Tuesday, November 19, 2013

New guidelines that may increase statin use are a BAD idea....

Today's Post:  Tuesday, 11-19-2013

There are several new guidelines for statin use and some even make some sense.

But some of them redefine statins from a specialty drug that reduces LDL cholesterol and inflammation to a generic heart protector that very large numbers of people should take who do not take them now.

One cardiologist with a good understanding of effective heart protection said he saw an estimate that the number of people who have been taking statins in the United States, 45 million, could easily go to 70 million!

I’ve seen evidence that statins are a remarkably bad and limited drug!

I think that evidence strongly suggests that the number of people in the United States taking them should be less than ONE million!

So you can imagine my reaction to having the problem get that much worse!

Here are the most important of these reasons not to use statins for most people who now take them.

First, the doctors prescribing them already do NOT know this key information needed to qualify them to do so.  These guidelines do NOT account for these facts either. 

1.  Several years ago the Berkeley Heart Lab discovered that measures of heart risk factors were remarkably more diverse and numerous than had previously been known and that there are large individual differences, many of them genetic, between people in these readings and how they respond to heart drugs and statins in particular.

They found that most people get little benefit from statins and that for every 100 such people taking statins only one heart attack is prevented.  They did find that some people did get decent protection from statins; but they are a minority.

That test then cost about $600 and is likely more like $700 or more now.  So this wasn’t much used.

BUT, far worse, almost no doctors ever heard this work existed! 

The statin drug makers certainly didn’t publicize it!

But those facts remain!  And, I’m indebted to cardiologist Arthur Agatson who wrote an article saying that a genetic test for just this single difference is only $150 now.

That means that every single prescription for statin drugs given to people who have NOT had this $150 test show they are in that minority is very poor medical practice indeed.

If doctors were properly informed of this, it would be malpractice.  (To be fair, if doctors were that informed many if not most of them would test first.  They simply don’t know enough to qualify to prescribe statins now.)

2.  But why is that such a bad idea and such poor medical practice?

It is even worse than you might imagine in your worst nightmares!

Here’s why:

a) Good studies show that 9% of the people given statins develop type 2 diabetes.  

But type 2 diabetes jumps the risk of heart attack, doubling it for men and quadrupling it for women PLUS causing blindness, and mental decline, and foot amputation, and MUCH higher medical care costs.   You can hardly cut excessive health care costs if you use drugs that cause over NINE times as much harm as the good they do.

This means for example, that if 25 million new people take statins, 2.25 million of them will get type 2 diabetes in addition to those who now develop it from other causes.  That will cost millions more dollars just as our medical care costs are so high they are harming our economy.

b)  Other than stopping eating and drinking foods that are proven heart attack starters such as hydrogenated oils and all the others  --

The MOST protective action people can take to prevent heart attacks and strokes and mental decline AND type 2 diabetes is to do quite vigorous exercise, even if in brief sessions, most days of every week.

People do need to know how to begin doing and how to do these exercises safely.  But that is extremely doable.

And research shows that the more consecutive years people do this the better their protection gets!

It couldn’t be any clearer!

If there is a drug that harms people who do those exact kinds of exercises or even kills some of them, it should be a black box drug with very limited use.

Statins have exactly that effect!  The evidence is in.  The facts show that statins do exactly that.

The research was reported in a New York Times article.  Even worse, the better job people do on these exercises, the more harm statins do them!  This is a horrible state of affairs in my view.

This means that a strong case can be made that even people for whom the genetic tests show statins can be protective, they would be well served to use such exercise and other methods to get this protection – and NOT take statins. 

(The good news is that some statins do this less.  Those can be taken in lower doses and combined with dietary upgrades and other protective methods.  And, there is research suggesting that people who take 200 to 400 mg a day of ubiquinol may avoid some or all of this side effect.)

Once again, doctors rarely have heard of this and yet write hundreds of statin prescriptions anyway.

(Older people who are bed-ridden and have already had a heart attack or have very high risk factors and test in the group that statins help may be the one group for whom statins are a good idea.)

What then do doctors do who want to help their patients avoid heart attacks if they know not to prescribe statins?

There are two answers.

They need to learn the lifestyle upgrades that ARE quite effective in doing that and tell their patients to begin doing them.  (See our recent list of exactly such upgrades and why to make them in our related post a few days ago on why most people do NOT need to take blood pressure drugs because those who do those upgrades already HAVE the protection they need.)

The second thing they need is to have an effective and affordable service that helps people learn and begin those lifestyle upgrades.  We are working on that now and DO plan to offer it to doctors. 

In the same way doctors delegate to statin drugs now with these poor results, we think they can delegate the far more protective lifestyle upgrades to us or a similar service.

So there is hope for the future even with the dreadful news now.  

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Blogger David said...

Why the new AHA guideline put people on statins who should not be!

I just got the INH Health Watch email from NaturalHealthDossier this morning with why that looks likely.

"The Deadly Secrets of the New AHA Heart Disease Guidelines

If your doctor wanted to put you on statins, how high of a risk do you think you should have for a heart attack? Minimally.

Keep in mind, these are some of the deadliest drugs on the market. So if you agree to go on them, you’re opening yourself up to side effects like muscle problems, dementia, depression, chronic fatigue, hypertension, and stroke. Even worse? They create the problem they are supposed to be fixing and preventing…heart disease!

You’d think that only people at an alarmingly high risk should even be considered as candidates for taking these drugs, right? Wrong. In fact, you’d be way off. We only wish that was the case.

According to newly published American Heart Association (AHA) guidelines, pretty much everyone should be taking these dangerous pills.

The new guidelines recommend that doctors prescribe cholesterol-lowering statins for anyone with a heart disease risk of just 7.5 percent or more. 7.5 percent! And the story only gets worse from there…

The AHA is using a new risk calculator to create these guidelines. It’s supposed to predict 10-year risk for heart attack in patients over 40.

But this calculator is hiding more than one deadly secret.

According to Harvard University’s Dr. Paul Ridker, the new calculator overestimates heart disease risk by 75 to 150 percent.

That means millions of people targeted for statin therapy aren’t “at risk”... even by the AHA’s ridiculously low standards. For example, a person formerly at a four percent risk is now at an eight percent risk.

If you’re a white male over 62, guess what? You’re automatically at risk. Same goes if you’re a white female over 70. Even if you have no other risk factors, you are at risk. Your doctor will probably try to put you on statins.

It makes no sense whatsoever. These criteria don’t jive at all with any of the new research. The calculator was built with data from 20-year old studies.

The problems don’t end there. The calculator counts lots of risk factors. It looks at age, HDL cholesterol, blood pressure, diabetes status, and smoking status.

But it doesn’t include the single most important risk factor in heart disease.

The AHA admits that C-reactive protein (CRP) is the best predictor of heart disease.

CRP measures inflammation. People with higher CRP levels have a two to three times greater risk for heart disease than those with lower levels. The AHA also says that CRP is a better indicator of heart disease risk than LDL cholesterol.

The kicker is that you can keep CRP levels under control with diet and exercise. No need for statins! Maybe that’s why CRP didn’t make the cut in the guidelines. The AHA says that the new guidelines aren’t about prescribing more medication. But if your doctor goes by the Association’s insane criteria (7.5 percent risk level) on top of using a faulty calculator that overestimates your risk by as much as 150 percent, chances are you’re going to get a prescription for statins.

Prevention is the best medicine. It’s just not the most profitable. Taking steps to prevent heart disease naturally can help lower your risk and keep you off of dangerous statins altogether.

Find out your CRP to understand the bigger picture of what’s going on in your body.
Reducing inflammation and naturally lowering LDL cholesterol are the safest ways to avoid heart disease. And it all begins with diet.

Eating a paleo style diet free of grains is a great start. You should put an emphasis on organic vegetables, wild-caught cold water fish, and grass-fed beef. Clean sources of omega-3 fatty acids will help lower inflammation as well as LDL cholesterol. Some of the best choices are nuts, avocados, and salmon.

There are plenty of other natural, safe, and effective ways to protect your heart....."

7:59 AM  
Blogger David said...

Since I posted this, I saw three things that are relevant:

1. Most people who take statins take other drugs. New research shows that those who statins with other drugs have far more muscle pain and damage than those who only take statins. This is because their liver can only process so much at a time and so they wind up with higher than intended statin levels and the damage that causes.

2. At the recent Salesforce convention in San Francisco, a Dr David Agus said three things. He said that more and more we will use personalized care and prevention based on what we find from individualized data. In those two things I believe he is totally correct.

But he has no clue how to do this for real prevention because he also said everyone should take statins and a daily baby aspirin for prevention. Surprisingly he has never heard of the genetic test that we now know allows us to know if someone is in the majority that gets hardly any heart attack prevention from taking statin or is not.

Nor does he seem to know that some people eat and drink heart attack starters and never exercise while others are the reverse or how much more effective going from the bad side of this to the good side is in preventing heart attacks than taking statins even for the people they help! Nor has he ever heard of the type 2 diabetes risk and the muscle damage risk of taking statins.

Taking a baby aspirin is even less effective than taking statins in preventing heart attacks and causes about that many deaths from gastrointestinal and brain bleeding.

The available data already show that statins and baby aspirins are NOT the best method of heart attack prevention.

3. The article that described Dr Agus's remarks in the San Francisco Chronicle also has the opinion of Dr Rita Redberg, a cardiologist at UCSF. She says that far more people will suffer side effects of taking statins than will be helped by statins. She said that most people taking statins always feel tired or more so than they would have without statins. "She believes the most important message to send is the most basic one: People should eat healthy and exercise regularly." & "Everybody should be counseled to reduce their risks by making positive changes in their lifestyles."

She is totally correct that this is true for everyone.

But she is a bit less correct when she says the genetics don't matter. They do matter and so does what people are already doing and not doing. To get the most effective program for each person, it does matter what their priority risks are genetically and what their current readings are and what they already do right and wrong.

In THAT, Dr Agus was correct I think.

Personalized and individualized care will enable us to help people know what to do first and what to work the hardest to get done and what methods are best to use.

3:42 PM  
Blogger David said...

It seems it's even worse as the huge number of people likely to be harmed is 18 % of 25 million -- a LOT of folks harmed!!

"New York Times Op Ed
Don’t Give More Patients Statins
...the American Heart Association and the American College of Cardiology issued new cholesterol guidelines that essentially declared, in one fell swoop, that millions of healthy Americans ... statins -- for undefined health "benefits."

According to our calculations, it will increase the number of healthy people for whom statins are recommended by nearly 70 percent.

This may sound like good news for patients, and it would be -- if statins actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects.

However, none of these are the case.

Statins are effective for people with known heart disease.

But for people who have less than a 20 percent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail even to reduce the risk of serious illness -- ...., based on the same data the new guidelines rely on, 140 people in this risk group would need to be treated with statins in order to prevent a single heart attack or stroke, without any overall reduction in death or serious illness.

At the same time, 18 percent or more of this group would experience side effects, including muscle pain or weakness, decreased cognitive function, increased risk of diabetes (especially for women), cataracts or sexual dysfunction.

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease.

According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.
.... we have more reasons to be wary about the data behind this expansion....

....In fact, committee members noted that cholesterol lowered by drugs may not have the same effect as cholesterol lowered by nondrug methods, such as diet, exercise and being lucky enough to have good genes.

The process by which these latest guidelines were developed gives rise to further skepticism. The group that wrote the recommendations was not ....free of conflicts of interest; several of the experts on the panel have recent or current financial ties to drug makers. In addition, both the American Heart Association and the American College of Cardiology, while nonprofit entities, are heavily supported by drug companies.

The American people deserve to have important medical guidelines developed by doctors and scientists on whom they can confidently rely to make judgments free from influence, conscious or unconscious, by the industries that stand to gain or lose.

We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead .... we should be focusing on the real factors that ... reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. ....
John D. Abramson, a lecturer at Harvard Medical School and the author of “Overdosed America: The Broken Promise of American Medicine,” ..... Rita F. Redberg is a cardiologist at the UCSF Medical Center and editor of JAMA Internal Medicine."

12:56 PM  

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