Statins

[atmat]

Peoria Profile | Peoria Magazine

Boyd Obstetrics and Gynecology opened its doors in 1994 with the goal of bringing the latest technology and procedures in women’s healthcare to the Peoria area.

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So this is your father? Where is the reference to the ND?

 

[Marbles]

So this is your father? Where is the reference to the ND?

The MD is from the Caribbean. Not exactly a high quality education, though just like a professional certification doesn't mean some is default correct (expert fallacy) a one step above a diploma mill education doesn't mean someone is not any good.

He is also stepping out of his area of expertise as an OB giving opinions on statins, smart people making judgements on things they don't fully understand is pretty dangerous. Especially if those judgements can be explained to a kid at the dinner table as it says there is not much discussion of the details. Further, what we know changes, those conversations at the dinner table certainly didn't account for more recent data, and were probably based on questions that were valid in the early 90s, but have since been answered with high quality data.

Never take even an expert at face value, you want the explanation behind their opinion.

 

[North of 60]

Wholeheartedly agree with Marbles.

 

[whaack]

Y’all are a riot. Like I said to start, if your Dr recommends a statin with zero discussion of diet, exercise and lifestyle you have a paid drug dealer not a physician. If you want to be a cog in the medical wheel knock yourself out.

 

[atmat]

Y’all are a riot. Like I said to start, if your Dr recommends a statin with zero discussion of diet, exercise and lifestyle you have a paid drug dealer not a physician. If you want to be a cog in the medical wheel knock yourself out.

So not answering my questions about your local authority, but instead resorting to insults?

 

[whaack]

So not answering my questions about your local authority, but instead resorting to insults?

What question? I linked his bio. Feel free to google him. He’s a very well respected women’s health specialist and OB/Gyn surgeon

With way my point remains the same. Nearly all basic health and medical information is easily understood by the masses if you want to educate yourself.

I simply pointed out his credentials bc there is a false narrative about the “consensus “ of efficacy of many of these drugs. Dr such as him and MANY others question the official narrative which is why we saw a mass exodus of health care professionals during COVID.

 

[Mike Islander]

They haven’t updated lipid guidelines since the publication of PREVENT. So, most recent guidelines still use pooled cohort ascvd calculator.

And where did I say a CAC of 0 can’t allow safe depreciation of statins in patients hoping to avoid (although the logic of this isn’t great in younger patients seeking long term prevention)?


Sent from my iPhone using Tapatalk

"If your 10 year risk score is > 7.5% you should be on a at least moderate intensity statin."

You wrote this well after the CAC discussion and stated it flatly without qualification, just as the PA did to me. If you didn't mean what you said...I can't read your mind.

My post, which triggered all the CAC talk, simply noted that my PA made a recommendation based on an old calculator with no further checks. If I followed her direction, I'd be taking drugs TODAY that I dont need, with side effect exposure, however rare. And you wrote down the same ASCVD guidelines. CAC not only negates what you wrote, but it is explicitly covered by the most active USA guidelines, as I quoted.

I don't think statins are the devil. But I recognize they are currently overprescribed for primary prevention; perhaps up to 30%. And I don't willingly take drugs that I don't need.

 

[Marbles]

"If your 10 year risk score is > 7.5% you should be on a at least moderate intensity statin."

You wrote this well after the CAC discussion and stated it flatly without qualification, just as the PA did to me. If you didn't mean what you said...I can't read your mind.

My post, which triggered all the CAC, talk simply demonstrated that my PA made a recommendation based on an old calculator with no further checks. If I followed her direction, I'd be taking drugs I dont need, with side effects exposure, however rare. And you wrote down the same ASCVD guidelines. CAC not only negates what you wrote, but it is explicitly covered by the most active USA guidelines, as I quoted.

You do know the MESA score, which you quoted, gives a 10 year risk percentage, right?

He did not say which tool to use. But, the other problem with CAC is it has poor evidence for actually improving patient outcomes when used. Which outcomes are what matters.

Part of this is even if MESA gives a 3% risk, the number needed to treat to prevent a significant event is only about 100, while the number needed to harm significantly with a statin is much lower.

 

[Mike Islander]

You do know the MESA score, which you quoted, gives a 10 year risk percentage, right?

He did not say which tool to use. But, the other problem with CAC is it has poor evidence for actually improving patient outcomes when used. Which outcomes are what matters.

Part of this is even if MESA gives a 3% risk, the number needed to treat to prevent a significant event is only about 100, while the number needed to harm significantly with a statin is much lower.

The MESA score indeed gives a 10-year risk percentage based on actual plaque, which is why the ACC/AHA guideline explicitly allows CAC to override age-based pooled-cohort risk. Large cohorts show that when CAC = 0, 10-year event rates fall below 2 %, even if the pooled risk is ≥ 7.5 %. At that level, the number-needed-to-treat exceeds 400, while serious-harm NNH is > 200 — so benefit is negligible. CAC doesn’t need to “improve outcomes” directly; it improves selection, ensuring statins are used where plaque exists and avoided where it doesn’t. That’s why guideline language says CAC = 0 → “reasonable to withhold or delay statin” absent smoking, diabetes, or strong family history.

 

[esorekim05]

I think if you’re elderly (>65) I’m more comfortable with the assertion that a CAC = 0 means you don’t need a statin as there is very good data of a very low risk over coming 5-10 years.

However, prevailing hypothesis currently in preventive cardiology is that atherosclerosis is a product of risk factors (high ldl, LPa, blood glucose, blood pressure, smoking, inflammation, etc.) over time.

So telling a patient who we hope will live 20+ years to not control risk factors including high ldl (an easily modifiable risk factor with statins) is far from guaranteed to be the right advice and definitely warrants shared decision making. For example, someone who really values avoiding meds or wants RCT data of
benefit before taking one, stopping isn’t unreasonable.

Whereas for someone else who doesn’t mind meds might reasonably continue for the likely but unproven (we don’t have randomized clinical trials with this sort of time horizon due to the near impossible logistics) benefits of statins in patients with risk factors but CAC = 0.


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[Marbles]

What question? I linked his bio. Feel free to google him. He’s a very well respected women’s health specialist and OB/Gyn surgeon

With way my point remains the same. Nearly all basic health and medical information is easily understood by the masses if you want to educate yourself.

I simply pointed out his credentials bc there is a false narrative about the “consensus “ of efficacy of many of these drugs. Dr such as him and MANY others question the official narrative which is why we saw a mass exodus of health care professionals during COVID.

I have a friend in ortho, he said OB surgeons are far to eager to cut and don't let them do a C-section. Must be a valid critique coming from

The MESA score indeed gives a 10-year risk percentage based on actual plaque, which is why the ACC/AHA guideline explicitly allows CAC to override age-based pooled-cohort risk. Large cohorts show that when CAC = 0, 10-year event rates fall below 2 %, even if the pooled risk is ≥ 7.5 %. At that level, the number-needed-to-treat exceeds 400, while serious-harm NNH is > 200 — so benefit is negligible. CAC doesn’t need to “improve outcomes” directly; it improves selection, ensuring statins are used where plaque exists and avoided where it doesn’t. That’s why guideline language says CAC = 0 → “reasonable to withhold or delay statin” absent smoking, diabetes, or strong family history.

So, first, there is a calculator that specifically includes CAC, it has been brought up several time. A CAC of 0 does NOT universally results in low risk. The argument that it does is to replace the individual with the group, which whenever possible individuals should be treated.

No, plaque and calcification are not the same thing and the terms cannot be used interchangeably (this is like using the term break pads to discuss break fluid). You can have a CAC of zero and be having unstable angina from a 95% left main stenosis. Just like you break pads can be good, but due to old fluid your break performance can be dangerously inadequate.

2018 is a long time ago. Ever wonder why the PREVENT Risk Calculator excludes CAC even though it was developed by the AHA in 2023? Using 2018 guidelines is not egregious, but there is a lot of information doing so excludes from decision making in this case. Guidelines are a tool, not devine ordinance, and if one has better information they are obligated to use it.

Also, reasonable in a guideline does NOT equate to should. It means the decision is defendable, but not that it is THE correct choice. You can read such wording as indicating there is uncertainty in the data are the risks vs benefits are pretty much a wash.

And yes, it must improve long term outcomes to be useful, otherwise it is a waste of the patients money and time. CAC also leads to harm in the form of unneeded work up, testing, and stress. I have personally witnessed this harm and had to halt diagnostic cascades resulting from inappropriate CAC tests.

CAC is a tool with uses, but like all tools it must be understood. It is used poorly in more cases than not in my experience.

 

[BadDogPSD]

If high cholesterol causes heart disease, and statins lower cholesterol, roughly 50% of adults are taking statins, why is heart disease still the leading cause of death? Shouldn't heart disease be eliminated by now?

 

[atmat]

If high cholesterol causes heart disease, and statins lower cholesterol, roughly 50% of adults are taking statins, why is heart disease still the leading cause of death? Shouldn't heart disease be eliminated by now?

This is a vast oversimplification of the pathogenesis of CVD.

Heart disease is well-mapped and multifactorial. LDL — which statins target — is a measurable, key component of risk, but it’s far from the only factor.

 

[omicron1792]

Nc A S

If high cholesterol causes heart disease, and statins lower cholesterol, roughly 50% of adults are taking statins, why is heart disease still the leading cause of death? Shouldn't heart disease be eliminated by now?

because everyone has to die of something.

 

[Marbles]

If high cholesterol causes heart disease, and statins lower cholesterol, roughly 50% of adults are taking statins, why is heart disease still the leading cause of death? Shouldn't heart disease be eliminated by now?

Age adjusted mortality from heart disease has decreased 66% between 1970 and 2022 (from 761 to 258 per 100,000). Using logic as simple as the above, if the other 50% of adults would take a statin then we can get to 100%.

But, it is not that simple. Even the term heart disease is a very broad term that includes many disorders not helped by statins such as alcoholic cardiomyopathy, cardiac amyloidosis, aortic stenosis, mitral regurgitation, atrial fibrillation, WPW, Brugada syndrome, and connective tissue disorders, to list a few.

In 1970, 91% of all heart disease deaths were due to ischemic heart disease (the type most helped by statins), in 2022 53% were from ischemic heart disease with a 89% age adjusted decrease in ischemic heart disease deaths with acute MI (heart attack) dropping from killing 354 people per 100,000 to killed 40 per 100,000.

Some of this is due to better acute treatment, but some is due to better prevention due to statins.

 

[Mike Islander]

I have a friend in ortho, he said OB surgeons are far to eager to cut and don't let them do a C-section. Must be a valid critique coming from

So, first, there is a calculator that specifically includes CAC, it has been brought up several time. A CAC of 0 does NOT universally results in low risk. The argument that it does is to replace the individual with the group, which whenever possible individuals should be treated.

No, plaque and calcification are not the same thing and the terms cannot be used interchangeably (this is like using the term break pads to discuss break fluid). You can have a CAC of zero and be having unstable angina from a 95% left main stenosis. Just like you break pads can be good, but due to old fluid your break performance can be dangerously inadequate.

2018 is a long time ago. Ever wonder why the PREVENT Risk Calculator excludes CAC even though it was developed by the AHA in 2023? Using 2018 guidelines is not egregious, but there is a lot of information doing so excludes from decision making in this case. Guidelines are a tool, not devine ordinance, and if one has better information they are obligated to use it.

Also, reasonable in a guideline does NOT equate to should. It means the decision is defendable, but not that it is THE correct choice. You can read such wording as indicating there is uncertainty in the data are the risks vs benefits are pretty much a wash.

And yes, it must improve long term outcomes to be useful, otherwise it is a waste of the patients money and time. CAC also leads to harm in the form of unneeded work up, testing, and stress. I have personally witnessed this harm and had to halt diagnostic cascades resulting from inappropriate CAC tests.

CAC is a tool with uses, but like all tools it must be understood. It is used poorly in more cases than not in my experience.

FACT: for asymptomatic adults evaluating atherosclerotic cardiovascular risk, CAC is the single most predictive test ever validated for individual prognosis. INDIVIDUAL PROGNOSIS = the actual patient in question. Me. Or you if you go see your doc.

For my case, CAC is not only diagnostic, but predictive. It's necessary and sufficient to allow ME to confidently refuse statins, for now, based on actually evaluating actual disease...in me.

If I had listened to my young, inexperienced, uncurious PA, I'd be unnecessarily taking stains today. And my risk of harm would be double my risk of benefit.

 

[Marbles]

FACT: for asymptomatic adults evaluating atherosclerotic cardiovascular risk, CAC is the single most predictive test ever validated for individual prognosis. INDIVIDUAL PROGNOSIS = the actual patient in question. Me. Or you if you go see your doc.

No, you still over state the case, even though you have repeatedly quoted parts of source that contradict that. Plenty of people with diabetes or strong family histories are asymptomatic. Read your own posts.

For my case, CAC is not only diagnostic, but predictive. It's necessary and sufficient to allow ME to confidently refuse statins, for now, based on actually evaluating actual disease...in me.

If I had listened to my young, inexperienced, uncurious PA, I'd be unnecessarily taking stains today. And my risk of harm would be double my risk of benefit.

Yeah, your CAC of three says you have coronary artery disease and based on your own posts a 3% risk of a major coronary event in the next 10 years assuming you are 45 or older. If younger that 45, don't count on that data. As as stated earlier, the NNT for 3% risk is 100, your own cited NNH with a statin was 200. A CAC of 3 is not zero and cannot be treated as a zero.

You also pointed out that just getting a proper BP dropped your risk enough to keep a statin from being recommended. In other words, other than giving you a small dose of radiation and relieving you of a small sum of money, the test didn't actually change anything.

Now, some of that is based on the impression that your goal is to avoid statins. If my impression is wrong, and you would have strongly wanted a statin if the CAC was elevated, then the test did serve a useful purpose in your case. Your treating a CAC of 3 as equivalent to a 0 reinforces this.

80ish% of the time, when I offer a CAC, but push for a verbal commitment to start a statin if it is elevated above 100, most people decide they don't want it, because their mind is already made up and they are only interested in confirmation, not actually assessing risk. They leave stating intent to eat healthier, loose weight, exercise more, Etc, then return in a year and 80ish% of the time have changed nothing. That is the sad reality of preventative care.

Some people make massive changes, it feels like most of the ones that do that also take advice. It is awesome to see someone come back healthier and get to strip away meds, I whish it happened more.

 

[Ridge Runner]

A lot to read through here and some reason don't feel any smarter.

Just had my annual went on Crestor 2 years ago with a total cholesterol of 275. Last year Total cholesterol was 185. Problem was I felt like i was having memory issues. Quit taking a few months ago but cholesterol last week was up to 265. I do feel like I am more "sharp" when not taking. Working through with my Dr. now on alternatives to Statins. With the "perceived" side affects and what I've read I'm cautious with using statins. Would like to figure out another alternative.

I use "sharp" and perceived because the difference is not pronounced more of a feeling than noticeable difference.

 

[Mike Islander]

No, you still over state the case, even though you have repeatedly quoted parts of source that contradict that. Plenty of people with diabetes or strong family histories are asymptomatic. Read your own posts.

Yeah, your CAC of three says you have coronary artery disease and based on your own posts a 3% risk of a major coronary event in the next 10 years assuming you are 45 or older. If younger that 45, don't count on that data. As as stated earlier, the NNT for 3% risk is 100, your own cited NNH with a statin was 200. A CAC of 3 is not zero and cannot be treated as a zero.

You also pointed out that just getting a proper BP dropped your risk enough to keep a statin from being recommended. In other words, other than giving you a small dose of radiation and relieving you of a small sum of money, the test didn't actually change anything.

Now, some of that is based on the impression that your goal is to avoid statins. If my impression is wrong, and you would have strongly wanted a statin if the CAC was elevated, then the test did serve a useful purpose in your case. Your treating a CAC of 3 as equivalent to a 0 reinforces this.

80ish% of the time, when I offer a CAC, but push for a verbal commitment to start a statin if it is elevated above 100, most people decide they don't want it, because their mind is already made up and they are only interested in confirmation, not actually assessing risk. They leave stating intent to eat healthier, loose weight, exercise more, Etc, then return in a year and 80ish% of the time have changed nothing. That is the sad reality of preventative care.

Some people make massive changes, it feels like most of the ones that do that also take advice. It is awesome to see someone come back healthier and get to strip away meds, I whish it happened more.

Why? Just why?

“A CAC score of 1–10 represents minimal calcified plaque and should not be considered diagnostic of coronary artery disease.”
— SCCT/AHA/ACC Expert Consensus, JACC Imaging, 2018"

1. A 3 CAC is near the measurable floor and treated the same as a 0 by most physicians. In fact it recently surveyed that 65% - 70% physicians treat it the exact same as a 0 regarding statin recommendations. You can look that one up on your own. Actually, you can look up both surveys.

2. A 3 does NOT equal a 3% risk over 10 years. Where did you get that number? MESA shows for a CAC of 1-10 that it indicates a 1-1.3% risk over 10 years, with a 0 score as high as 0.8%. Essentially no difference. And 3, if actually valid, is at the very bottom of that range.

3. CAC has a statistical variability of plus/minus 2%-5%. Up to HALF of those who get a second CAC after showing 1-10 score measure 0 on the next scan. My point is that we're in the noise here.

The test VERIFIED that I have no meaningful disease whatsoever. And that's a 5-10 year indicator. I like the verification.

The goal of my post was to WARN patients about what happened to me. As we've seen in the responses, many experienced the same thing...a PA/Doc putting them on statins without considering the one test that diagnosis actual disease. Remember, I had to self-educate before I realized that my artificially high clinical blood pressure alone put me over the threshold of "recommending a statin" using the blunt force ASCVD. I did the CAC to satisfy my own curiosity. A lifetime of CAC tests is about equal to ONE MAMMOGRAM SERIES worth of radiation. No measurable cancer risk. Thankfully it serendipitously showed the PA that she tried to "put me on a program of statins" without justification. I didn't throw it in her face. I simply asked for a CAC referral, and she interpreted the results. She knows what she did. Hopefully she learned from it. Hopefully docs who read but didn't post, and who aren't as caring or careful as you, also learned from this discussion. I do genuinely appreciate your input on this.

 

[omicron1792]

Why? Just why?

“A CAC score of 1–10 represents minimal calcified plaque and should not be considered diagnostic of coronary artery disease.”
— SCCT/AHA/ACC Expert Consensus, JACC Imaging, 2018"

1. A 3 CAC is near the measurable floor and treated the same as a 0 by most physicians. In fact it recently surveyed that 65% - 70% physicians treat it the exact same as a 0 regarding statin recommendations. You can look that one up on your own. Actually, you can look up both surveys.

2. A 3 does NOT equal a 3% risk over 10 years. Where did you get that number? MESA shows for a CAC of 1-10 that it indicates a 1-1.3% risk over 10 years, with a 0 score as high as 0.8%. Essentially no difference. And 3, if actually valid, is at the very bottom of that range.

3. CAC has a statistical variability of plus/minus 2%-5%. Up to HALF of those who get a second CAC after showing 1-10 score measure 0 on the next scan. My point is that we're in the noise here.

The test VERIFIED that I have no meaningful disease whatsoever. And that's a 5-10 year indicator. I like the verification.

The goal of my post was to WARN patients about what happened to me. As we've seen in the responses, many experienced the same thing...a PA/Doc putting them on statins without considering the one test that diagnosis actual disease. Remember, I had to self-educate before I realized that my artificially high clinical blood pressure alone put me over the threshold of "recommending a statin" using the blunt force ASCVD. I did the CAC to satisfy my own curiosity. A lifetime of CAC tests is about equal to ONE MAMMOGRAM SERIES worth of radiation. No measurable cancer risk. Thankfully it serendipitously showed the PA that she tried to "put me on a program of statins" without justification. I didn't throw it in her face. I simply asked for a CAC referral, and she interpreted the results. She knows what she did. Hopefully she learned from it. Hopefully docs who read but didn't post, and who aren't as caring or careful as you, also learned from this discussion. I do genuinely appreciate your input on this.

You do realize 1-1.3% is up to 60% greater risk than 0.8%?

Your numbers show that 3 is significantly different risk than 0 on CAC. He has been telling you the fact that someone has a 3 shows some calcification. The number of those people that then proceed to have CAD morbidity is real. Also, 10 year risk is short term when looking at a 30 or 40 year old man. We don’t know what that risk is in 30-40 years, but we can infer at simple extrapolation of 10 year risk that it’s 4-5%, and most would infer that it would be much higher than that. A relatively safe drug that has proven to reduce that risk is perfectly justifiable.