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Lipids: A Different Perspective, Part Three (Cholesterol, Heart Disease, Atherosclerosis, statin)

re: cholesterol
re: statin

See also: LIPIDS. A DIFFERENT PERSPECTIVE, Part Two

Crackpot theories about cholesterol and statins and atherosclerosis are still the standard of care (abuse) in modern medicine. One of many runaway trains that enable Modern Wealthcare*.

Here is a perspective that any objective MD capable of critical thinking would have difficulty disagreeing with. Not that most MDs have critical thinking skills, sad but true.

* The repudiation of health and transfer of wealth from patients to “care” givers, while destroying any chance at better health via terrible advice, always treating symptoms and rarely causes, and never a cure. There is nil “health” in healthcare, a bitter pill of a word in its misleading suggestiveness.

LIPIDS. A DIFFERENT PERSPECTIVE, Part Three

2022-11, by BY DR. BAYNE FRENCH, MD DC. Excerpts, emphasis added.
TG = triglycerides, CVD = cardiovascular disease, CAD = coronary artery disease

...As Abramson et al (BMJ. 2013) reported, for the majority of people for which statins are prescribed (specifically for "primary prevention," people who DO NOT have heart disease), the benefit is lacking, while side effects and risks are significant.

Very often, the "36% reduction" in heart attacks attributable to statin treatment is mentioned with little understanding of what that means. It is a statistical figure referring to relative risk reduction. The actual reduction in heart attacks was 1% (3% down to 2%). This is absolute risk reduction. The benefit of statin medication for relatively healthy people without known heart disease is just not there. A group of independent researchers reviewed vast data (Cochrane Database Systematic Reviews) and found the evidence limited that statins help prevent a first heart attack, and “caution” should be taken in prescribing them for this reason (75% of statin prescriptions are written for low-risk patients).

An independent (no industry funding) group of doctors and scientists formed a group whose foundation is a concept called NNT (number needed to treat). It is a way of looking at the real benefit and risk of treatment. Their work on statins (and other interventions) can be found at www.thennt.com. It is not favorable in regards to statin use.

Experimental verification is itself also a rather imperfect tool. I think it is essential to understand that every time someone uses science or research, he is not talking about the work of some omnipotent beings with access to revealed truths but of fallible people working in a currently accepted paradigm and socialized into a scientific family and job structure. Bernie knows that well-intentioned "experts" make mistakes all the time. And that initially well-intentioned research can easily be swayed by funding, grants, and the promise of career advancement.

Summary

  • Educate yourselves. Rely not on standard advice on lipids. Break the thrall of conventional wisdom.
  • Understand that much of the research done on lipids has been drug industry-funded. The cookie-cutter recommendations on lipids are the antithesis of individualized medicine...
  • Carbs and especially sugar trigger the liver to make more fat and chol in a process called lipogenesis... High carb and especially high sugar diets drive the production of TG, lower HDL, increase the number of LDL particles, and reduce the size of LDL particles (Parks et al. Proc Nutr Soc. 2002; Krauss et al. J Nutr. 2001).
  • Reliance on LDL as a prognostic marker for CVD is misguided and outdated. Prado et al (J Clin Lipidol. 2011), among many others, showed that heart disease risk is much better determined by LDL-P (LDL particle number) and LDL size. Advanced lipoprotein testing is necessary to determine these values. If this is not possible, the most useful part of the standard lipid panel is the TG/HDL ratio. It really should be under 3.
  • Reduce inflammation. Hansson et al (NEJM. 2005) is responsible for a study some authorities consider pivotal in our understanding of the mechanisms behind inflammation, not cholesterol, as the root cause of atherosclerosis.

...

WIND: today’s Big Pharma and industrial medicine is 99.99% follow the money based on anti-science and “pull” in getting dubious to dangerous but highly profitable con games approved by the FDA.

Statins in Persons at Low Risk of Cardiovascular Disease

... The USPSTF found that statins have a 0.46% absolute benefit (NNT = 217) for nonfatal heart attacks.Statins for the prevention of cardiovascular disease in adults: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;316(19):2008-2024."  This NNT is probably artificially improved (lowered) by the predominance of events that occurred in high-risk individuals. In trials, however, 30% to 40% fewer heart attacks occurred in statin groups compared with placebo groups, suggesting that the benefit is reliable and can therefore be accepted as the best available estimate. Nonfatal strokes occurred in 0.32% fewer patients taking statins (NNT = 313), with the same caveats.Statins for the prevention of cardiovascular disease in adults: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;316(19):2008-2024."

...

Benefits

  • No statistically significant mortality benefit
  • 1 in 217 avoided a nonfatal heart attack (myocardial infarction)
  • 1 in 313 avoided a nonfatal stroke

Harms

  • 1 in 21 experienced pain from muscle damage
  • 1 in 204 developed diabetes mellitus

WIND: an absolute benefit of 0.46% with needing to treat 217 people for one “success” is laughably inappropriate. This is the crackpot unethical medicine that is practiced today, at huge cost in money and physiological damage from side effects to the other 216 of 217 people. Diabetes is no laughing matter, nor is muscle damage (which in rare cases can destroy the kidneys). And that’s assuming the numbers are credible, which they are not. And even if credible, they are not statistically significant—could be random chance—crackpot medicine.

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