Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
What's said in the posts from the "keyboard experts" here is EXACTLY why I don't get my medical advice from online open forums, LOL.
I don't mind reading people's opinions and their own experiences, but no one should be giving medical advice. We're talking heart disease here.
We have asked all our doctors about the statins and our reluctance to take them. We've been through tests and have calcified plaque now in our arteries. My doctor is a data geek and I'm sure he'll retest me to see if the statin is doing any good.
Q: Can statins actually reverse plaque buildup?
A: Yes. There have been several clinical studies — many of them done here at Cleveland Clinic — that show statins can reverse plaque buildup.
Two statins in particular, atorvastatin, which is sold under the brand name Lipitor, and rosuvastatin, which is sold under the brand name Crestor, are the strongest statins.
Clinical studies using ultrasound in the coronary arteries have shown that when you are on high doses of these medicines, even if you have plaque buildup already, you can stabilize the plaque on statin therapy.
If your LDL cholesterol is lowered below 70 mg/dL, you can even see a regression in the plaque by up to 24%. So having really a low LDL cholesterol level can help stabilize any plaque buildup you have, and prevent further plaque progression.
Yes, all true, unfortunately. Statins definitely can save the lives of the small minority who have the genetic defect of extreme high cholesterol. Find out if you one of those, or not. MOST are NOT.
And keep in mind also that statins can cause the very things you are trying to avoid! Raising blood glucose levels is exactly what you do not want.
And yes, combinations of drugs are not tested and possible bad effects are not known.
No one benefits from all this over-prescribing except the drug industry. And MDs are as vulnerable to advertising as anyone else.
Facetious take.
Why would anybody want to take a statin when the drug when the drug isn't efficacious, studies are done by drug companies that nobody believes, cause diabetes and conditions we don't know about, combination with other drugs unknown and doctors don't read the actual studies and blindly follow treatment guidelines?
No reason at all except to benefit the drug companies. The statin came off patent in 2011. There are newer drugs now that the greedy companies are trying to make more money because they are new and on patent.
In a few years people will be saying why do we need expensive drugs when we have older cheaper drugs like statins that do the same thing?
Bring back the deworming drugs see if they work. Let's not have any drug company studies and go by word of mouth on social media and forums. That is the new reality and people will buy into it more.
Last edited by Medical Lab Guy; 01-04-2024 at 02:33 PM..
Why would anybody want to take a statin when the drug when the drug isn't efficacious, studies are done by drug companies that nobody believes, cause diabetes and conditions we don't know about, combination with other drugs unknown and doctors don't read the actual studies and blindly follow treatment guidelines?
No reason at all except to benefit the drug companies. The statin came off patent in 2011. There are newer drugs now that the greedy companies are trying to make more money because they are new and on patent.
In a few years people will be saying why do we need expensive drugs when we have older chepar drugs like statins that do the same thing?
Bring back the deworming drugs see if they work. Let's not have any drug company studies and go by word of mouth on social media and forums. That is the new reality and people will buy into it more.
You ignored all the sensible information some of us have posted here. You have no rational arguments so all you can do is make fun of anything that questions the mainstream dogma.
You ignored all the sensible information some of us have posted here. You have no rational arguments so all you can do is make fun of anything that questions the mainstream dogma.
I didn't ignore all of the sensible conventional medical dogma. I also understand you trying to balance out all of the conventional medical dogma with the non-conventional medical dogma.
The conventional medical dogma includes the cholesterol theory of disease with the conventional medical dogma of using statin drugs to treat high cholesterol levels and reducing risk.
Conventional medical dogma does include evidenced based medicine. It also embraces medical specialists issuing practice guidelines as guidelines to be used by doctors as simply guidelines knowing there will be exceptions inclusive of not using statins. There are other drugs besides statins on the market. The use of those other drugs are to be used when statins can not be taken. That's all included in the dogma.
Edit
The questioning of medical dogma happens every day. The way those are addressed is via RCT. The dogma will change if and when RCTa are repeated and confirmed and are better than the previous treatments or actions. The new dogma is then set.
I didn't ignore all of the sensible conventional medical dogma. I also understand you trying to balance out all of the conventional medical dogma with the non-conventional medical dogma.
The conventional medical dogma includes the cholesterol theory of disease with the conventional medical dogma of using statin drugs to treat high cholesterol levels and reducing risk.
Conventional medical dogma does include evidenced based medicine. It also embraces medical specialists issuing practice guidelines as guidelines to be used by doctors as simply guidelines knowing there will be exceptions inclusive of not using statins. There are other drugs besides statins on the market. The use of those other drugs are to be used when statins can not be taken. That's all included in the dogma.
Edit
The questioning of medical dogma happens every day. The way those are addressed is via RCT. The dogma will change if and when RCTa are repeated and confirmed and are better than the previous treatments or actions. The new dogma is then set.
Dogma is a set principles laid down by an authority, asserted to be true. That's precisely what these guidelines are, but dogma is not evidence based medicine nor science. It's just dogma.
And depending on what society of experts you get, the dogma changes.
Quote:
Appropriately enough for meeting held in Rome, Italy, at today’s European Society of Cardiology 2016 Congress, the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) said clinicians should stress a Mediterranean-style diet in patients at high risk of cardiovascular disease. They also said high risk patients who do not have high cholesterol should not be prescribed a statin.
The updated treatment rules--released today at the meeting--take a more moderate position than those of US specialty societies on prescribing statins or other drugs.
Physicians should rely more on their own assessment of each individual patient, rather than simply numbers, in deciding who needs cholesterol-lowering medications, the European societies said.
In new ESC/EAS guidelines recommend an individual LDL cholesterol target based on risk (defined by comorbidities and 10-year risk of fatal cardiovascular disease (CVD). For example, in high risk patients the target is LDL cholesterol less than 2.6 mmol/L (100 mg/dL).
This “person-based” approach differs from US guidelines which recommend giving a statin to all high risk patients even if they have low cholesterol.
“The American approach would mean considerably more people in Europe being on a statin—the task force decided against this blanket approach,” said Ian Graham a physician from Ireland who is the ESC’s chairperson on the guidelines task force.
Now, I'm not one to argue one set of experts are right over another set of experts. You should elevate the evidence, but I suggest to the casual reader to trust European guidelines more than American ones. They live longer, have less incidence of CVD, and their medical bodies are less corrupt than ours (though still too much money from conflicted parties makes it into the pockets of those who draft these guidelines).
Dogma is a set principles laid down by an authority, asserted to be true. That's precisely what these guidelines are, but dogma is not evidence based medicine nor science. It's just dogma.
And depending on what society of experts you get, the dogma changes.
The reason why dogma is important in medicine are many. One can not learn without dogma. One always learns generalizations before they can learn exceptions. Science can not advance because it is built on the previous set of truths.
As to a set of principles and those principles set into guidelines, what is the difference between guidelines and policies and procedures? Policies and procedures are dogmatic. They are set up by somebody in authority. They may or may not be based in science. It depends on who is setting up the policy and the basis of the policy.
Most if not all of the errors and serious mistakes and complications in my experience is derived from not following policies and procedures. Anybody who has ever investigated any errors would find this to be true.
This what makes medicine so dogmatic and that is because it can cause the loss of life. The practice of medicine is controlled with dogma. Those not adhering to the dogma can lose their license if it deviates so much to be a problem.
Not all of medicine is evidence based. When a policy or practice guideline is set up they give the evidence. They give the strength of the evidence. The evidence is graded. You might not agree with the evidence that they cite but they do cite the evidence. They also state that they are guidelines that might not apply to every individual. They also state that they don't always state obvious contraindications because one assumes common sense. They are establishing the general rule and not going to state every exception. That is up to the individual doctor to determine.
Various parts around the world will have differing policies based on regional genetics and cultural and economical differences. European countries with universal healthcare will often not approve expensive new cancer drugs that have a marginal improvement in outcomes. It isn't simply based on the clinical studies.
As far as your specific 2016 European reference it has changed updated.
JAMA Cardiol. 2022 Aug; 7(8): 836–843.
Statin Eligibility for Primary Prevention of Cardiovascular Disease According to 2021 European Prevention Guidelines Compared With Other International Guidelines
For primary prevention of atherosclerotic cardiovascular disease (ASCVD), the 2021 European Society of Cardiology (ESC) guidelines on statin use (hereafter European-ESC) recommend a new risk model (Systematic Coronary Risk Evaluation 2 [European-SCORE2]) as well as new age-specific treatment thresholds (≥7.5% 10-year ASCVD risk if aged 40-49 years and ≥10% if aged 50-69 years).
You have to ask yourself why it changed to be more consisent with the US recommendations. They recommend a new risk model.
The only conclusion that one can conclude with is that the evidence was more persuasive because of new studies compared to past otherwise they would have not changed it.
Various parts around the world will have differing policies based on regional genetics and cultural and economical differences. European countries with universal healthcare will often not approve expensive new cancer drugs that have a marginal improvement in outcomes. It isn't simply based on the clinical studies.
Statins are not on patent anymore, they're cheap. In fact, European guidelines have curtailed statins Rx greatly since 2016 when Crestor become off patent.
RCTs are done across countries these days, so not sure why regional genetics would play a huge role. European body's review the same clinical trials as Americans do.
Quote:
As far as your specific 2016 European reference it has changed updated.
JAMA Cardiol. 2022 Aug; 7(8): 836–843.
Statin Eligibility for Primary Prevention of Cardiovascular Disease According to 2021 European Prevention Guidelines Compared With Other International Guidelines
For primary prevention of atherosclerotic cardiovascular disease (ASCVD), the 2021 European Society of Cardiology (ESC) guidelines on statin use (hereafter European-ESC) recommend a new risk model (Systematic Coronary Risk Evaluation 2 [European-SCORE2]) as well as new age-specific treatment thresholds (≥7.5% 10-year ASCVD risk if aged 40-49 years and ≥10% if aged 50-69 years).
You have to ask yourself why it changed to be more consisent with the US recommendations. They recommend a new risk model.
From your article:
Quote:
In this cohort study representing 66 909 apparently healthy individuals, 4% qualified for statins according to the 2021 ESC guidelines compared with 20% to 34% according to guidelines from the ESC/European Atherosclerosis Society in 2019,
That means per 2019 guidelines, 20-34% would qualify for statins vs 4% after 2021. Basically in Europe today, women almost never qualify for a statin. There is good reason for that, I can elaborate later, not to get this off track.
Dogma is a set principles laid down by an authority, asserted to be true. That's precisely what these guidelines are, but dogma is not evidence based medicine nor science. It's just dogma.
And depending on what society of experts you get, the dogma changes.
Now, I'm not one to argue one set of experts are right over another set of experts. You should elevate the evidence, but I suggest to the casual reader to trust European guidelines more than American ones. They live longer, have less incidence of CVD, and their medical bodies are less corrupt than ours (though still too much money from conflicted parties makes it into the pockets of those who draft these guidelines).
European doctors respond.
“We have guidelines in place to try to prevent cardiovascular disease but the risk threshold in this new guideline means that almost nobody qualifies for treatment in many countries, which will lead to almost no prevention of future cardiovascular disease in those countries,” lead author Martin Bødtker Mortensen, MD, PhD, Aarhus University Hospital, Denmark, commented to theheart.org | Medscape Cardiology. “We argue that the risk thresholds need to be lowered to get the statin eligibility in European countries to be in line with thresholds in the UK and US, which are based on randomized controlled trials,” he added.
Mortensen explained to theheart.org | Medscape Cardiology that the original SCORE risk model used in ESC guidelines was problematic as it only predicts the 10-year risk of fatal atherosclerotic cardiovascular events, whereas those from the US and UK used both fatal and nonfatal cardiovascular events.
“Now the ESC has updated its model and the new model is much better in that it predicts both fatal and nonfatal events, and the predicted risk correlates well with the actual risk. So that’s a big step forward. However, the new thresholds for statin treatment are far too high for low-risk European countries because very few individuals will now qualify for statin therapy,” he said.
“The problem is that if we use these guidelines, the vast majority of those individuals who will develop cardiovascular disease within 10 years will not be assigned statin therapy that can reduce this risk. There will be lots of individuals who are at high risk of cardiovascular disease, but these guidelines will not identify them as needing to take a statin,” Mortensen commented.
“If we use the UK or US guidelines far more people in these low-risk European countries would be eligible for statin therapy and we would prevent far more events than if we use the new ESC guidelines,” he added.
“We have guidelines in place to try to prevent cardiovascular disease but the risk threshold in this new guideline means that almost nobody qualifies for treatment in many countries, which will lead to almost no prevention of future cardiovascular disease in those countries,” lead author Martin Bødtker Mortensen, MD, PhD, Aarhus University Hospital, Denmark, commented to theheart.org | Medscape Cardiology. “We argue that the risk thresholds need to be lowered to get the statin eligibility in European countries to be in line with thresholds in the UK and US, which are based on randomized controlled trials,” he added.
Mortensen explained to theheart.org | Medscape Cardiology that the original SCORE risk model used in ESC guidelines was problematic as it only predicts the 10-year risk of fatal atherosclerotic cardiovascular events, whereas those from the US and UK used both fatal and nonfatal cardiovascular events.
“Now the ESC has updated its model and the new model is much better in that it predicts both fatal and nonfatal events, and the predicted risk correlates well with the actual risk. So that’s a big step forward. However, the new thresholds for statin treatment are far too high for low-risk European countries because very few individuals will now qualify for statin therapy,” he said.
“The problem is that if we use these guidelines, the vast majority of those individuals who will develop cardiovascular disease within 10 years will not be assigned statin therapy that can reduce this risk. There will be lots of individuals who are at high risk of cardiovascular disease, but these guidelines will not identify them as needing to take a statin,” Mortensen commented.
“If we use the UK or US guidelines far more people in these low-risk European countries would be eligible for statin therapy and we would prevent far more events than if we use the new ESC guidelines,” he added.
Those are not "European doctors", that is 1 doctor who disagrees with the new guidelines. Aren't you all about listening to the guidelines and not questioning them?
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
