Friday, December 17, 2010

Doctor recommends statins when they actually would be a dreadful idea....

Today's Post: Friday, 12-17-2010

Someone I know has a low, borderline case of type II diabetes.

She has HBA1C readings of 6.2 to 6.5 and fasting glucose readings usually about 119 to 140.

(HBA1C is the more accurate reading of average blood sugar so is more predictive and useful to know of these two readings. Her HBA1C reading is about 10% lower than where real trouble starts, 7.0 and up -- but 10% higher than the desirable range, 5.8 and under.)

She also has total cholesterol of 192, HDL of 67, triglycerides of 100, and LDL of 105.

Her doctor suggested she might do well to consider taking statin drugs.

That’s actually a dreadful recommendation. It’s clearly NOT indicated for such readings.

Worse, there IS a recommendation that IS needed for such readings that the doctor did not know to make and did not make.

As some of my readers know, there are a number of heart health indicators for which you can get your blood tested.

1. And, three of the most important are triglycerides, HDL, and the ratio between them.

That’s because some research done, I think at Harvard, found that this ratio is an inexpensive but quite accurate way to test for the small particle LDL that is actually the heart damaging and heart disease creating kind of cholesterol. (Small particle LDL is just small enough it literally fits into the chinks in your artery walls. So it’s like pouring sand into an engine to have a lot of it in your blood –NOT good!)

2. It’s also important to have normal blood sugar that tests as 5.9 or less on the HBA1C test and to usually test at 119 or below on fasting glucose. (Desirable readings are 5.7 and less and 99 or less on fasting glucose.)

Excessively high glucose readings cause microscopic damage to your capillaries and blood vessel walls. This can and has caused foot amputation and blindness. But heart disease is caused by your body depositing plaque to put patches on such damage to too large a degree. High glucose or blood sugar has just this effect. The direct damage to the blood vessels and capillaries feeding the heart also weaken it.

3. Having total cholesterol be under 240 is desirable; but the reason for that is that such readings are found most often when your LDL is over 160. Some LDL is relatively harmless since it rolls over the surface of your blood vessels like a beach balls or tumbleweeds. But LDL readings of 160 and up or to some degree 130 and up suggest that the amount of the dangerous small particle LDL is high also. So it’s likely that LDL readings of well under 129 are desirable. LDL readings of 109 or less or even 99 or less may be more desirable.

But, notice that total cholesterol and LDL are SECONDARY indicators.

Yes. Lower readings tend to be better; and very high is NOT good. But the triglyceride to HDL ratio and the blood glucose measures are the far more directly accurate measures of heart disease and blood vessel disease risk.

So, THOSE are the ones to focus most on improving if they are not good.

For HDL the minimum OK level for women is 45 or more; but the desirable range is 60 or more.

For triglycerides, one source suggests under 199 is OK. But I very strongly suspect that 149 or less is more accurate. And, 100 or less is desirable.

So, if a woman has an HDL reading of 200 and an LDL reading of 40, the ratio is 5 to one! Women with such readings are likely currently developing worsening levels of cardiovascular and heart disease. This ratio and ratios worse than this are very high risk for stroke and heart attacks and other circulatory problems!

Conversely, a woman with an HDL reading of 67 and triglycerides of 100 is at low direct risk for heart disease. The ratio is a bit less than 1.5 to one.

Statins do prevent some heart attacks. But for every 100 people who take them, they only prevent 3 heart attacks on the average. Meanwhile they cause a much larger fraction of the people who take them to have much less energy and get tired easily. For every 100 people who take statins about 3 get cataracts that would not have gotten them otherwise. And some people who take statins develop serious memory loss and/or muscle damage.

Further, the Berkeley Heart Lab research has found of the very detailed groups of people their technology allows them to type genetically for style of heart attack risk and what interventions are most protective for each type, only ONE is truly helped most by statins. ALL the others do far better taking niacin instead!

So, for the drug companies to sell the idea that everyone with any kind of heart disease risk at all should take statins is so incorrect as to seem unethical to me!

And, THAT’s for people at high risk!

For people at low risk based on the LDL measure and the HDL triglyceride ratio, it is most definitely NOT indicated!

So, the for a woman with an HDL reading of 67 and triglycerides of 100 is at low direct risk for heart disease by that measure and an LDL reading of 105, again with a directly indicated risk that is low, statins are clearly a very poor choice. The very tiny upside is dwarfed by the cost to take the statins alone. When you add in all the side effects from taking the statin drugs that are likely or possible, it becomes a horribly bad idea.

But there’s even more! It seems that taking statins tend to increase blood insulin levels, insulin resistance, and increase blood sugar levels. To be sure, that research is very little known! But it means that taking statins is actually contraindicated in this case! It’s a truly dreadful idea. It would likely make this woman’s real problem and heart risks worse!

However, an HBA1C reading of 6.5 is a yellow light and fasting glucose of 140 is a red light. So, a woman who wants to stay off drugs but lower her heart disease risk should focus her efforts on doing more and better of the things that improve those readings.

Vigorous exercise whether calisthenics done fast, strength training where the exercises take some real effort to do by the end, or interval cardio where the intense parts of the intervals have been gradually built up to take some real effort to do have been demonstrated to lower HBA1C even when done in a few bursts of two minutes or less a few times on most days.

So, a recommendation to do such exercises several times each week AND to keep a daily log that can be reviewed and to help insure they are actually done most days of most weeks IS indicated.

Statins are not.

In fact, that kind of exercise has also been shown to be far more directly heart protective than statins because it also directly lowers the dangerous small particle LDL in the people who do it!

This doctor apparently only knew that high blood sugar increased heart disease risk and that statins might lower such risks.

In this case, I think this is a very poor and inaccurate recommendation. It’s far more likely to do harm if followed than to produce a benefit.

As we’ve described, there are some people where statins are a good idea. But for most people they are not.

The only good news in this is that there are some things that do help most people that we have described in other posts.

For example, Niacin is potent enough that it’s best used in moderation and amounts of 1,000 mg a day or a bit less in divided doses. Levels higher than that sometimes cause liver problems and should only be used by people at very high risk who are having their liver functions regularly checked by their doctor.

But for people with bad heart health indicators it’s a far better choice than statins. And, for people with moderately elevated blood sugar, vigorous exercise every week and an almost exclusively low glycemic diet with no refined grains and few sugars does far more good than statin drugs.

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