Framingham and cholesterol

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fergus

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Cholesterol levels seem to be a big concern for lots of people these days. We're all egged on (I'm so sorry) to lower our total cholesterol, or improve our ratios, in the hope of avoiding heart disease.
The lower our cholesterol, the better, right?
The seminal study in the field is the Framingham, started in 1948, and it's still the one most commonly referred to by doctors on the subject. But what does it actually say?

There is a direct association between falling cholesterol levels over the first 14 years of the study and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dl per year drop in cholesterol levels.
Click to expand...

Converting that into UK terms, that means a 1mmol/l fall in cholesterol level equals and increased risk of total mortality of 429%. Still taking that statin?

fergus
 
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cugila

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Hi Fergus.

I take statins have done for quite a few years. I don't have a problem with them but I know that other people do. Do you know what is considered too low a Cholesterol level ?

Ken.
 
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fergus

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The Conference on Low Blood Cholesterol and Mortality seemed to suggest that risk of death fell for women as cholesterol levels rose. For men, the BMJ in 1995 stated that levels below 4.8mmol/l were associated with the highest mortality from all causes.
The Lancet in 1998 claimed each 1mmol/l increase in total cholesterol corresponded to a 15% decrease in mortality!!!!

fergus
 
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cugila

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Oh Dear. :(

As my TC is 3.2 do you think I should start arranging the 'final passage' now then ? :D

Ken.
 
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wallycorker

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cugila said:
Hi Fergus.

I take statins have done for quite a few years. I don't have a problem with them but I know that other people do. Do you know what is considered too low a Cholesterol level ?

Ken.
Click to expand...
The China Study showed that the distribution of chinese cholesterol levels finished where those in the western world started - i.e. the two distributions had hardly any overlap. Despite that some chinese people did still suffer from coronary heart disease suggesting that the levels that we considered safe are not absolutely safe.

However, I seem to remember that one of the findings from the Framlingham Study showed that that no one with a cholesterol level of less than 4.0 had died of an heart attack during the duration of the study. However, please be aware that this is from my recollection and may not be precisely the case.
 
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wallycorker

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cugila said:
Oh Dear. :(

As my TC is 3.2 do you think I should start arranging the 'final passage' now then ? :D

Ken.
Click to expand...
Perhaps they'll be able to put us in the same box. I got my latest TC result yesterday and that was 3.1. :roll:
 
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cugila

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Hi John.

Don't know whether I should congratulate you or commiserate with you. Mind you we could get a discount from the undertakers, BOGOF !! :D

Ken
 
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graham64

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My brothers an undertaker shall I get you a quote :?:
 
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cugila

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Does he do horses and things ? I hope a double booking won't cause too many problems. Will be in touch once the shock has died down. Must see my friends before I go. I think a barrel or two of Guinness would be good as well. No cakes, just plenty of Bacon & Eggs and Fergus Bread. :D

Ken.
 
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MaryChristine

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This is very interesting information. Thank you Fergus.

I read somewhere that any benefit from statins in the prevention of cardiovascular disease is due to their anti-inflammatory effect rather than their cholesterol-lowering action ie they are anti-inflammatory drugs with the (possibly undesirable?) side effect of reducing cholesterol.

As cholesterol is a natural substance produced by the body and necessary to its proper maintenance and function, I would very much like to know what the lowest safe level is but so far have not been able to find out. If anyone can tell me, or point me in the right direction, I would be very grateful.

My total blood cholesterol was 4.7 on diagnosis and 3.3 at my first annual review this month, the reduction being due to life-style changes, not medication, and I currently have quite good blood glucose level control (HbA1c 5.4%) but I was nevertheless encouraged to start taking a statin. I said I'd think about it (ie Find Out a Bit More for Myself).

Everyone is different and, as with all medication, benefit versus possible adverse effects must be considered on an individual basis.

Best wishes

MaryChristine
 
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cugila

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Hi MaryChristine.

Fergus has already answered your question earlier in this thread, it's several posts back and came as a shock to me as well. Take a look.

Ken.
 
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fergus

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You're quite right MaryChristine.
The only apparent benefit from statins appears to be found in men over 50 who have already suffered a heart attack. As far as I can tell, there is no evidence of any kind that taking statins reduces overall mortality in women.
It looks to me as if it is the anti-inflamatory effect, not the (LDL) cholesterol lowering effect that reduces the risk in that small group of men. Surely an aspirin woould do just as well!!!!
As for cholesterol, there is strong evidence against lowering cholesterol levels at all! There was a French study in the Lancet in 1989 on elderly women which showed the lowest mortality rate at an average cholesterol level of 7 and the highest at an average of 4.i.e. a mortality rate 5 times higher in the lower cholesterol group.
Funny how the $1bn dollar marketing budget for statins couldn't spare the cash to publicise it, eh?

fergus
 
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cugila

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Hi Fergus. I still find all this doom and gloom a tad over the top. I have looked at all that you have provided and am still not convinced. The British Heart Foundation has a completely opposite view of how Cholesterol should be treated. I go along with their view and the use of statins in men and women.

http://www.bhf.org.uk/living_with_a_hea ... atins.aspx

Surely total cholesterol is not the important figure here ? It is more to do with the LDL / HDL and Trygliceride levels which are the causes of mortality ? Your TC could be as low as you like or as high as you like but if those other markers are all over the place you would probably die early !
I think we are going to have to agree to disagree on this one.

Ken
 
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fergus

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Sorry Ken, I hope I didn't come over as doomy gloomy because that wasn't my intention at all.

I was hoping to encourage a bit of healthy scepticism regarding the significance of cholesterol and the supposed benefits of statins in lowering levels. I have no doubt there are some people who will benefit from taking statins.

However, it seems that they are being prescribed across the board, with no statistical evidence of any benefit to the vast majority of people. That's particularly true for women for whom a raised cholesterol level doesn't appear to be a risk factor for heart disease, full stop. Spiral's link also makes a similar point.

If the NHS's stated intention is that all diabetics aged 40 and over should be taking statins, then I think we should be asking why.

All the best,

fergus
 
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TheTartanPimpernel

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"If the NHS's stated intention is that all diabetics aged 40 and over should be taking statins, then I think we should be asking why."

Perhaps the answer is:

"The take-home message is that sustained reduction of LDL-cholesterol with simvastatin is safe and produces a substantial reduction in major vascular events in a wide range of high-risk individuals, irrespective of cholesterol levels at the start of treatment. This is particularly important for groups such as diabetics, who are at increased risk of vascular problems, but may have "normal" cholesterol levels. The relative risk reduction is remarkably constant, at about 25%, but the absolute benefit clearly depends on the individual's baseline risk."
 
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