Monday, November 25, 2013

Cholesterol guidelines: More on statins

New guidelines about cholesterol levels and treatment were supposed to clear things up, but I'm just more confused.

Should I be taking statin drugs every day just because my LDL cholesterol number is high, which is "bad," and even though my HDL cholesterol is also high, which is "good."

Under these new guidelines, nearly half the U.S. population would be using statins to stave off heart attacks and strokes, according to Dr. Nortin Hadler, a UNC Chapel Hill professor of medicine and microbiology/immunology.

In a recent article for Scientific American, Hadler and his co-author remind us that these drugs are not without potential side effects and will offer no substantive benefits to many.

The article, entitled "How Clinical Guidelines Can Fail Both Doctors and Patients," says the authors of the new guidelines "were faced with robust data that demonstrates a correlation between cholesterol level and clinical outcomes over time. But despite the substantive science behind the connection, the correlation is weak. The guideline neglects to emphasize this fact."

Hadler, widely known for writing books such as "Worried Well" and "Citizen Patient," is skeptical about much of the treatment that medical doctors recommend today, including such broad prescribing of cholesterol-fighting drugs.

Here's is a link to the piece co-authored by Hadler and Dr. Robert McNutt, a former editor at the Journal of the American Medical Association  and the Journal of General Internal Medicine. McNutt is a professor of Medicine at the University of Wisconsin and Rush University Medical Center.


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Low grade systemic inflammation certainly has a place in the development of coronary heart disease. However, heart disease is multifactorial and inflammation does not exclude other factors. Poor cholesterol ratios (TC/HDL) is still a risk factor. And there are others: cholesterol oxidation, insulin resistance, free radicals, lack of omega-3 fatty acids (increases the risk of arrhythmias and thrombosis), endothelial dysfunction, vascular and aortic calcification etc.
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