want statins, he was clearly a very genuine and very very clever man. He said he had also seen the same videos, he also said in his opinion I would be ten times more likely to have a serious stroke without the statins. I find it extremely difficult to believe that this man would be encouraging me to do anything for any other reason than to help me.

We are effectively at our low carb party conference, or in the low carb church, the converted preaching to the converted. Maybe Scientologists? I hope this thread does not discourage someone taking something that could one day prevent them from having a stroke

As I openly admit to being uneducated and thick, I would encourage all to ignore me. Back under my rock I go.

 

[becca59]

@Lupf an excellent post I enjoyed reading it.
Just to point out Type 1s are also asked to take statins. I have resisted so far with support from my consultant. Mainly because I have strange allergies to many drugs. This year my consultant was concerned about the rise in my results. Just to point out, for a type 1 I am pretty low carb with a good HbA1c and high TIR. He also mentioned that scientists are starting to suspect that a good HDL isn’t all its cracked up to be. I didn’t ask more details about this as I’m not interested in taking them at the moment, but am not as adamant as I was, and may indeed change my mind in the future. But that is my decision to make through my own personal research, not through pressure from anyone.

 

[bulkbiker]

I find it extremely difficult to believe that this man would be encouraging me to do anything for any other reason than to help me

But it doesn't have to be delberate.
There has been a huge amount of "research" on statins and it is all held by Sir Rory Collins at Oxford.
The raw data has never been published for assessment.

 

[bulkbiker]

People on this forum have strong opinions on statins. I hope @bulkbiker, who started this thread with almost 500 entries, you will agree with me that you are in this category.

I think I make my position pretty clear in the very first post.

From everything I have seen and read the "benefits" of statins use seem to be either non existent or exceedingly few and there do appear to be a number of harms they can do (like all medications).

I also disagree with the dubious "science" behind the "fat clogs your arteries" and "high LDL is causal of heart disease" because so far as I am aware neither is proven.

 

[Outlier]

I simply add to this fascinating discussion the observation that it is very difficult to prove a negative. So statements that indicate x% of people "would have" had this or that health event if they hadn't taken this or that medicine, are opinions with no solid study behind them. Everyone is entitled to opinion, but not for wrapping it up as truth. As far as groups being tested for research, it would be a hot day in Manchester if all their other health issues, diet and lifestyle were taken into account. We are dynamic beings, not just walking ailments or potential health problems.

 

[Lupf]

I think I make my position pretty clear in the very first post.

From everything I have seen and read the "benefits" of statins use seem to be either non existent or exceedingly few and there do appear to be a number of harms they can do (like all medications).

I also disagree with the dubious "science" behind the "fat clogs your arteries" and "high LDL is causal of heart disease" because so far as I am aware neither is proven.

yes, you are very clear, which makes it easy to argue.

Your statement "the "benefits" of statins use seem to be either non existent or exceedingly few" does not hold. Most of the critics of statins point to the many problems of statins, as you and others have pointed out in this thread. While for many T2 diabetics the benefits of statins seem to be small or even negligible, for people who have a high risk of heart disease, maybe even had a heart attack, a reduction of this risk by 30% could be relevant. There are enough problems with statins, but I haven't seen critics arguing that it has no use at all.

Your second statement "I also disagree with the dubious "science" behind the "fat clogs your arteries" and "high LDL is causal of heart disease" because so far as I am aware neither is proven." is a pivotal scientific question as one of the rationale for LCHF diets is that fat is good for you. This is the area where medical scientists are currently hotly debating. It would help if medical establishment and policy makers would look more at the new evidence without previous bias. As far as I am aware, the Ancel Keys study that fat is causing heart attacks, could never be corroberated and not for lack of trying. Today there is unfortunately no consensus yet but I agree with your assessment of the evidence that "fat does NOT clog arteries" and would predict that at some point in the future, this will become universally accepted. I haven't read enough to convince myself on the consequence of high LDL, but would not be surprised, if it turns out to be correct as well.

 

[Lupf]

I simply add to this fascinating discussion the observation that it is very difficult to prove a negative. So statements that indicate x% of people "would have" had this or that health event if they hadn't taken this or that medicine, are opinions with no solid study behind them. Everyone is entitled to opinion, but not for wrapping it up as truth. As far as groups being tested for research, it would be a hot day in Manchester if all their other health issues, diet and lifestyle were taken into account. We are dynamic beings, not just walking ailments or potential health problems.

I am not quite sure what you mean with "prove a negative". I certainly agree that it is difficult to disentangle the effect that a scientific trial is studying - e.g. do statins reduce heart attacks? - from other issues like diet, lifestyle and genetics of patients. However, this is can be done, namely by correctly setting up treatment and control groups where one takes the medicine and the other a placebo. While all the other effects that you mention do influence the study, these should average out over a sizable number of patients, and the remaining distortions should affect treatment and control groups in the same way, and can be subsequently removed. The final result, say a change in the probability of developing a heart attack in the next 10 years, is just that, a probability.

On the level of the individual you then need to fold in your diet, lifestyle and genetics to turn this into an absolute probabilty. This still won't predict your future with certainty, e.g. even if your probability for getting a heart attack is 50% there is still a one in two chance that you won't, but you probably would take action and have your arteries checked. For small total changes of probability, the effects are often not noticeable on an individual level.

Finally as individuals we have choice to change our diet and lifestyles (but not our genetics). This then changes our prior probability for a potential outcome. For example, as a newly diagnosed T2 you can greatly reduce your risk of diabetes complications if you succeed in reducing your HbA1c to non-diabetic or pre-diabetic levels.

I hope this is useful.

 

[Outlier]

You have stated the very essence of 'proving a negative' by your correct use of 'probabilty'. It is so easy for research 'probabilities' to be trotted out as 'facts'. The rest I hope I have already explained by reference to all the other individual circumstances that make us individuals in health terms as well. Thus sweeping statements allegedly based on research must be questioned, otherwise the important results tend to be diluted by surmise and inference, which is a huge pity as the result is that none of it is trustworthy or to be taken at face value. look at all the nonsense we diabetics get, from the Eatwell plate onwards. Research or bias? Health or profit? The only way to keep research trustworthy is to challenge it in those areas where it is weak.

 

[Lupf]

You have stated the very essence of 'proving a negative' by your correct use of 'probabilty'. It is so easy for research 'probabilities' to be trotted out as 'facts'. The rest I hope I have already explained by reference to all the other individual circumstances that make us individuals in health terms as well. Thus sweeping statements allegedly based on research must be questioned, otherwise the important results tend to be diluted by surmise and inference, which is a huge pity as the result is that none of it is trustworthy or to be taken at face value. look at all the nonsense we diabetics get, from the Eatwell plate onwards. Research or bias? Health or profit? The only way to keep research trustworthy is to challenge it in those areas where it is weak.

OK, I see what you are getting at. So let me add a few more points. I would agree with you that sweeping statements need to be questioned, but only up to some point. Let me try to give an example. Smoking kills is a sweeping statement, but this is now universally accepted, even by the tobacco companies. Burning fossil fuels is causing global warming and its effects are being quantified better each year, see e.g. the most recent report of the Intergovernmental Panel on Climate Change. People denying this either don't know that this is now a scientific consensus or worse have an agenda. A panel discussion with two scientists arguing about if the measured temperature increase is mainly due to human activity, is false balance. For one of the panel member you could find immediatley 1000 of others as a replacement, with the other, it is often an isolated opinionist and you should check where they are paid from.

Medical research is notoriously difficult, but the same principle applies. False balance caused the MMR scare, which sadly has lead to a reappearance of fatalities from measles. When it comes to food and drugs it becomes more difficult. Just like the tobacco companies and now the oil and gas industry were employing loads of politicians, lawyers and also scientists to claim black is white despite all the evidence, drug companies are trying to overstate the effectiveness of drugs, lobbying politicians and policy makers, generously funding friendly scientists or worse. My advice is the same: follow the money. This is also true for treatment of diabetes. The advice we get is sometimes based on flimsy evidence, e.g. eating fat is clogging up your arteries, however, low fat is huge business and these companies are not going without a fight. You say "to keep research trustworthy is to challenge it in those areas where it is weak." While research can improve confirmation bias, which often is unconscious, mostly researchers are trying hard to not fall into these traps. We should worry about false balance also here. To me it is more like " to keep advice by FDA, policymakers and governments trustworthy is to challenge it in those areas where the evidence is weak."

There is hope, though. Sometimes new research leads quickly to a change of treatment, e.g. Helicobacter pylori was found to be a common cause of ulcers only around 1990 leading to a simple cure with antibiotics, before people were given medicine to reduce acid production in stomach, so only reducing the symptoms and continued to suffer. If every surgery has at least one T2 patient who started with a HbA1c of aorund 100 and acheives remission for 5 years or more by diet alone, the penny should drop eventually.

 

[Outlier]

Let's hope!

 

[pixie1]

Its a target of 50-90% of patients with T2 over 40 etc etc etc.
You don't get money for just one you need a large number of them.

Its possibly why. every Tom, **** and Harriet are on them. Plus not wanting to acknowledge the side affects.

 

[notafanofsugar]

Thank you for putting all this information in one thread!!!!

 

[zand]

Can't see your URL pic?

 

[bulkbiker]

Interesting new study from Norway

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2753.2011.01767.x