Well, I'm still pretty confused. The only vegetable oils in our house that are not still part of the raw vegetable are olive oil and canola oil. The canola is used for cooking when the olive oil is not suitable. Whatever you may think, canola oil is not hydrogenated, and whether or not it is heat extracted is irrelevant if it is only used for cooking. You are going to have a very hard time producing any evidence that either of these oils is detrimental to good cardiac health, or probably good health in general, but if you can I'm certainly willing to consider it.
Not on cholesterol meds? New guidelines may change that
- Thread starter steve williams
- Start date
Frantz, I don't think we're at cross-purposes here, I'm just not sure why you're picking on vegetable oil as a culprit. I personally have been avoiding both animal fats and hydrogenated vegetable oils since the mid-1970's, by which time there was already a significant body of evidence showing both had adverse effects on vascular health at least. I just don't think that has much to do with a couple of prominent physician groups advocating widespread pharmaceutical use for primary prevention of heart disease, unless you're using it as an example of the inappropriate focus of American medicine in general towards medication rather than more natural methods.
Frantz
Please explain why this is a worrisome trend. Does the notion of a longer healthier life cause you to worry
More people on statins means a significant drop in heart attacks down the road, imo. I am borderline high cholesterol and have been on pravastatin 50mg for the last 3 years. My ldl is below 90. I'm a believer.
I agree Christian
we are all adults and can make health care decisions based on our own personal past health and/or family history
My doc has been lowering my statin dosis during the last 2 years, mostly because I am doing more exercise and having healthier food, to 1/4th of the original dosis I started with. if things continue the same, I will switch to homeopathy and give it a try, based on his recommendation as well.
Christian, the studies do not show that statins decrease the number of MIs. That's part of the controversy and several years ago the FDA required the pharmas to relabel their product information.
I take a small amount of Crestor daily to help the hdl, ldl has been around 50 for years now. I tend to be quite aware of what I eat and 80% of the time it's a Mediterranean style diet. Evoo always except for any hi temp frying and that's peanut. Even for omelets and eggs its evoo and just a touch of ghee. I suspect genes have some part to play here.
There is little disagreement with recommendations to use statins for secondary prevention, and not much disagreement about using them primary prevention in people with multiple cardiovascular risk factors and elevated LDL cholesterol. The controversies arise with recommendations for people with risk factors (even only one) and "normal" LDL cholesterol levels to take statins, and for people with no risk factors but an elevated cholesterol to take statins. In those situations there are NO studies showing better survival in those taking statins, in fact there is a trend to increased all cause mortality (not statisitically significant, yet) in the groups taking statins. As Myles says, there is also no lower mortality from MI's, but there is if you include all cardiovascular deaths (including strokes and PE); which means there is increased mortality in those groups from non-cardiovascular causes.
However, 10-15% of people taking statins will develop Type II diabetes, and significant numbers will be unable to continue on the drugs due to elevated liver enzymes and/or myopathic symptoms.
So how does a provider explain this to a patient in one of the two controversial groups mentioned above? Like this: there are no scientific studies showing longer life, and a substantial minority of patients will develop potentially serious side effects from these drugs, but two "expert" panels of doctors, who almost all get significant amounts of money from the companies that make these drugs, think you should take them for the rest of your life? How many doctors are going to do this? And even if they did, how many patients are going to hear anything except "two expert groups of doctors think you should take these drugs"?
However, 10-15% of people taking statins will develop Type II diabetes, and significant numbers will be unable to continue on the drugs due to elevated liver enzymes and/or myopathic symptoms.
So how does a provider explain this to a patient in one of the two controversial groups mentioned above? Like this: there are no scientific studies showing longer life, and a substantial minority of patients will develop potentially serious side effects from these drugs, but two "expert" panels of doctors, who almost all get significant amounts of money from the companies that make these drugs, think you should take them for the rest of your life? How many doctors are going to do this? And even if they did, how many patients are going to hear anything except "two expert groups of doctors think you should take these drugs"?
BALTIMORE, MD — US researchers have devised and validated a novel method of estimating LDL-cholesterol levels[1]. The new method, which was tested and validated in more than 1.3 million individuals, uses an adjustable factor to estimate very low-density lipoprotein (VLDL) cholesterol to account for variance in triglyceride and non-HDL cholesterol levels used in the Friedewald equation.
To heartwire , lead investigator Dr Seth Martin (Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD) said, "The Friedewald equation works well for average patients, but an estimation of VLDL using an adjustable factor provides a more accurate and robust assessment of LDL cholesterol" from patient to patient, especially in high-risk patients with hypertriglyceridemia and low levels of LDL cholesterol.
The results of the study are published online November 17, 2013 in the Journal of the American Medical Association.
Large Sample of US Individuals
LDL cholesterol is estimated using the Friedewald equation. In the Friedewald equation, said Martin, there is an assumed fixed 5:1 ratio of triglyceride levels to VLDL cholesterol. However, the problem is assuming this fixed 5:1 ratio across a range of triglyceride and non-HDL-cholesterol levels. Other studies, for example, have shown evidence of variance in the ratio, ranging as high as 9:1 in one study.
To address the problems inherent in the Friedwald measurement, the group decided to take advantage of the large cohort of patients available to them in the Very Large Database of Lipids (VLDL-1B). Using VLDL-1B, the researchers took a sample of cholesterol measurements obtained directly after ultracentrifugation from 1 350 908 adults, adolescents, and children in the US between 2009 and 2011.
Instead of using the fixed ratio of triglycerides to VLDL cholesterol to estimate LDL, they used an adjustable ratio as determined from more than 900 000 patients in the derivation cohort. As expected, the derivation cohort showed wide interindividual variance in the triglyceride/VLDL ratio. In their analysis, triglyceride and non–HDL-cholesterol levels explained approximately two-thirds of the variance in the triglyceride/VLDL ratio.
The researchers then performed a regression analysis that accounted for lipids, age, and sex to determine strata-specific median triglyceride/VLDL-cholesterol ratios. Based on these values, a 180-cell table of median triglyceride and non-HDL cholesterol levels was devised. The adjusted ratio of triglycerides to VLDL cholesterol can be obtained in the table using the values of triglycerides and non-HDL cholesterol.
For those patients with triglycerides <400 mg/dL, the overall concordance of the novel method of measuring LDL was 91.7% when compared with the direct measurement of LDL cholesterol. In contrast, the Friedewald-estimated measurement of LDL using the fixed ratio had a concordance of just 85.4%.
"The greatest improvement in concordance occurred in classifying LDL cholesterol lower than 70 mg/dL, especially in patients with high triglyceride levels," Martin told heartwire . For example, in individuals with triglyceride levels ranging from 200 to 399 mg/dL and LDL cholesterol of less than 70 mg/dL, the estimated Friedewald measurement of LDL cholesterol had just a 40% concordance with the direct measurement of LDL cholesterol compared with 84.0% concordance using the adjustable ratio.
The researchers say the 180-cell table they devised for the adjustable ratio "could be could be coded into an online calculator, smartphone application, or automated laboratory reporting system." Compared with the Friedewald estimation, classifications based on US and European clinical practice guidelines using LDL-cholesterol estimates with this novel method are more concordant with LDL-cholesterol levels obtained using direct measurements, they conclude.
Information from Industry
From Lilly: A treatment option you might consider for children and adults with ADHD
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Just this week, as reported by heartwire , new guidelines from the American College of Cardiology (ACC) and AHA, developed in conjunction with the National Heart, Lung, and Blood Institute (NHLBI), emphasized abandoning treating elevated LDL-cholesterol levels to a specific target, such as the older recommendations of <70 mg/dL or <100 mg/dL in secondary-prevention patients. Instead, the new guidelines emphasize treating risk, urging clinicians to treat patients with a moderate- or high-intensity statin depending on the patient's baseline risk for cardiovascular disease.
Martin said that despite the shift with the new guidelines, physicians still need to measure LDL cholesterol to determine baseline risk. In addition, they will need to recheck their patient's cholesterol levels even once treatment has started to make sure they are achieving the desired absolute reductions. In addition, European and Canadian guidelines still emphasize treating to target, so it is important to measure LDL-cholesterol levels accurately.
Martin reports no conflicts of interest. Disclosures for the coauthors are listed in the paper.
References
1 comment
To heartwire , lead investigator Dr Seth Martin (Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD) said, "The Friedewald equation works well for average patients, but an estimation of VLDL using an adjustable factor provides a more accurate and robust assessment of LDL cholesterol" from patient to patient, especially in high-risk patients with hypertriglyceridemia and low levels of LDL cholesterol.
The results of the study are published online November 17, 2013 in the Journal of the American Medical Association.
Large Sample of US Individuals
LDL cholesterol is estimated using the Friedewald equation. In the Friedewald equation, said Martin, there is an assumed fixed 5:1 ratio of triglyceride levels to VLDL cholesterol. However, the problem is assuming this fixed 5:1 ratio across a range of triglyceride and non-HDL-cholesterol levels. Other studies, for example, have shown evidence of variance in the ratio, ranging as high as 9:1 in one study.
To address the problems inherent in the Friedwald measurement, the group decided to take advantage of the large cohort of patients available to them in the Very Large Database of Lipids (VLDL-1B). Using VLDL-1B, the researchers took a sample of cholesterol measurements obtained directly after ultracentrifugation from 1 350 908 adults, adolescents, and children in the US between 2009 and 2011.
Instead of using the fixed ratio of triglycerides to VLDL cholesterol to estimate LDL, they used an adjustable ratio as determined from more than 900 000 patients in the derivation cohort. As expected, the derivation cohort showed wide interindividual variance in the triglyceride/VLDL ratio. In their analysis, triglyceride and non–HDL-cholesterol levels explained approximately two-thirds of the variance in the triglyceride/VLDL ratio.
The researchers then performed a regression analysis that accounted for lipids, age, and sex to determine strata-specific median triglyceride/VLDL-cholesterol ratios. Based on these values, a 180-cell table of median triglyceride and non-HDL cholesterol levels was devised. The adjusted ratio of triglycerides to VLDL cholesterol can be obtained in the table using the values of triglycerides and non-HDL cholesterol.
For those patients with triglycerides <400 mg/dL, the overall concordance of the novel method of measuring LDL was 91.7% when compared with the direct measurement of LDL cholesterol. In contrast, the Friedewald-estimated measurement of LDL using the fixed ratio had a concordance of just 85.4%.
"The greatest improvement in concordance occurred in classifying LDL cholesterol lower than 70 mg/dL, especially in patients with high triglyceride levels," Martin told heartwire . For example, in individuals with triglyceride levels ranging from 200 to 399 mg/dL and LDL cholesterol of less than 70 mg/dL, the estimated Friedewald measurement of LDL cholesterol had just a 40% concordance with the direct measurement of LDL cholesterol compared with 84.0% concordance using the adjustable ratio.
The researchers say the 180-cell table they devised for the adjustable ratio "could be could be coded into an online calculator, smartphone application, or automated laboratory reporting system." Compared with the Friedewald estimation, classifications based on US and European clinical practice guidelines using LDL-cholesterol estimates with this novel method are more concordant with LDL-cholesterol levels obtained using direct measurements, they conclude.
Information from Industry
From Lilly: A treatment option you might consider for children and adults with ADHD
Consider what treatment might mean to your patients with ADHD.
Learn more about a treatment option
Just this week, as reported by heartwire , new guidelines from the American College of Cardiology (ACC) and AHA, developed in conjunction with the National Heart, Lung, and Blood Institute (NHLBI), emphasized abandoning treating elevated LDL-cholesterol levels to a specific target, such as the older recommendations of <70 mg/dL or <100 mg/dL in secondary-prevention patients. Instead, the new guidelines emphasize treating risk, urging clinicians to treat patients with a moderate- or high-intensity statin depending on the patient's baseline risk for cardiovascular disease.
Martin said that despite the shift with the new guidelines, physicians still need to measure LDL cholesterol to determine baseline risk. In addition, they will need to recheck their patient's cholesterol levels even once treatment has started to make sure they are achieving the desired absolute reductions. In addition, European and Canadian guidelines still emphasize treating to target, so it is important to measure LDL-cholesterol levels accurately.
Martin reports no conflicts of interest. Disclosures for the coauthors are listed in the paper.
References
1 comment
So to rbbrt and Frantz and other naysayers.
I have a very good friend a few years younger than me. He's a pediatrician with a family history of heart disease but not him. He has two sons age 33 and 35 both with normal lipids. As a result he is not on statins even though suggested. Totally asymptomatic until yesterday when he developed chest pain and was admitted to the CCU with an acute MI necessitating a stent. So did medicine and you guys miss out on this one because you would not have him on statins. I suppose all of you would NOT recommend statins for his 35 yo brother. Rbbrt quotes statistics with potential risks of statins such as myopathy, diabetes etc. personally and IMHO it amounts to negligence not to treat his brother with statins. But what do I know. I'm just a retired Obgyn
I have a very good friend a few years younger than me. He's a pediatrician with a family history of heart disease but not him. He has two sons age 33 and 35 both with normal lipids. As a result he is not on statins even though suggested. Totally asymptomatic until yesterday when he developed chest pain and was admitted to the CCU with an acute MI necessitating a stent. So did medicine and you guys miss out on this one because you would not have him on statins. I suppose all of you would NOT recommend statins for his 35 yo brother. Rbbrt quotes statistics with potential risks of statins such as myopathy, diabetes etc. personally and IMHO it amounts to negligence not to treat his brother with statins. But what do I know. I'm just a retired Obgyn
I feel very sorry for your friend, but of course you know he could easily have had a massive MI even if he had been taking statins. They reduce the risk, they don't eliminate it, and that risk reduction statistically applies only to the group, not the individual
Perhaps more to the point, he followed your advice, considered the options and decided not to take statins.
Perhaps more to the point, he followed your advice, considered the options and decided not to take statins.
Good to rationalize rbbrt. You must do a lot of HMO managed care as there they speak of lives and not patients. Good to rationalize it. Perhaps I should ask you if you would have treated him before his MI and now that you know his history and based on what you just posted I sense you wouldn't treat his brother now
Steve, how many patients did you have who did everything right yet had a 3rd trimester fetal demise?
I don't do any managed care, just work in an ER, and I'd say that at least 80% of my patients with Acute Coronary Syndrome are on statins when they present.
I don't do any managed care, just work in an ER, and I'd say that at least 80% of my patients with Acute Coronary Syndrome are on statins when they present.
So why treat anyone. I see your point. So please answer. Would you treat his brother once again referring to your last post. His brother is 35
If someone has a history--or say with new genetic testing a predisposition to CHD--don't you think that there are other things that should be changed first? To play Devil's advocate, isn't this a case of CYA where doctors are afraid of patients non-compliance to changing their lifestyle and as a result, must put them on meds?
No Myles. I love all of you arm chair quarterbacks who quote statistics. I understand. However based on what you say the risks outweigh the benefits do why treat anyone
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