ANY DOCTORS/MED STUDENTS HERE? Need medical cholesterol evidence page

[mmsantos]

I just had a long discussion with a medical student about cholesterol and statins, and she said that there is evidence supporting high cholesterol intake/blood levels and heart disease mortality. Also, that statins effectively reduce mortality (mentioned 4S study). I looked at Mark's post, but he didn't put any references on his cholesterol guide.

Does anyone know of solid evidence refuting these claims? Also, does the liver produce less cholesterol when you eat more cholesterol?

How does atherosclerosis START? Looking online yielded varied results. From my understanding, it appears that a lesion or injury can become inflamed, then come the LDL which get oxidised, etc. What causes this lesion or injury? Basically, what's the first step. The person I talked to said that in med school you learn that it starts with high levels of LDL in the blood which build up in arteries, which I believe to be utter BS. How can something the liver produces in vast quantities be so harmful to you?

Help appreciated!

[Cubbieblue]

CHeck out spacedoc.com for some good info on why you do NOT want to take a statin.

[RitaRose]

Bullshit.

Check out this study which shows that it's a U-shaped curve for men and a straight line for women. And especially with women, the higher your cholesterol, the lower your risk of mortality. For men, there's a sweet spot. If you want a simpler explanation of the study, you can look here. It isn't a simple "high cholesterol is bad".

Also, triglyceride levels and the type of LDL (small and dense or large and fluffy) seem to be better predictors of heart disease over total cholesterol anyway.

[sbhikes]

The Blog of Michael R. Eades, M.D. » Truth versus hype in the Jupiter study
The Blog of Michael R. Eades, M.D. » Statin panic

I searched Dr. Eades' blog for 4S and here's a comment that pretty much sums it up:

busy, January 17, 2008 at 9:29 am

I really enjoy your blogs. Thank you. With 4S, LIPID, HPS studies on statins ( http://www.rxfiles.ca/acrobat/cht-li...r%20trials.pdf ) trials showing reduced mortality in secondary prevention, is there still no room in your arsenal to prescribe these?

Hey Busy–

This says exactly what I wrote in my post a while back (The Blog of Michael R. Eades, M.D. » Statin panic). Statins have been shown to bring about some slight reduction in all cause mortality in men under the age of 65 with established heart disease. Were I such a person or if I had one in my practice I might consider a statin drug only after I had tried every dietary and supplement regimen I could put together without effect.

Cheers–

MRE

[Dirlot]

My understanding it is the small dense LD,L which eating vegetable oils encourage, cause the real problems. Eating saturated fat encouraged the fluffy LDL.

[TheyCallMeLazarus]

I am a third year medical student, so I will try to do the best I can

First of all, the answer to the question of "what causes atherosclerosis?" is, for most anyone that takes in all the evidence is a resounding "no one knows". The current understaning is that it is a sequela of several vascular pathologies, with components involved in chronic inflammation, low HDL over many years, etc. It is within this multi-faceted etiology that I believe a paleo diet, which will generally reduce systemic inflammation caused by gluten, leptin, and the like, shows promise.

One key point that I would make about statins, high cholesterol diets, and vascular disease is to isolate a single word in the article cited above, that being "secondary" prevention. That has a very specific meaning in medicine. It means, in short, what preventative steps can be taken to lessen the advancement of a disease that is already present. So yes, a statin is a good tx for someone with already advanced arteriosclerosis, but this is very different than saying that it should be given to a healthy person. Someone with coronary artery disease (which we assume in most any male over 55) should most certainly not be on a paleo diet, because by definition this condition implies that their regulatory system has lost its moorings. At this point, your options are a DASH diet (all fruit and veg, lean meats only, low salt) and drugs.

So overall, I think the discussion gets mottled in the fact that there are really TWO questions that we should be asking. First of course is, "what is good for you?", but the second is at least as important, "for who?"....because anyone that acts as if it is one size fits all, a facet that I must say this community is generally very good at recognizing, does not understand our physiology.

[Dave RN]

Don't forget that medical schools get a lot of $$ from big pharma. And you know what that means...

[bionicsamm]

TheyCallMeLazarus, from your post is evident that medicine still hasn't changed their teaching techniques. A primal diet isn't age specific nor condition specific.

[jimhensen]

TheyCallMeLazarus, from your post is evident that medicine still hasn't changed their teaching techniques. A primal diet isn't age specific nor condition specific.

A primal diet isn't age specific but eating a high fat diet might not be the healthiest option for everyone.

[jimhensen]

These are some studies that came up in google scholar when searching for statins + mortality. They side with your med student friend. In fact, I haven't seen any studies that say that statins seem to do anything other than prevent death...funny how that works, huh?

Effect of Statins on Risk of Coronary Disease, December 22/29, 1999, LaRosa et al. 282 (24): 2340

Statin Therapy, Cardiovascular Events, and Total Mortality in the Heart and Estrogen/Progestin Replacement Study (HERS)

Statin Therapy May Be Associated With Lower Mortality in Patients With Diastolic Heart Failure

ScienceDirect - Journal of Cardiac Failure : Statins Associated With Reduced Mortality in Patients Admitted for Congestive Heart Failure