Author Topic: Statins Again  (Read 4078 times)

0 Members and 1 Guest are viewing this topic.

Offline Alan

  • Member
  • Posts: 3,154
    • Type 2 Diabetes - A Personal Journey
Statins Again
« on: 11 June 2015, 12:32:54 AM »
In preparing a post for another forum I found the best source of links on the statin debate to be right here. I went back through the many topics and collated this list of links posted on this forum to papers, blogs and other articles on the subject .

I hope it helps anyone considering whether or not to accept the drug.
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)

Offline Alan

  • Member
  • Posts: 3,154
    • Type 2 Diabetes - A Personal Journey
Re: Statins Again
« Reply #1 on: 11 June 2015, 12:36:38 AM »
This chart was too big to include in the opening post:



Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)

Offline nytquill17

  • Global Moderator
  • Posts: 6,465
  • It's all in the balance.
Re: Statins Again
« Reply #2 on: 11 June 2015, 01:35:01 PM »
Wow, thanks for all that legwork, Alan! I know I've often said to people that they can "search the forum for other statin discussions and links". Now I will just point them here!
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline lozzark

  • Member
  • Posts: 1,286
Re: Statins Again
« Reply #3 on: 11 June 2015, 02:50:44 PM »
Hi Alan,


Very good to see all these links in one place.


I think what we are up against is articles like this one below.  Doctors read article like it and it reinforces their belief that statins are the best thing sliced bread.  When I read it, it looked so convincing.  It needs going through and dismantling with a fine tooth comb!


http://www.bcmj.org/article/ancel-keys-and-lipid-hypothesis-early-breakthroughs-current-management-dyslipidemia
T2 Dx 2000 Metformin Gliclazide HbA1c 53 BP 129/79 Cholesterol 5.4, HDL 1.16, LDL 2.9.

Offline Pattidevans

  • Administrator
  • Posts: 23,650
  • It's ONLY Diabetes. It could be something worse!
Re: Statins Again
« Reply #4 on: 11 June 2015, 04:53:03 PM »
See.. It's an excellent forum!  Glad you have made it a sticky Nyt.

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline nytquill17

  • Global Moderator
  • Posts: 6,465
  • It's all in the balance.
Re: Statins Again
« Reply #5 on: 11 June 2015, 05:24:53 PM »
A few things I see on reading through it :


Disclaimer - I haven't read any of the studies mentioned so I don't know what was actually reported (vs. what is reported about what was reported), what choices were justified and how, etc.

No mention of the data Keys excluded from the 7 countries trial. This is also the first time I realized that the 7 countries trial involved a recall element, that is, part of the data is based on what people remembered and reported having eaten. Self-report data such as this can certainly be useful and in some cases is unavoidable/the only way to get the data you're looking for, but it's also less reliable because it depends on people's memory and on their willingness to disclose.

Correlation is implied as causation in almost every single instance where they cite data. "X group eats more dietary fat and has more heart disease than Y group" doesn't prove that fat causes heart disease. What other factors may be implicated? Carb quantity? Carb type (refined vs. whole grains)? Activity level? Hours spent sitting? Stress levels? Pollution? Other nutritional deficiencies?

None of the statin trials reported appear to have been done on normal populations. This brings up two points. One - therefore we can only generalize results at best to "high risk" populations. Which is already an assumption of a sort (that said populations are homogenous and normalized and there aren't other factors involved). And when it comes to determining high risk, again, "other factors" becomes an issue. What is it about being diabetic that increases heart disease risk, and whatever "it" is, would statins effectively treat that? What is it about having had a prior heart attack that makes another one more likely, and do statins effectively treat that? (it appears so, at least, this is the one population that we have significant information about). There is no guarantee that what increases risk in one population is the same as what increases risk in another. Same way as treating high blood sugar can require very different approaches depending on what is really at the heart of it (autoimmune, IR, other metabolic disorders, something else?)

Two - how is "normal" defined? Not only "at what level" but literally how did we come to that decision? I notice in some places they cite certain levels as being "near normal" and in other places similar levels are reported as being "at risk", ex. 5.5 for the highest level of mortality in the Japanese studies, vs. 5.5 as "near-normal" in the AFCAPS and ASCOT studies cited further down. Also, are we defining normal as being "what generally healthy members of the population have" or are we defining it based on "what we usually see in studies" or "what we usually see in studies minus a little bit because we assume the study participants are diseased?" Are we defining normal or healthy cholesterol as something that is realistically achievable without intervention for the majority of healthy people, or are we defining it on paper based on conclusions we have already drawn about what healthy cholesterol ought to be? If we put "normal" at 4, and most of the population is at 5, then every time someone with a "high" (but actually quite average) cholesterol of 5 dies from heart disease that adds to the statistics that say that "high" cholesterol contributes to heart disease and heart disease deaths.

I also note that there is very little attention given to whether lowering cholesterol in general, and statins in particular, have other harmful effects on the cardiovascular or other systems. In other words there is no cost-benefit analysis mentioned. Yes, for a drug to be released, a cost-benefit study is required, however what are the "costs" that were taken into account (typically only mortality or serious side effects during the period of the study) and what other things might have been overlooked? For example what if statins reduce inflammation and lower cholesterol counts (it appears that they do) but then lead to whatever cholesterol IS produced being of lower quality and therefore more damaging to the cardiovascular system? What is the overall reduction to risk in that case? Plus, "safety" and "efficacy" as statistical terms don't cover the entirety of a drug's effects - that's why we see so many drugs that make it to market only to be recalled. A larger swathe of the population generates more data over more time than a concentrated study, and things pop up that were missed before. But in many cases these additional effects aren't made the focus of subsequent studies, so they don't get cited in the literature, and thus they don't get included in education programs.

Of course the same critical analysis can be applied to the other side of this debate. No study is without unconsidered factors (you can never control for everything, on the one hand, and on the other hand new knowledge is updating what we consider as a "factor" all the time, for example we now know that total cholesterol isn't the whole story and we have to look at breakdowns and ratios to be able to draw meaningful conclusions). And every study must make methodological choices, which means that it could also have been done a different way and perhaps gotten different results. In the end what I always draw from these kinds of debates is that we are certain, in fact, of very little in any scientific field. And a good scientist will agree that certainty is an illusion. However by the time it has been filtered through the public health machine and reached the level of patient education/general knowledge, all these things are presented as facts, with the idea that it is possible to know exactly what the right answer is, and going against that right answer is potentially a mortal sin. In the end even science involves a certain amount of personal belief.
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Alan

  • Member
  • Posts: 3,154
    • Type 2 Diabetes - A Personal Journey
Re: Statins Again
« Reply #6 on: 12 June 2015, 12:07:48 AM »
I should have added the qualification I noted when I posted elsewhere.

This is a diverse and broad collection ranging from expert comment to anecdotal opinion. Some are good, some are rubbish but before you discard the opinion pieces note that many are supported by further cites. Personally, there are enough science-supported reports among these for me to happily continue to say no when my doctor pushes this drug.
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)

Offline lozzark

  • Member
  • Posts: 1,286
Re: Statins Again
« Reply #7 on: 12 June 2015, 01:15:34 AM »
Hi Nytquill17 & Alan,


I am very grateful for your observations and thoughts.  I've said no to these drugs every time my doctor pushed them since the last millennium.  The reason I posted an article "from the other side" was to show why doctors might think statins have benefits. You can see for yourself that a supposedly authoritative article is full of holes. Doctors do not have time to do detailed research, or detailed analysis of supposedly peer reviewed articles, and very few are inclined to oppose conventional wisdom so generally they accept what their professional associations tell them. The majority of patients are simply going to accept what their doctors say.  What if the research were  wrong?  Statins may cause more trouble than they are worth for many people, but the "establishment" is all self-reinforcing and nothing yet can be done to challenge their wisdom.
T2 Dx 2000 Metformin Gliclazide HbA1c 53 BP 129/79 Cholesterol 5.4, HDL 1.16, LDL 2.9.

Offline Avocado

  • Member
  • Posts: 1,535
    • My French website
Re: Statins Again
« Reply #8 on: 12 June 2015, 12:17:52 PM »
Brilliant to see all those links in one place !
Anne

Atypical Type 2, thin, not insulin resistant, diagnosed March 2007. Very low carb (30 - 50g per day) Paleo diet and exercise - Prandin (Repaglinide) 0.5mg. Aortic Valve Replacement Jan 2014, Osteoporosis, Small airways disease, probable coeliac - Strontium Ranelate 2g/d, Omacor 2g/d, vitamin K2 300mcg/d, Aviticol (vit D3) 20,000 IU every week, Qvar 100 2/day.

Current HbA1c 33 Current total cholesterol 7, HDL 3.5, LDL 3.2, triglycerides 0.4

Offline sedge

  • Global Moderator
  • Posts: 13,785
Re: Statins Again
« Reply #9 on: 12 June 2015, 04:57:53 PM »
Yes - Ace!

With the caveat that you'll never get a GP not to mention anyone higher up the NHS chain - to believe it.  I swear you, Anne, must have the only consultant in England that isn't!  Or - much more likely as far as I'm concerned - do you manage to convey the salient points to such people in a convincing way?

I could do with lessons - I'd just had a statin rant with a new D consultant the other day, when the DSN - who does know me in passing but doesn't know me - innocently asked about my pump - well you know the delays I've been having! - so afraid she got it in the ear about THAT too.  I really wish I knew her email address so I could apologise!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

  • Administrator
  • Posts: 23,650
  • It's ONLY Diabetes. It could be something worse!
Re: Statins Again
« Reply #10 on: 12 June 2015, 05:49:07 PM »
Is there no more news on your new pump Sedge?
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Avocado

  • Member
  • Posts: 1,535
    • My French website
Re: Statins Again
« Reply #11 on: 12 June 2015, 05:50:37 PM »
I've never said much Jenny other than that my high HDL is protective (that's what 'they' think.....I'm not sure it's anything to do with it but as long as mainstream believes it to be the case....), and so also my ratio is in the very protective range (again what mainstream thinks). I've also mentioned the Friedewald formula and shown him my LDL calculated using the Iranian formula. My last few GPs were also okay....one of them was a bit concerned so I said I was very happy with my lipids and pointed out that a CT angiogram had shown my arteries to be clear. I don't know about the current one, he's gone and written on my notes that I have 'pure hypercholesterolemia' - I looked that up and found that it's familial hypercholesterolemia - dozy doc doesn't realise I've been investigated for that and I haven't got that !  They don't read back through the notes anymore. But the way GPs are at the moment at my surgery, they change all the time, the place has really gone downhill, so there's not much to worry about. But if I got a controlling GP I'd just say I'd think about it and not see him again....or maybe in my fantasy I downright refuse and quite Dr Kendrick et all - fun, but maybe not.
Anne

Atypical Type 2, thin, not insulin resistant, diagnosed March 2007. Very low carb (30 - 50g per day) Paleo diet and exercise - Prandin (Repaglinide) 0.5mg. Aortic Valve Replacement Jan 2014, Osteoporosis, Small airways disease, probable coeliac - Strontium Ranelate 2g/d, Omacor 2g/d, vitamin K2 300mcg/d, Aviticol (vit D3) 20,000 IU every week, Qvar 100 2/day.

Current HbA1c 33 Current total cholesterol 7, HDL 3.5, LDL 3.2, triglycerides 0.4

Offline sedge

  • Global Moderator
  • Posts: 13,785
Re: Statins Again
« Reply #12 on: 13 June 2015, 01:24:05 AM »
Is there no more news on your new pump Sedge?

Won't hijack, I'll say in the pump thread Patti.  But NO basically.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Alan

  • Member
  • Posts: 3,154
    • Type 2 Diabetes - A Personal Journey
Re: Statins Again
« Reply #13 on: 13 June 2015, 09:56:33 PM »
Hi Alan,


Very good to see all these links in one place.


I think what we are up against is articles like this one below.  Doctors read article like it and it reinforces their belief that statins are the best thing sliced bread.  When I read it, it looked so convincing.  It needs going through and dismantling with a fine tooth comb!


http://www.bcmj.org/article/ancel-keys-and-lipid-hypothesis-early-breakthroughs-current-management-dyslipidemia
This bloke seems to think the sun shone out of a part of Keys anatomy; never questioning the methodology of Key's "studies". I reckon Taubes' analysis of Key's work showed at least incompetence if not outright fraud.
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)

Offline lozzark

  • Member
  • Posts: 1,286
Re: Statins Again
« Reply #14 on: 15 June 2015, 01:18:45 PM »
I found this guy very good.  He tells the story well - well worth watching.
About 30 mins in he explains what Key's fatal error was.
[He did not do part of the regression analysis that showed it was sugar (esp fructose), not fat, that was the key factor in CVD]
https://www.youtube.com/watch?v=dBnniua6-oM&feature=youtu.be
T2 Dx 2000 Metformin Gliclazide HbA1c 53 BP 129/79 Cholesterol 5.4, HDL 1.16, LDL 2.9.