Discussion Pro/Con Statin Cholesterol Lowering Drugs
Posted: Wed Feb 25, 2009 6:01 pm
Editor - this was split from the opthamologist post
Kath, if the Lipitor has lowered your cholesterol, then it is "working", since that is partly what it is meant to do. The obvious question is whether lowering your cholesterol will translate into a lower risk of CVD. The "cholesterol skeptics" claim that lowering cholesterol is of no benefit - however, the evidence indicates that it does - at least in certain groups of people depending on their risk factors.
If you doubt that high cholesterol increases one's risk of CVD, one only has to look at people who have a genetic disorder known as familial hypercholesteremia and are known to have a higher incidence of heart disease. Furthermore, the use of statins has been shown to reduce this risk and reduce the incidence of cardiovascular events in these patients.
For people who do not have familial hypercholesteremia, the evidence of benefit for statins is strongest for middle-aged men who are already at high risk. Women have often been underrepresented in clinical trials of statins, and may benefit less than men; however, meta-analyses do show a benefit in women at high risk.
I don't know where you stand in terms of risk factors - but I think this is something you should discuss with your doctor. Ultimately, it is your choice as to whether the benefit outweighs the monetary costs as well as the possible risks. For instance, in one study (ASCOT-LLA), 100 people had to be treated for 3 years with Lipitor to avoid one heart attack. This is just to illustrate - the population in that study might not be relevant to your particular circumstance. What is your treatment goal? When you read about statins being ineffective in women, what exactly is it ineffective at doing - reducing cholesterol, reducing mortality, reducing heart attacks, reducing vision loss, or a combination of these? I think you should talk to your doctor about what the goals of therapy are, and if they are evidence-based.
Ultimately, high LDL cholesterol is just one risk factor for atherosclerosis. I personally think that lowering your cholesterol will benefit you, but I don't know by how much and whether the benefit justifies the price of Lipitor. I also think that a multipronged approach is important. If your blood pressure is high, you might want to look into lifestyle modifications that may mitigate this risk factor. Another important lifestyle modification that is often difficult to implement is regular exercise - but even daily 20-30 minute walks can help lower your CVD risk (speak to your doctor first though). You might also want to look into supplementing with folic acid, vitamin B6 and B12, especially if your homocysteine levels are high. Also make sure you are eating a healthy diet with lots of fruits and vegetables. There is some evidence that dietary fiber may slow the progression of atherosclerosis.
kath wrote:Don Harry,
I did not know about the Lp(a) connection to statins.
My cholesterol dropped from 226 to 147 and triglycerides from 134 to 64 while taking Lipitor.
It has been a difficult decision to stop taking a drug that gives such impressive results. After countless hours researching statins especially pertaining to how ineffective they are on women I decide to stop taking Lipitor without my doctors consent. I don't understand why doctors keep using statins as the only line of defense for CVD.
Thank you for that added information along with the books you have recommended.
Have you ever heard of the Pritikin Diet by Robert Pritikin? It's a weight loss book but also used to help stop or possibly reverse atherosclerosis.
Kath, if the Lipitor has lowered your cholesterol, then it is "working", since that is partly what it is meant to do. The obvious question is whether lowering your cholesterol will translate into a lower risk of CVD. The "cholesterol skeptics" claim that lowering cholesterol is of no benefit - however, the evidence indicates that it does - at least in certain groups of people depending on their risk factors.
If you doubt that high cholesterol increases one's risk of CVD, one only has to look at people who have a genetic disorder known as familial hypercholesteremia and are known to have a higher incidence of heart disease. Furthermore, the use of statins has been shown to reduce this risk and reduce the incidence of cardiovascular events in these patients.
For people who do not have familial hypercholesteremia, the evidence of benefit for statins is strongest for middle-aged men who are already at high risk. Women have often been underrepresented in clinical trials of statins, and may benefit less than men; however, meta-analyses do show a benefit in women at high risk.
I don't know where you stand in terms of risk factors - but I think this is something you should discuss with your doctor. Ultimately, it is your choice as to whether the benefit outweighs the monetary costs as well as the possible risks. For instance, in one study (ASCOT-LLA), 100 people had to be treated for 3 years with Lipitor to avoid one heart attack. This is just to illustrate - the population in that study might not be relevant to your particular circumstance. What is your treatment goal? When you read about statins being ineffective in women, what exactly is it ineffective at doing - reducing cholesterol, reducing mortality, reducing heart attacks, reducing vision loss, or a combination of these? I think you should talk to your doctor about what the goals of therapy are, and if they are evidence-based.
Ultimately, high LDL cholesterol is just one risk factor for atherosclerosis. I personally think that lowering your cholesterol will benefit you, but I don't know by how much and whether the benefit justifies the price of Lipitor. I also think that a multipronged approach is important. If your blood pressure is high, you might want to look into lifestyle modifications that may mitigate this risk factor. Another important lifestyle modification that is often difficult to implement is regular exercise - but even daily 20-30 minute walks can help lower your CVD risk (speak to your doctor first though). You might also want to look into supplementing with folic acid, vitamin B6 and B12, especially if your homocysteine levels are high. Also make sure you are eating a healthy diet with lots of fruits and vegetables. There is some evidence that dietary fiber may slow the progression of atherosclerosis.