Great post, Greg! You made so many good, patient-oriented points. I appreciate the shout outs, too! Your point about them being simultaneously too complex and too simple is really compelling. I think that point underlies my take-home that the entire process is broken: it's too broad in scope, too complex, insufficiently focused on patient preferences, and compromised by intellectual bias and industry relationships. A better process would require a higher evidentiary threshold for Class I recommendations, fewer recommendations overall, less redundancy and wordsmithing, clearer and more useful figures, and fewer authors with strong intellectual or financial stakes in the outcome. But I loved your other point too - nothing really changed (though I worry payers and lawyers will use this as fodder).
Thank you! After your post on this last week, I went through the last 8 different aha/acc guidelines and did the same exercise. Over all of them, 61% of class 1 recommendations are based on b-nr or c LOE. It’s totally wild
Way too much emphasis on cholesterol without context. Insulin resistance and life styles and other factors all ignored. Conveyor belt medicine at best. Do we even have a solid grasp on how these guidelines are interpreted and acted upon by family physicians? Shared decision making anyone?
Statins for primary prevention have not been shown to prevent death or cardiac events. Statins increase risk for dementia and DM2. I began statin ~25 years ago on advice of my family doctor & agreed to it because I am adopted & don’t know my family history. Now @ 75 years old physically active (running & gym), with no cardiac events I stopped my statin because I don’t want to take the chance of burdening my wife taking care of a demented old man, my cholesterol has gone up but I don’t care.
Its the side effects that are they telltale signs. Muscle cramps in my calves, while walking or jogging. Cramps in my calves and occasionally hamstring while sleeping. Weakness in muscles.....
That happened more than a decade ago. Also I believe it affects the liver as well.
I am not a Doctor nor a Nutrisinist so i will not give any advice. What I did do was go on a protein diet recommended by two friends that had great results from using this diet plan and also after visiting a nutritional store, i chose a path that i felt I could follow.
Its not easy but the results were great. My doctor and Endocrinologist were really happy with the results.
I’ve had cholesterol near 300 even when I was a skinny teenager. My whole Italian side does, I’m sure if I could eat Mediterranean I’d be fine nothing else seems to work. But is too expensive
Cholesterol runs in my family as well. The one thing I forgot to mention is that's i started going on long walks, I started slow, and worked my way up to 10k per night. That had a lot to do with my losing weight and bringing my Blood pressure down and cholesterol levels down a well.
Yes there have been studies, statins are highly recommended for High Risk individuals with heart condition and stroke, blocked arteries.
I do not have all the numbers or studies.
As to the question of alternative treatments, ten years ago there were hardly any other treatments. My daughter works in a hospital, she mentioned to me that there are more alternatives these days.
Well, it's worth knowing HDL and triglycerides, as a low HDL/TG ratio (<2) is a reliable indicator of insulin resistance, which is most definitely a risk factor for heart disease and many other health maladies. Insulin resistance can be addressed with a well-formulated low carb diet and ruthless elimination of all veg oils/seed oils.
Around eighteen years ago, I was prescribed Lipitor, about six months following the first dose i started to have issues , cramping in my legs, weakness.... Ok lets try Crestor, nope same thing, Zocor nope........
You know where im going with this.
It might not be for everyone. I found a secret bullet on my own. I lost thirty pounds, started eating healthy, and exercising. Might not work for everyone but it definetly worked for me.
I’m glad you noted GLP-1 albeit briefly. I am 74 w a family history of heart disease and coronary surgeries and stents, which I have avoided. 35 years ago my PCP started me on statins-Crestor. At 65, after slow increases in blood pressure, started amlodipine. Added a low dose of Meloxicam to help me lessen hand arthritis that interrupted my sleep. Had elevated glucose and weight kept increasing - to 220lbs, height 5’9”. I began semaglutide in August and loss 2lbs/week for 22 weeks so 175 lbs now. Exercise, walk, continue to do yard work. Now phasing out Semaglutide. Lab work improved dramatically- glucose 160 down to88, LDL calculated 120 to 60, triglycerides from 60 to 40, non HDL from 130 to 68. Also had good heart ejection fraction test score of 65% at age 71 which I attribute to statin and exercise. 3of 4 siblings have coronary disease. My 2 points are that: I believe my PCP took my family history of coronary disease very seriously when I was 40 years old by starting the statin, and that GLP-1 may become a huge key to improvements as you allude to. I know to never substitute one experience for double blind studies but as you noted, some patients respond differently than others and I wanted to reinforce both. And I can’t close without noting that I have had every vaccine and boosters. I don’t understand all the terminology but thoroughly enjoy your scientific approach applied individually to your patients. We learn from you.
I'm afraid it's too late to have us believe any of that. After the covid farce, shamefully consented to by most MDs, many of us have done our research. It's mostly conflicts of interest aimed at making people buy ever more 'preventive' drugs. In the midst of that fog, are any published results credible? AFAIC, they are are simply undecidable
For me I was always taught “Guidelines provide the map—but you still have to drive the car”.
100%
Great post, Greg! You made so many good, patient-oriented points. I appreciate the shout outs, too! Your point about them being simultaneously too complex and too simple is really compelling. I think that point underlies my take-home that the entire process is broken: it's too broad in scope, too complex, insufficiently focused on patient preferences, and compromised by intellectual bias and industry relationships. A better process would require a higher evidentiary threshold for Class I recommendations, fewer recommendations overall, less redundancy and wordsmithing, clearer and more useful figures, and fewer authors with strong intellectual or financial stakes in the outcome. But I loved your other point too - nothing really changed (though I worry payers and lawyers will use this as fodder).
Thank you! After your post on this last week, I went through the last 8 different aha/acc guidelines and did the same exercise. Over all of them, 61% of class 1 recommendations are based on b-nr or c LOE. It’s totally wild
That’s incredible, and incredibly disturbing.
Way too much emphasis on cholesterol without context. Insulin resistance and life styles and other factors all ignored. Conveyor belt medicine at best. Do we even have a solid grasp on how these guidelines are interpreted and acted upon by family physicians? Shared decision making anyone?
Statins for primary prevention have not been shown to prevent death or cardiac events. Statins increase risk for dementia and DM2. I began statin ~25 years ago on advice of my family doctor & agreed to it because I am adopted & don’t know my family history. Now @ 75 years old physically active (running & gym), with no cardiac events I stopped my statin because I don’t want to take the chance of burdening my wife taking care of a demented old man, my cholesterol has gone up but I don’t care.
You started with a premise that is false and came to the wrong conclusion. Have fun with that.
How so?
Just say no to drugs
So thoughtful! I am hesitant to take statins because I’m already in pain every day.
there is no evidence that statins do anything but harm to women.
Have there been studies done, or is it that a lack of studies exist and therefore the claim is “no evidence exists”?
google it
Its the side effects that are they telltale signs. Muscle cramps in my calves, while walking or jogging. Cramps in my calves and occasionally hamstring while sleeping. Weakness in muscles.....
That happened more than a decade ago. Also I believe it affects the liver as well.
I am not a Doctor nor a Nutrisinist so i will not give any advice. What I did do was go on a protein diet recommended by two friends that had great results from using this diet plan and also after visiting a nutritional store, i chose a path that i felt I could follow.
Its not easy but the results were great. My doctor and Endocrinologist were really happy with the results.
I’ve had cholesterol near 300 even when I was a skinny teenager. My whole Italian side does, I’m sure if I could eat Mediterranean I’d be fine nothing else seems to work. But is too expensive
Cholesterol runs in my family as well. The one thing I forgot to mention is that's i started going on long walks, I started slow, and worked my way up to 10k per night. That had a lot to do with my losing weight and bringing my Blood pressure down and cholesterol levels down a well.
Curious as to whether there has been research related to evaluating guidelines v outcomes? Eg, do these recommendations improve outcomes?
Yes there have been studies, statins are highly recommended for High Risk individuals with heart condition and stroke, blocked arteries.
I do not have all the numbers or studies.
As to the question of alternative treatments, ten years ago there were hardly any other treatments. My daughter works in a hospital, she mentioned to me that there are more alternatives these days.
Don't LDL subtypes matter any more? I thought small dense LDL was bad and large fluffy LDL was unproblematic?
Best cholesterol value is which is not measured (ie cholesterol isn't worth measuring)
Well, it's worth knowing HDL and triglycerides, as a low HDL/TG ratio (<2) is a reliable indicator of insulin resistance, which is most definitely a risk factor for heart disease and many other health maladies. Insulin resistance can be addressed with a well-formulated low carb diet and ruthless elimination of all veg oils/seed oils.
Thank you finally someone who gets it!
Thank you,
Around eighteen years ago, I was prescribed Lipitor, about six months following the first dose i started to have issues , cramping in my legs, weakness.... Ok lets try Crestor, nope same thing, Zocor nope........
You know where im going with this.
It might not be for everyone. I found a secret bullet on my own. I lost thirty pounds, started eating healthy, and exercising. Might not work for everyone but it definetly worked for me.
I’m glad you noted GLP-1 albeit briefly. I am 74 w a family history of heart disease and coronary surgeries and stents, which I have avoided. 35 years ago my PCP started me on statins-Crestor. At 65, after slow increases in blood pressure, started amlodipine. Added a low dose of Meloxicam to help me lessen hand arthritis that interrupted my sleep. Had elevated glucose and weight kept increasing - to 220lbs, height 5’9”. I began semaglutide in August and loss 2lbs/week for 22 weeks so 175 lbs now. Exercise, walk, continue to do yard work. Now phasing out Semaglutide. Lab work improved dramatically- glucose 160 down to88, LDL calculated 120 to 60, triglycerides from 60 to 40, non HDL from 130 to 68. Also had good heart ejection fraction test score of 65% at age 71 which I attribute to statin and exercise. 3of 4 siblings have coronary disease. My 2 points are that: I believe my PCP took my family history of coronary disease very seriously when I was 40 years old by starting the statin, and that GLP-1 may become a huge key to improvements as you allude to. I know to never substitute one experience for double blind studies but as you noted, some patients respond differently than others and I wanted to reinforce both. And I can’t close without noting that I have had every vaccine and boosters. I don’t understand all the terminology but thoroughly enjoy your scientific approach applied individually to your patients. We learn from you.
A friendly reminder: you're only postponing death.
I'm afraid it's too late to have us believe any of that. After the covid farce, shamefully consented to by most MDs, many of us have done our research. It's mostly conflicts of interest aimed at making people buy ever more 'preventive' drugs. In the midst of that fog, are any published results credible? AFAIC, they are are simply undecidable
Misguided ideas have amazing inertia when profits increase.
Yeah right. You still have no idea of the role of cholesterol in women's health.
Yeah, but when are health groups, insurance and doctors going to apply these guidelines to care and testing?
What about Dave Feldman and Nick Norwitz among some of the people involved in cholesterol study? This study has been going on for years!