and my doctor wants to have a talk with me about lowering my cholesterol. I’m already doing all of the easy things so I suspect he will want to put me on drugs.
I think the evidence for the effectiveness of statins is very convincing. The absolute risk reduction from statins will depend primarily on your individual baseline risk of coronary disease. From the information you have provided, I don’t think your baseline risk is extraordinarily high, but it is also not negligible.
You will have to make a trade-off where the important considerations are (1) how bothered you are by the side-effects, (2) what absolute risk reduction you expect based on your individual baseline risk, (3) the marginal price (in terms of side effects) that you are willing to pay for slightly better chance at avoiding a heart attack. I am not going to tell you how to make that trade-off, but I would consider giving the medications a try simply because it is the only way to get information on whether you get any side effects, and if so, whether you find them tolerable.
(I am not licensed to practice medicine in the United States or on the internet, and this comment does not constitute medical advise)
I don’t want to complain about downvotes, but if someone believes that the above comment is misleading in any way I would like to hear the argument.
I am mostly posting this because I have a strong hunch that if an admin looks up who downvoted the above comment , they will discover sockpuppet belonging to a man known by many names.
Cholesterol—specifically, the importance of “cholesterol” (actually, lipoproteins) numbers—is a hotly contested topic. There are so-called cholesterol wars about it. The mainstream position has been slowly evolving from “cholesterol is the devil” to “LDL is the devil” to “You need to look at HDL and trigs as well, but LDL is bad anyway” to “It’s complicated” :-/
Doctors, unfortunately, tend to have a hard boundary in mind and if your cholesterol is above it, they feel the need to drive it below that boundary. I am not a fan of this approach.
Statins are a whole big separate issue. My impression is that statins have been shown to be quite effective for cardiac patients, that is, people who already had a cardiovascular event and are at high risk for another one. The use of statins for primary prevention, that is for people without any history of CVD is another thing. Pharma companies, obviously, really really want statins to be used for primary prevention.
The problem is that the effectiveness of statins for primary prevention is iffy. Essentially claims for it rest on a single trial called Jupiter. Before it, the Cochrane Collaboration stated that the use of statins for primary prevention was not shown to be useful. After that trial Cochrane changed the review and said that “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.” You can read the entire review (pay attention to absolute risk reduction numbers).
ETA: What, Cochrane reviews are behind a paywall now? I thought they were free-access. In any case, here is a link to a freely-available version.
If you feel you need to do something about your LDL without statins, try changing your diet. In particular, saturated fats push up LDL (but they also push up the “good” HDL).
You did the 23andMe thing, right? What’s your APOC3 status?
Actually, check APOE first as it has pronounced effects. It’s usually considered to be an Alzheimer’s risk factor, but besides that it affects your cholesterol levels and specifically how they react to the saturated fat in your diet. See e.g. this paper or a high-level overview.
Excellent article. Do you happen to know of any evidence based research on cholesterol? Mine just came back at:
Whole Cholesterol 242
Triglycerides 73
HDL 55
LDL 172
and my doctor wants to have a talk with me about lowering my cholesterol. I’m already doing all of the easy things so I suspect he will want to put me on drugs.
I think the evidence for the effectiveness of statins is very convincing. The absolute risk reduction from statins will depend primarily on your individual baseline risk of coronary disease. From the information you have provided, I don’t think your baseline risk is extraordinarily high, but it is also not negligible.
You will have to make a trade-off where the important considerations are (1) how bothered you are by the side-effects, (2) what absolute risk reduction you expect based on your individual baseline risk, (3) the marginal price (in terms of side effects) that you are willing to pay for slightly better chance at avoiding a heart attack. I am not going to tell you how to make that trade-off, but I would consider giving the medications a try simply because it is the only way to get information on whether you get any side effects, and if so, whether you find them tolerable.
(I am not licensed to practice medicine in the United States or on the internet, and this comment does not constitute medical advise)
I don’t want to complain about downvotes, but if someone believes that the above comment is misleading in any way I would like to hear the argument.
I am mostly posting this because I have a strong hunch that if an admin looks up who downvoted the above comment , they will discover sockpuppet belonging to a man known by many names.
Do you have other risk factors for heart disease such as high blood pressure?
Not blood pressure which is around 122⁄84. No family history, but 23&me says I have a 1.13x risk of Coronary Heart disease. I’m not overweight.
Cholesterol—specifically, the importance of “cholesterol” (actually, lipoproteins) numbers—is a hotly contested topic. There are so-called cholesterol wars about it. The mainstream position has been slowly evolving from “cholesterol is the devil” to “LDL is the devil” to “You need to look at HDL and trigs as well, but LDL is bad anyway” to “It’s complicated” :-/
Doctors, unfortunately, tend to have a hard boundary in mind and if your cholesterol is above it, they feel the need to drive it below that boundary. I am not a fan of this approach.
Statins are a whole big separate issue. My impression is that statins have been shown to be quite effective for cardiac patients, that is, people who already had a cardiovascular event and are at high risk for another one. The use of statins for primary prevention, that is for people without any history of CVD is another thing. Pharma companies, obviously, really really want statins to be used for primary prevention.
The problem is that the effectiveness of statins for primary prevention is iffy. Essentially claims for it rest on a single trial called Jupiter. Before it, the Cochrane Collaboration stated that the use of statins for primary prevention was not shown to be useful. After that trial Cochrane changed the review and said that “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.” You can read the entire review (pay attention to absolute risk reduction numbers).
ETA: What, Cochrane reviews are behind a paywall now? I thought they were free-access. In any case, here is a link to a freely-available version.
If you feel you need to do something about your LDL without statins, try changing your diet. In particular, saturated fats push up LDL (but they also push up the “good” HDL).
You did the 23andMe thing, right? What’s your APOC3 status?
I’m not sure which SNP or position for the APOC3 gene you are referring to.
Actually, check APOE first as it has pronounced effects. It’s usually considered to be an Alzheimer’s risk factor, but besides that it affects your cholesterol levels and specifically how they react to the saturated fat in your diet. See e.g. this paper or a high-level overview.
APOC3 is this.
I’m E3/E3 for APOE which I guess means I have less to worry about.