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Old 09-21-2019, 06:29 PM
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So it is unknown whether the connection is causation, correlation, confounding, outlier from something else, etc. Although most likely one of the first two...
Correct. The studies were aimed at gauging elloquis and xarallto's effectiveness at preventing additional clots along with complication data such as bleeding when compared to the standard of care, coumadin.

The studies were designed to test for patients on those medications. It was not randomized to look for any CV calcification.

The study did not look at LDL's or triglicerides or medication compliance, it did not consider age (elderly are more likely to have CV disease and be on coumadin...)

The studies were not conducted in a way to actually test for these conclusions which people are drawing. It was only looking at the safety profile and efficacy of the medications at preventing clots and complications of bleeding.

The problem with drawing inferences is that without knowing, every cardiac valve and bypass patient could have been on coumadin (already having CV disease), and every DVT patient on xarallto, and all the afib patients on elliqus. Then drawing the conclusion coumadin leads to CV disease (which was present prior to medication) would be flawed....
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Old 09-22-2019, 04:15 AM
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Originally Posted by Im RIght View Post
1. Nothing is without risks. There is a risk of the condition, and risk of the medication. I would not advise someone to just take a medication without reasons. If one has elevated cholesterol, or other risk factors such as diabeties, stents or events, then the benefits typically out weight the risks.

2. Muscle pains are not permanent. If the myalgia is too great, stop the mediation. And, for someone with few medical options, no one's ever died of muscle pain... (although rabdo is a rare possibility but I think you get my point).

3. Crestor (and livalo) is more hydrophilic than all the statins, this makes the muscle pains less probable.

4. Lower doeses, or every other day dosing along with CoQ10 do a great job of eliminating the muscle pains from statins.



There is some theory it is not necessarily the drug, but the low LDL concentrations that allow for the plaque regression. Crestor is the most potent statin which is why it was used in the studies. Rapatha howver is an injectable that works in a much different way and is far greater at LDL reduction than even crestor.

https://www.webmd.com/heart-disease/...aque-buildup#2

There is no game of just winners. If you consider the sun as a "medication" in how you are administering it for the benefits, there are risks as well. One must gauge their own risk tolerances to determine if the benefits are worth it as you did with crestor above.
Of course, one should gage risk and benefit. That is a controversial area with statins and cholesterol lowering medications, of course, what benefits are given. One would hope they would extend life, but studies have not found that.

Along with the side effects of muscle pains, fatigue, memory loss etc, another area that bothers me about statin medications is that studies have not found statins to extend life. They do lower LDL cholesterol, but that hasn't been found to significantly extend the life of those taking the medications.

Along these lines, In the UK recently it became possible to purchase statin medications without a prescription. Dr. Aseem Malhotra, a well known prevention cardiologist, expressed his concerned over this in a TV interview. That can be seen here ~

"Aseem Malhotra chats on Sky News about the over-hyping of the benefits of statins and a call for a review of their use."

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Old 09-22-2019, 11:01 AM
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Along with the side effects of muscle pains, fatigue, memory loss etc, another area that bothers me about statin medications is that studies have not found statins to extend life. They do lower LDL cholesterol, but that hasn't been found to significantly extend the life of those taking the medications.
I read there are no significant studies, zero, showing statins prevent first heart attacks. If you can find one, let's see it.
Yet every doctor recommends statins when cholesterol hits xxx, regardless of your heart health.
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Old 09-22-2019, 11:15 AM
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I read there are no significant studies, zero, showing statins prevent first heart attacks. If you can find one, let's see it.
Yet every doctor recommends statins when cholesterol hits xxx, regardless of your heart health.
Cholesterol as a raw number, I would agree with you.

However, have you read studies that state no correlation of between LDL's and CV/MI events?

Is your position reduced/increased CV/MI events has no effect on life expectancy?

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Of course, one should gage risk and benefit. That is a controversial area with statins and cholesterol lowering medications, of course, what benefits are given. One would hope they would extend life, but studies have not found that.
https://www.repathahcp.com/reducing-risk/lower-ldl-c/

The science is quite clear. It is a straight line correlation between LDL's and 5 year CV events risk. The above chart is for reference of 20+ studies.

If your position is CV events are not indicators of life shortening events, then we will agree to disagree. Not all MI's end in death, but eventually they will. Not all occlusive disease is a life shortening event, but risks of amputations and bypass surgeries are not without their own risks...

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Along with the side effects of muscle pains, fatigue, memory loss etc,
Lipophillic statins such as zocor and lipitor are much more likely to cause these probles. Hydrophillic statins such as livalo and crestor do not have this as typical profile risks. They do not cross the blood brain barrier easily, they do not effect the muscle fibers and neuro pathways as easily. I can kill the right person with any medication, so risks will always exist, but these medications present with a much lower risk profile vs the older statins.

Rapatha, the newest of the cholesterol lowering medications, does not have those as risks; it's for statin intolerant patients.


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Originally Posted by Cranberry View Post
They do lower LDL cholesterol, but that hasn't been found to significantly extend the life of those taking the medications.
Again, the science is very clear. It is a straight line correlation between 5 year event risks vs level of LDL's. I would really like to read one of the studies you are implying exist that state otherwise.

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Originally Posted by Cranberry View Post
Along these lines, In the UK recently it became possible to purchase statin medications without a prescription. Dr. Aseem Malhotra, a well known prevention cardiologist, expressed his concerned over this in a TV interview.
There are lots of reasons I believe one should be medically managed by a professional if taking statins which includes periodic lab work 3 months after initiation and every 6 months there after. Risks for rhabdo and risks to the liver dysfunction are 2 reasons, along with med to med interactions.
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Old 09-22-2019, 11:33 AM
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Originally Posted by Im RIght View Post
https://www.repathahcp.com/reducing-risk/lower-ldl-c/

The science is quite clear. It is a straight line correlation between LDL's and 5 year CV events risk.
Those studies showing reduced MI events are run on people with prior heart attacks, prior stroke victims - a crucial point but always omitted by the TV advertisements and others.
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Old 09-22-2019, 09:41 PM
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Those studies showing reduced MI events are run on people with prior heart attacks, prior stroke victims - a crucial point but always omitted by the TV advertisements and others.
Let's stick to our discussion not other's or TV ads...

You did not argue the at risk population would benefit from lower LDL's. So why do you only consider the at risk population those with a history of a CV event?

According to the CDC of the 750,000 reported MI's per year, 500,000 of them are first time events. https://www.cdc.gov/heartdisease/facts.htm

Would those first timers NOT have benefited from lower LDL's? Does that straight line correlation not apply to people who have never had a documented MI or CV event? Does something in the body change after a CV event which turns LDL's from intert to active?

You are making the claim, or at least implying, that only people with documented CV history will benefit from lower LDL's, yet 2/3's of all annual events (MI) are first time events. What is your rationale to support 2/3's of the annual MI patients would not have benefited from lower LDL's prior to the event but will afterwards?


EDIT: An article I found... you need to read more than the title in researching anything...

TITLE: Most Heart Attack Patients' Cholesterol Levels Did Not Indicate Cardiac Risk

TEXT: We found that less than 2 percent of heart attack patients had both ideal LDL and HDL cholesterol levels....

https://www.sciencedaily.com/release...0112130653.htm

Would seem we can agree to disagree on what "most" means. It's old, but was the first that came up on google... My point is don't just read the highlights. Sometimes, the truth is buried in there.
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Old 09-23-2019, 01:57 AM
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Just show me a real study that statins prevent heart attacks in people who have not had one. Simple.
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Old 09-23-2019, 05:09 AM
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Originally Posted by Im RIght View Post
Cholesterol as a raw number, I would agree with you.

However, have you read studies that state no correlation of between LDL's and CV/MI events?

Is your position reduced/increased CV/MI events has no effect on life expectancy?


https://www.repathahcp.com/reducing-risk/lower-ldl-c/

The science is quite clear. It is a straight line correlation between LDL's and 5 year CV events risk. The above chart is for reference of 20+ studies.

If your position is CV events are not indicators of life shortening events, then we will agree to disagree. Not all MI's end in death, but eventually they will. Not all occlusive disease is a life shortening event, but risks of amputations and bypass surgeries are not without their own risks...


Lipophillic statins such as zocor and lipitor are much more likely to cause these probles. Hydrophillic statins such as livalo and crestor do not have this as typical profile risks. They do not cross the blood brain barrier easily, they do not effect the muscle fibers and neuro pathways as easily. I can kill the right person with any medication, so risks will always exist, but these medications present with a much lower risk profile vs the older statins.

Rapatha, the newest of the cholesterol lowering medications, does not have those as risks; it's for statin intolerant patients.



Again, the science is very clear. It is a straight line correlation between 5 year event risks vs level of LDL's. I would really like to read one of the studies you are implying exist that state otherwise.


There are lots of reasons I believe one should be medically managed by a professional if taking statins which includes periodic lab work 3 months after initiation and every 6 months there after. Risks for rhabdo and risks to the liver dysfunction are 2 reasons, along with med to med interactions.
OK sure, off the top of my head, here are some counter points in articles I'm familiar with on cholesterol lowering medications -

"It’s about time some people were straight with the statistics on statins"

http://www.drbriffa.com/2014/02/14/i...cs-on-statins/

&

"Evidence links higher cholesterol with lower risk of death in older individuals"

http://www.drbriffa.com/2014/08/15/e...r-individuals/

&

"How Much Longer Will You Live If You Take A Statin"

https://drmalcolmkendrick.org/2015/1...take-a-statin/
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Old 09-23-2019, 09:29 PM
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Just show me a real study that statins prevent heart attacks in people who have not had one. Simple.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481400/

Quote:
Reductions in all‐cause mortality, major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins.
Your turn. Show me a real study that stats statins do not prevent heart attacks in people who have not had one.
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Old 09-23-2019, 09:41 PM
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"Evidence links higher cholesterol with lower risk of death in older individuals"
In 85 year olds (the cohort in the study above), MI's are very low on the list of cause of mortality. Collateral circulation is well established. I agree this age group is most likely not going to benefit from this medication/reduction of cholesterol anymore than they will from annual mammograms. Is your take-away 40 year old women should not get mammograms because an 85 year old will not benefit from such an exam?
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Old 09-24-2019, 05:10 AM
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In 85 year olds (the cohort in the study above), MI's are very low on the list of cause of mortality. Collateral circulation is well established. I agree this age group is most likely not going to benefit from this medication/reduction of cholesterol anymore than they will from annual mammograms. Is your take-away 40 year old women should not get mammograms because an 85 year old will not benefit from such an exam?
Well, I don't really follow the mammogram debate. I have noticed though that nearly every year of late a new study comes out saying that mammograms are not beneficial. These are studies that the press picks up. As an example from Reuters ~

"New study adds to evidence that mammograms do not save lives"

https://www.reuters.com/article/us-m...A1B1RJ20140212

excerpt:

A new study has added to growing evidence that yearly mammogram screenings do not reduce the chance that a woman will die of breast cancer and confirms earlier findings that many abnormalities detected by these X-rays would never have proved fatal, even if untreated.

The research, published on Wednesday in the British Medical Journal, is the latest salvo in a decades-long debate over the benefit of mammograms. The 25-year study of 89,835 women in Canada, aged 40 to 59, randomly assigned the volunteers to receive either annual mammograms plus physical breast exams or physical exams alone.

The women started receiving mammograms from 1980 to 1985. At the time, doctors believed screening saved lives by detecting early-stage cancers, which were considered more treatable than cancers detected later, especially in women aged 50 to 64.

Instead, the study “found no reduction in breast cancer mortality from mammography screening,” the scientists wrote, “neither in women aged 40-49 at study entry nor in women aged 50-59.”

The findings echo research such as a 2012 study in The New England Journal of Medicine which found that screening mammography “is having, at best, only a small effect on the rate of death from breast cancer. ..."

To me it's troubling as the common breast cancer screening causes a good amount of fear and unnecessary procedures.
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Old 09-24-2019, 05:53 AM
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Well, I don't really follow the mammogram debate.
Not a debate.

My point is you are comparing geriatrics who have a very low risk profile for the specific diseases (death from MI) as a way to discredit the benefits of statins in the most vulnerable population. prime disease years for both breast cancer (my point) and MI's (mid 40 to mid 60). The study you quoted (and obviously didn't read) deals with the risk benefits of 80+ year old's taking statins.

Get it? Would you apply the results of a study that discusses the risk benefits of mammograms in 90 year olds and apply those findings to a 45 year old? Because that's what you just did with the above reference for statin therapy.

To answer for you, no, you did not quote an article that discussed mammograms on geriatrics, yet you did so with statins... Collateral circulation is much more advanced and effective in the geriatric population which makes MI's from ASD a much lower probability and again I agree with the diminished returns for statin therapy in that age group.
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Old 09-24-2019, 10:17 AM
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Yes, Iamright.

And you disregarded the study i posted about the lack of benefit given for statins.

https://drmalcolmkendrick.org/2015/1...take-a-statin/

excerpt:

"....You cannot stop people dying. You can only make them live longer. How much longer is the key question. With statins this question has been answered. You can, to be generous, add a maximum of two days per year to life expectancy.

Which means that if you were to take a statin for thirty years you could expect to live about two months longer. (Possibly three, more likely one). Assuming, and this is a big assumption, that none of the trials done have been in any way biased towards statins. Even though every single one was funded by the pharmaceutical industry. Further assuming that any benefits seen in the trials will continue for the next twenty-five years.

Why, you may ask, has the pharmaceutical industry never chosen to present the results of the statin trials in this way? In truth that is a bit of a silly question. I think anyone with a half functioning brain knows why the pharmaceutical industry has never chosen to present the result of the statin trials in this way. A 36% reduction in fatal heart attacks does sound rather better than, one extra day of life for every year you take a statin – best case scenario in primary prevention… Does it not?



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Originally Posted by Im RIght View Post
Not a debate.

My point is you are comparing geriatrics who have a very low risk profile for the specific diseases (death from MI) as a way to discredit the benefits of statins in the most vulnerable population. prime disease years for both breast cancer (my point) and MI's (mid 40 to mid 60). The study you quoted (and obviously didn't read) deals with the risk benefits of 80+ year old's taking statins.

Get it? Would you apply the results of a study that discusses the risk benefits of mammograms in 90 year olds and apply those findings to a 45 year old? Because that's what you just did with the above reference for statin therapy.

To answer for you, no, you did not quote an article that discussed mammograms on geriatrics, yet you did so with statins... Collateral circulation is much more advanced and effective in the geriatric population which makes MI's from ASD a much lower probability and again I agree with the diminished returns for statin therapy in that age group.
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Old 09-24-2019, 11:50 PM
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From the "study" you wanted me to discuss...
Quote:
About a year ago I submitted a paper to the BMJ entitled ‘Statins in secondary prevention, lives saved or lives extended.’ To be more accurate, I was the lead author of the paper. So I should say ‘we’ submitted a paper. I have to report that the paper was rejected, re-written and rejected again. In the end I couldn’t get it published.
And his bitch and moan fest, I mean "study" you linked to, went down hill from there.

It is an opinion piece or commentary of no scientific substance. You may as well quoted someone else from this forum on this topic in this thread as it carries just as much weight as an opinion. It is not a study and was therefore not considered anything worthwhile, however if that's what you are clinging to,
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And you disregarded the study i posted about the lack of benefit given for statins.
It is NOT a study. It IS a commentary. It is the bitter note written by someone who could not accurately describe how his data was calculated. The BMJ has a rich history of publishing articles contrary to current paradigm so long as they are accurate in their data and pass the same peer review standards as every other article... which Mr. Kendrick could not do. Was he too lazy to submit to other journals? I doubt it, but then you'd know he was rejected multiple times and then the conspiracy theory would be replaced with shoty workmanship standards on his part.

He was unable to meet the peer review standards, which is much different than to suggest his findings would change the paradigm of medicine and Big Pharm would go belly up, so it was no published as he would want you to believe.

In the "study" He complains about a real study funded by a pharmaceutical company, but never considered the flaws in his own attempt at confirmation bias in his writings. Nor does he discuss his funding sources, nor does he discuss own income which is derived from speaking to groups denying the risks of elevated blood cholesterol/triglicerides - at ANY level. I consider myself a reasonable person, and too much of ANYTHING is a bad thing... except cholesterol?

His position on food is this: I don't happen to think that saturated fats are in any way damaging or dangerous. If they were, they wouldn't taste so damn delicious. Nature tends to warn us off dangerous foods by making them taste bitter and icky. His actual words. Go ahead look it up.

I didn't now Mountain Dew and cotton candy and chilli cheese fries were so damn healthy! Did you?
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Old 09-25-2019, 01:09 AM
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The doctor wrote about the BMJ's published study which found about one day gained in life span per year of taking a statin. Not very impressive. Considering the common side effects of taking statins, it doesn't seem worth it.

https://drmalcolmkendrick.org/2013/0...r-that-matter/

excerpt:

....However, more recently the BMJ did decided to publish another paper entitled: ‘The effect of statins on average survival in randomised trials, an analysis of end point postponement1.’ They used slightly different mathematical techniques, including the ‘quick method.’ To quote:

‘We also calculated all areas in a less technical manner, that is, by drawing one or more triangles by hand on magnified paper prints of the survival curve for each study and then calculating the areas of these triangles by standard arithmetic. This is referred to as the quick method.’

I have to admit that’s my kind of maths. Get out the pencils and draw it all out by hand. They also looked at more studies than we did, and aggregated them. Which has benefits and disadvantages. Sometimes you are not comparing like with like. However, the main results of their study, and their conclusions, were as follows:

Results: 6 studies for primary prevention and 5 for secondary prevention with a follow-up between 2.0 and 6.1 years were identified. Death was postponed between −5 and 19 days in primary prevention trials and between −10 and 27 days in secondary prevention trials. The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.

Conclusions: Statin treatment results in a surprisingly small average gain in overall survival within the trials’ running time. For patients whose life expectancy is limited or who have adverse effects of treatment, withholding statin therapy should be considered

Overall their findings were far less impressive, even, than ours. They calculated, approximately, a single day of increase in life expectancy for each year of taking a statin. Slightly more in secondary prevention, slightly less in primary (people who have not previously had a heart attack or a stroke).....



It sort of reminded me of Dr Ezekiel J. Emanuel's opinion piece based upon study results. He suggests skipping the annual physical, which while not said includes cholesterol testing.

"Skip Your Annual Physical"

https://www.nytimes.com/2015/01/09/o...-physical.html

except:

...There is only one problem: From a health perspective, the annual physical exam is basically worthless.

In 2012, the Cochrane Collaboration, an international group of medical researchers who systematically review the world’s biomedical research, analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years that sought to evaluate the benefits of routine, general health checkups — that is, visits to the physician for general health and not prompted by any particular symptom or complaint.

The unequivocal conclusion: the appointments are unlikely to be beneficial. Regardless of which screenings and tests were administered, studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.

This lack of evidence is the main reason the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services — does not have a recommendation on routine annual health checkups. The Canadian guidelines have recommended against these exams since 1979.....
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Old 09-26-2019, 12:53 AM
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The doctor wrote about the BMJ's published study which found about one day gained in life span per year of taking a statin. Not very impressive. Considering the common side effects of taking statins, it doesn't seem worth it.

https://drmalcolmkendrick.org/2013/0...r-that-matter/

excerpt:

....However, more recently the BMJ did decided to publish another paper entitled: ‘The effect of statins on average survival in randomised trials, an analysis of end point postponement1.’ They used slightly different mathematical techniques, including the ‘quick method.’ To quote:
Actual text of the CONCLUSION, from the study you posted and did not read... BMJ... https://bmjopen.bmj.com/content/5/9/e007118

Quote:
What are the clinical implications of our findings? We believe that statins should be prescribed according to the prevailing guidelines. Statins are usually inexpensive and safe, at least in a clinical trial setting, the benefit in terms of mortality or non-fatal cardiovascular outcomes cannot reasonably be challenged.

Something else you might want to educate yourself on regarding the above posts you made... https://www.bmj.com/content/358/bmj.j4171/rr

Quote:
According to Wise, “Five years after the initial trial finished, around one third of the men who were originally assigned pravastatin or placebo were taking statins.” Thus, the majority of people on a statin during the study stopped taking their medication, and to make matters worse, one third of the people that had been on placebo began taking statins after termination of the trial. Hence, any control the investigators had during the 5 year study in which participants were on the drug versus placebo was lost with its termination.

To make matters worse, there was no monitoring of which subjects were on a statin following the termination of the 5 year study. According to Vallejo-Vaz et al, “No later data on the proportion of individuals taking statin therapy were available for the subsequent years of follow-up.” The only thing we can be reasonably certain of is that the majority of all people in the study from both groups were not taking a statin for the final 15 years of the follow-up period. Hence, the follow-up report of outcomes 15 years after the original trial was completed was so flawed as to render its findings uninterpretable.
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Old 09-27-2019, 06:01 AM
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Tragedy struck yesterday. A guy we knew died suddenly from a heart attack. He would have been in his middle 40s. He leaves behind two young kids. His in-laws lived across the street from my parents place and sometimes his kids would come over and play in my parents back yard. He was well to do, being a President and CEO of a local bank.

What ever one things of the cholesterol theory of heart diseases, thought to mention there are several other theories for the cause of heart attacks. Some of these other ideas are known but typically not well addressed.

* Stress and strain is believed to be leading causes of heart attacks. When possible keep stress levels down. The idea behind stress causing heart disease has to do with the fight or flight system. If one is to be in a fight, to stop excessive blood less the body will make it easier for the blood to clot. A blood clot can lead to a heart attack.

* Taking NSAIDS for an extended period of time can lead to heart attacks. The FDA places warnings on these medications for that issue.

* PPI drugs or also known as heart burn medicines have been found to increase the risk of a heart attack in studies. PPIs can interfere with the bodies ability to utilize nitric oxide.
Best to take PPI's for short periods of time if possible.

* Endothelium dysfunction and low nitric oxide (NO) levels. This heart disease theory won Dr. Louis Ignarro a noble prize in the 90s. NO has many uses in our body. Heart disease is one use. Today it is best known for ED/Viagra and similar medications that increase NO levels. There are over the counter NO supplements that are advertised frequently on TV. The older one gets the less NO the body is able to manufacture.

* Elevated Lipoprotein A. This theory of heart disease is often blamed for causing heart attacks in young people. It's often written about as being a genetic condition. There are no medications for LpA. Some approach lowering LpA with diet and supplements. Some believe this helps prevent heart attacks but I don't believe that has been proven.
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Old 09-27-2019, 04:31 PM
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Originally Posted by Im RIght View Post
That link is not a study of heart attack prevention in people who had no history of heart attacks. It is just a cherry-picked study of studies.
Further, no effort was made to use the studies' primary data to search for bias, only published data was used - data from a dozen trials that "were either fully or partially funded by pharmaceutical companies."
So my question is unanswered.
Regarding the authors I should add their other conclusion, which is that since a.) there are no downsides to statins and since b.) they reduce CVD, then b.) everyone, even the lowest risk persons on earth should take them. I wonder if they got a bonus for that suggestion. Read about it in STATINS FOR EVERYONE? by John D Abramson and Harriet G Rosenberg
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