Knowledge, Not Numbers #2

…High cholesterol levels are really a symptom, not a cause of cardiovascular disease. Not understanding this fact, a lot of people take medicine to try to lower their LDL cholesterol levels artificially. Attempting to control through medication the enzymes that produce elevated cholesterol is analogous to playing pool with a rope.

–Dr. Doug McGuff

Let’s review.

We’ve already discussed how both LDL and HDL are lipoproteins that carry cholesterol around the body. LDL carries it to areas damaged by inflammation; HDL carries it back out.

When LDL particles are big and fluffy in size, they can easily be carried away by HDL and they are not so susceptible to oxidation, human “rusting,” that damages them and you. Very small LDL, sometimes known as VLDL, is very susceptible to oxidation and cannot be easily carried away by HDL. (Of course all this is very simply put.)

We ended by looking at a whole heapin’ helpin’ of studies showing no link between general LDL levels or total cholesterol levels and heart disease. So now we shall discuss what actually does matter.

1. HDL. This is something that actually can be measured in your blood test, unlike LDL which is derived or calculated. Having nice high HDL levels actually does have a fairly strong correlation with good heart health. Total cholesterol and LDL have virtually none. HDL isn’t all there is to it, but the more of this you have clearing your arteries out, the better off you seem to be. At least, that’s what most experts think. To be honest, opinions are mixed. However, there is evidence that suggests that low HDL is associated with increased risk of heart attack-and no evidence that high HDL is anything but healthy. And, let’s reiterate–cholesterol isn’t the cause of heart problems, but a symptom. Here’s one study to chew on, if you’re interested.

2. Triglycerides are also measurable. Triglycerides are also pretty well correlated with heart health, unlike total cholesterol and LDL. High triglycerides is generally not something you want.

3. The most important piece of information on your lipid panel is the ratio of HDL to triglycerides. This ratio should be 2 or better: as in triglycerides of 100, HDL of 50. If your triglycerides are a nice, safe “good for you” low of 110, but your HDL is only 30, your ratio is 3.67 and that ain’t good. If you have a typical American panel of triglycerides around 170 and HDL around 40, you’re up to a ratio of 4.2. Nasty. If, like The Roommate, you’ve got triglycerides of 60 something and HDL of 70 something, your odds are stellar no matter what your LDL and total cholesterol are.

4. I’ve even got Dr. Oz on my side on this one. Well, technically not Dr. Oz, just his site. HDL is important. Triglycerides are indicative. HLD/triglyceride ratio is a very good indicator of heart health. LDL and total cholesterol are meaningless.

So now you may be asking, if HDL and HDL to triglyceride ratios are the only things that really matter in my cholesterol panel, why does my health care provider get all worked up about my “high” LDL? Or my “high” total cholesterol?

Because that’s all they can “fix.”

There’s no drug that can reliably raise your HDL levels. None that can reliably lower your triglycerides. All we have are statins, which can only lower LDL levels and sometimes total cholesterol. (Some of them can sometimes raise HDL.)

So let’s talk about statins for a bit.

1. They don’t work. Well, that’s not entirely true. They do reduce heart attacks and death rates nicely among middle-aged men who have already had a heart attack. If you are a woman, a child, a non-middle-aged man, or a man of any age who has not yet had a heart attack, statins as preventative don’t do a thing to your risk of death.

2. When they do work, it isn’t because they lowered cholesterol. It’s because they decreased inflammation. Or, possibly, because they cause your muscles to cannibalize for the greater good.

3. They come with an array of frightening side effects that outweigh any possible benefit, unless you, dear reader, are a middle-aged man who has had a heart attack. Statins:

  • Damage your muscles. Severely. And painfully. So much so that it can interfere with walking and other normal life activities. These guys know about this common complaint and biopsied the muscles of 83 people to test it. They included a bunch taking statins and a few who weren’t. I’ll let them explain it in their own words:

Patients reported that their symptoms were severe enough to interfere with the activities of daily living and that they had decreased exercise capacity. The symptoms had lasted for several weeks. Typically, the symptoms disappeared within days after cessation of statin therapy…Significant muscle injury was observed among patients with myopathy and in 1 patient who was taking long-term statin therapy and who had no myopathy…There was no significant damage in the fibres of control patients not taking statins.

  • Statins can cause liver or kidney damage. In fact this is common enough that in the past it was recommended that anyone taking a statin get regular liver checks. It’s a big issue in this study, which reviews the lit on 900 statin studies. It’s lots of fun to look at the charts and see all the numbers! Or maybe “fun” isn’t quite the word…
  • Statins are widely reported to cause dementia, memory loss and ALS. This shouldn’t be a surprise, since they suppress the body’s production of cholesterol. Your brain is 2% of your body weight, yet it uses 25% of your body’s cholesterol. It’s going to be one of the first things to suffer when you start denying the body cholesterol.

Now this is a bit controversial. A lot of this dementia talk is anecdotal–people taking them or watching friends take them notice that statins make you stupid. But, um…just google that phrase, “statins make you stupid.” See what you come up with. This is one of those situations where when we see smoke, we might actually wonder if there’s fire. Statin manufacturers are all over this from a PR perspective, but let me ask you this: if we googled “Tylenol makes you stupid” or “aspirin makes you stupid” or “carrots make you stupid” or “penicillin makes you stupid” what do you think we’d find? Thousands of people asking those questions? Hundreds of doctors and medical websites trying to answer them and reassure you that, “no, of course they don’t”?

Google any of those other phrases and you can’t find one person asking a question like that. Do it with statins and you get 147,000 hits. And yet American statin pushers would have us all believe that they are so safe that our children should be taking them, young women should be taking them, we should even be putting them in the water. Your child can’t even get an aspirin without special permission–but apparently it’s perfectly fine to just dissolve a statin in his drinking water.

In the last few days, headlines have been everywhere that statins actually protect you from dementia. If we ignore the pop news sites and go to science news sites that report on it (those are the ones written by people who understand science and are thinking about it), we find that the researchers who posted review articles about these findings considered the research to be, and I quote, “of poor quality.” This was an epidemiological, not a clinical study. Mostly worthless.

  • These side effects are all so common that recent studies show half of all people prescribed statins stop taking them, at least temporarily, out of concern/annoyance over side effects. This also skews results in epidemiological studies like the one I talked about above, because the studies are only looking at people who are taking their statins: up to half the people who are experiencing the side effects aren’t included because they stopped taking them.

For more on statins, I recommend this essay. This woman doesn’t even agree with me on the uselessness of total serum cholesterol numbers in determining heart health. But she has done a lot of research into statins and does agree that statins are dangerous for everyone and useless to most; which should tell you something.

And now, as The Pilot pointed out, new, extremely controversial guidelines have been issued that would put tens of thousands more people on statins. The guidelines and “risk calculator” are believed to overestimate risk by 100%, or even up to 175%. Funny, isn’t it? When you see an overestimation of, say, 10-30% you think: mistake. When you see one of 175% you think: someone’s being paid by the pharmaceutical companies.

I mean, come on. When we’re told that Harvard Medical is questioning this–vociferously–, when we know that thousands of doctors admit to being “startled” by these new cholesterol guidelines, when the guidelines are predicted to increase prescriptions–and hence profits to certain people–by a whopping 70%…I smell a rat.

I know we don’t live in Gotham City. Pharmaceutical companies aren’t trying to kill me or anyone else. But I also know I don’t live in Fairytale Princess Pink Wonderland. No pharmaceutical company gives a rip about me. My best interests are not their concern; nor should they be. Their concern is to make money so everyone can keep their jobs and feed and educate themselves and their children.

These companies are a business. In the past they’ve taken some big hits. People and governments that would never go to Kroger or Food Lion and demand that they start giving away food because “food is just so important and everyone needs it so it isn’t ethical to charge money for it” DID go to pharmaceutical companies and say “you know those drugs for AIDS and cancer and stuff that you spent years and enormous amounts of money developing? You need to start giving those away, or at least the patents away, because they are just so important and everyone needs them so it isn’t ethical to charge money for them.”

Question: water is important and essential, so why does my local government keep charging me for it? It’s a human right.

I digress.

Anyway, pharmaceuticals were taking a financial hit–and then they developed statins. We can argue all day about motives, but there’s no denying the fact that pharmaceutical companies have benefited tremendously from developing drugs that tens of thousands of people are taking; people who up until very recently would have been considered healthy. That article I just linked to describes statins as “a fairy tale story” in the industry in terms of how amazingly profitable they’ve been. And there’s also no denying that, should doctors stop prescribing statins and you stop taking them, pharmaceutical companies would take a huge financial hit.

Which makes all the connections between the doctors issuing guidelines about cholesterol levels and these pharmaceutical companies all that much more questionable.

I downloaded the new risk calculator for statins, given to us by people paid by those who produce statins. I plugged in my numbers. All it does it calculate my risk, supposedly (and over-calculates it by 100-175% according to Harvard, which, by the way, is not financed by statin sales.)

According to the calculator, if my risk of a heart attack is over just 7.5% they want me on a statin. And they make it super easy! I don’t even have to monitor my cholesterol levels anymore: all I have to do take the correct dose of my statin medications. My cholesterol levels somehow magically don’t matter once I have my pills.

Anyway, I started imputing numbers. It first wants to know your age. I’m 37. Then it wants to know my race. It then asks my total cholesterol (230 or so), my HDL levels (over 70), my systolic blood pressure (109) and whether I’m being treated for high blood pressure, diabetes, or am a smoker. (No, no and no.)

Despite the fact that my answers and numbers were ideal or better for HDL, blood pressure, and general health, my ten year risk is calculated at a whopping 38%.

Whip out the prescription pad.

Only…what I want to know is why they even ask about all these factors that obviously don’t count for anything. Why do I say that? Because when I changed my HDL factor only–from a great level proven to be healthy (anything over 60) to a known-to-be-dangerously-low level of only 30, my risk didn’t change one bit. It remained exactly the same as before.

I then changed my HDL back to its original, stellar number and changed my blood pressure from a desirable 109 to a borderline dangerous 125.

Still no change. Not even 1/100th of a percent.

So I changed that back too. Now the factor I messed with was my age. I pretended to be only 20 years old. My ten year risk remained exactly the same. Somehow, this calculator is sure that a 20-year-old woman with great HDL levels, great blood pressure, and no health problems has an almost 40% risk of having a heart attack before she turns 30.

Insanity.

After playing around at being 20 again, I changed that back, and this time I told it I was being treated for high blood pressure. No change. Changed that back and told it I had diabetes. No change. Changed that back and told it I was a smoker. Still no change. Not even 1/1,000 of a percent.

The only way I could get my risk to change was by messing with my total cholesterol level. That was obviously the only factor this thing considers. If I changed my total cholesterol level to 170–what the Mayo Clinic considers a perfect number that everyone should consider ideal–I was able to drop my risk to 8%.

That’s right. 8%–with every number across the board ideal. Ideal blood pressure, ideal cholesterol, ideal HDL levels, no health problems, not a smoker: yet they would still want to prescribe me a statin.

I changed my age back to 20, just to see. Even if I were only 20 years old, with cholesterol of 170, HDL of over 60, blood pressure under 110, and did not smoke, did not have any treatment for high blood pressure, and did not have diabetes, they still want me dosing up on their pills.

If anything, the Harvard criticism of this calculator is too mild. I can’t find any combination of input numbers that doesn’t end up with me being told to take a powerful prescription drug.

According to this risk calculator, which is based on the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, my actual risk of having a heart attack any time soon is <1%. And they even took off three points for being middle-aged and five points for having “high cholesterol.”

 

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