There are no spikes on the cholesterol vs health hazard graph. So what health risks related to mortality are doctors reducing by prescribing a statin drug to lower LDL cholesterol from any point on the graph by 7%, 14%, 21%? There's no benefit. Only side effects, aka negative consequences, that lead to the prescribing of several of the over 50 various drugs to treat the side effects of statins, and of themselves.
Ask an AI to list the side effects of Statins. The ask yourself, "WTF!"
*"for each doubling of statin dosage, one should expect to see a 7% reduction in LDL-C".
That's a really good deep dive. I wish you kept going on, but I'm used to reading this kind of literature, so I understand on some level why you felt the need to hold off on your rant. That was a good description of the Mevalonate pathway for people who have never heard of that
Is the science on what is considered high cholesterol uniform across the population? let's start with that because we know people with normal cholesterol have cardiovascular events as well as people with high LDL cholesterol. In my 15 years of looking at lipid profiles, that fact stood out to me as a red flag. It told me that some other mechanism was at play.
My suspicions are logical and demand a closer look. Meta studies show that metabolic factors play a big role when looking at normal LDL and High LDL. Wheather your LDL is high or low, meta studies show conclusively that normal LDL and high LDL in the presence of metabolic dysregulation cause higher rates of cardiovascular events. Dr Peter Attia showed this in a meta study of approximately 200K patients.
UCLA ICU department spoke out that their ICU had cardiovascular patients with normal LDL profiles. So, I strongly believe metabolic dysregulation in the presence of high or low LDL needs to be studied even more.
I just received a breast cancer diagnosis. My Nurse Practitioner has advised me that my cholesterol is very high and she believes it’s because of the inflammation ( tumour). She thinks I should take Lipitor for a short period of time - six months or so. I’m confused as it is but the thought of a statin ?
I feel good. 65 years old. Physically active. No other prescription drugs. What to do ?
Sounds odd, I know. Thinking on it, would it be that high cholesterol is causing the inflammation ? I was a little messed up at this appointment as you can well imagine.
Yes, one of my levels was a bit off and they offered me a statin. I said, "no, I'll just eat a bit less bacon". You know what is criminal? They never check your vitamin D levels.
The number of deaths don't increase by much with increasing cholesterol? I guess animal ag profits are more important than 100s of 1000s of preventable deaths.
As we all know ill and frail people have low LDL- certain cancers eat cholesterol- and are therefore more likely to die. This doesn't mean LDL is not bad. And because risk doesn't increase much doesn't mean you want risk to increase at all. Throwing more matches into a fire ain't gonna make much difference but better not to have a fire in your house.
High cholesterol is not heathy even if it's being used as energy. As is being shown in recent studies.
If high cholesterol is inherently bad, then why do the longest living people (centenarians) have much higher cholesterol than what is considered "normal"? Including total cholesterol and LDL cholesterol.
Sure, there's probably some upper limit that we should consider.
But, that limit is probably far higher than our common ranges of "normal"
‘At variance with young and aged people, centenarians with high Lp(a) serum levels also had high plasma concentrations of the proinflammatory cytokine IL-6, suggesting that genetic control of the Lp(a) serum level may attenuate with age
‘On the whole, these data support the hypothesis that a continuous and complex reshaping of lipid metabolism occurs in physiological aging, likely contributing to successful aging.’
This seems to say that in centenarians- the control of LDL is diminished-meaning that LDL rises. However, this rise is not from a rise in dietary saturated fat or cholesterol- it’s from a change in internal control. So the high lipoprotein does not show that previously thought unhealthy life style factors are no longer unhealthy. It shows with ageing control of LDL changes.
I agree, high cholesterol is a marker (the risk factor itself is high animal and processed food intake). However, like crossing a busy road, not all people get run over, some get away with it (some of the sardinian blue zone centenarians are smokers or ex-smokers), especially if they have access to other life style benefits, community, high blood pressure medication etc. Cholesterol under 150 and as low as 70 in healthy adults makes one virtually heart attack proof- CVD being the number one cause of death in the west.
Cholesterol levels above normal in old women in Sweden etc shouldn’t be taken as a green light for unlimited saturated animal fat consumption because it doesn’t alter the fact that the longest living populations are plant-based with meat eaten only on special occasions or not at all.
We shouldn’t be obsessing about cholesterol levels but rather overall diet quality- which is one centred around beans, soy, spices, wholegrains, nuts and garden vegetables-eaten- at communal gatherings.
As we know cholesterol levels in younger people is just a biomarker of health. The association holds true in younger people. The fact that physiology changes as we age and the biomarker limits also need to change does not mean that biomarkers for younger people, ie for most of most people’s lives, are wrong or unhelpful.
The studies focus on ‘the longest living people’-ie centenarians- this is disingenuous- many other populations including plant based ones are among the longest living ie they having centenarians among them. The studies don’t look at 100 year olds across the world, they look at particular populations.
Studies on 98 year old and older Ashkenazis show a gene that variant that protects against high cholesterol. The Masai also have a variant that enables them to live (to about 40) with high cholesterol.
So if you don’t have this gene but think it’s OK to have high cholesterol….
The range of ‘normal’ or ‘optimal’ may be higher than common ranges in active 100 year olds (which is confounded by other lifestyle factors in these populations and availability of blood pressure meds and other interventions) but that shouldn’t confuse the issue that in under 100 year olds above ‘normal’ is associated as a risk factor.
You have to live through all the other ages to get to 100, and the evidence shows you’re morely likely to have higher risk of CDV with higher than normal total and LDL.
Do you have information on statins and stroke prevention? My mom had a stroke 2 years ago and it was attributed to her genetically high cholesterol and was put on a statin because she already lived quite a healthy lifestyle. She has cognitively declined since starting the statin.
The best way to know if you have a problem that even requires a statin is to have a calcium score test (Google it). It is not usually covered by health insurance but costs $100-$150 and will tell you if you need a statin (or a bypass, or a stent) without the guessing.
I’ve had calcium scores and they do show some things. The problem with them is that they only show hard plaque. They do not show the soft plaque which will kill you. The hard plaque is normally anchored and moving, but soft plaque can drop and close an artery.
Please keep writing on this—I believe patients and the general public are getting the message. I recently had a patient with pretty high cholesterol according to the current guidelines—started on a statin by another provider although her 10-year CV risk is pretty low—under 5%. On the statin her A1c jumped to nearly equal a diabetes diagnosis and nothing else had changed. In UpToDate —there is a section on “significant” adverse effects—and then, relegated to a different section—a 3% incidence of new diabetes diagnosis is reported for the statin. I’m disgusted—seems to me a new diagnosis of diabetes is very significant.
- the first, self evident, is that diabetes is not good for your body and then you need to take another bunch of meds (with a whole set of adverse effects) to manage your blood glucose
- since having diabetes puts you automatically at higher risk of heart disease, cardiologists and diabetologists want your cholesterol to be even lower, so they are going to increase your statin doses
Hey Remnant, I'm a paid subscriber and noticed that I have not been receiving all your stacks. Found this one on notes, cross checked my inbox and did not see this one.
So here is something interesting for you. I come from a long lived family, my grandpa was the youngest who died just before his 90th birthday, but he had developed diabetes Late in life. Everyone else has lived to mid 90s at least. My mom is 88, my dad 90. I’m 55. My dads cholesterol, combined, is under 100. It’s so low that he is supposed to be taking meds to raise it but he can’t tolerate the, so he doesn’t. However, he eats SO MUCH fat, like a 1/4” thick on a roll at dinner. He goes through a tub of butter at least once a week, and that’s only one of his fat sources. He hates ‘bird’ so eats beef and pork almost exclusively. I won’t even go into the amount of butter and sour cream he puts on a potato, you get the picture. My dad is mentally sharp as a tack (he’s awesome).
Then there’s me. I have always exercised multiple times a week, I am careful about my diet but I don’t do keto or anything,just try to get whole foods and complex carbs, lots of fruits and veg, lean meats, etc. I track what 8 eat and focus on getting enough protein and fiber. My weight is great. (Upper 130s at 5’7”). My cholesterol is ‘high’. Specifically, my total runs in the 230s, last check LDL was 146, HDL 79, and triglycerides 42. So my triglyceride to HDL ratio is .53. When I had the cardiac IQ test done, my small particle LDL was around 1900. So definitely ‘too high’. I don’t know my moms specific numbers, but her cholesterol has a
My cholestrol levels dramatically increased after going through the menopause. A question for my GP who wanted to put me on statins is; surely the decrease in oestrogen levels suggests it's absence is a determining factor for increased cholestrol production in women, therefore it doesn't it serve a protective purpose. My mother's and brother's statin experiences underline the connection between statins and the onset of diabetes and mental decline. They both take far too many drugs. Some of which are to counteract the side effects of other drugs. Their quality of life has plummeted. My GP has, to her credit, acknowledged the statin- diabetes link. Thankfully, I live in the UK where I am not beholden to medical insurance demands that I be drugged against common sense.
Anyway, my moms cholesterol has always been in the normal range. So my question is... what do you think? Am I just unlucky or is there something I could be doing indifferently? Also, I will never go on a statin. The only prescription I have is estrogen and progesterone because of menopause, but the cholesterol thing has been going on for a few years.
The comparison between your parents and yourself is quite telling.
Namely, that you more or less keep your diet to the typical medical recommendation from most sought after cardiologists, primary care providers: whole food, carbs, fruit, veg, lean meat.
Yet, for some reason, your body seems to be responding with a lipid panel that is higher than "normal."
If this should tell you anything, it is that the mainstream understanding and recommendation is faulty at best.
The important things to consider are: how do you feel? Have you noticed any deficiencies in your body or mind's capacity to do tasks it could before, or overcome an obstacle that was previously not a problem?
If I had your lipid panel, I wouldn't really give it much thought. Triglycerides look great. High cholesterol is not necessarily a bad thing.
If I were to make any suggestion: enjoy more animal fat and protein. Enjoy fruit and veggies that are in season and well sourced (avoiding industrial fertilizer and herbicides). Listen to your body.
Thanks! I am active and healthy. The only real issue is trouble getting good deep sleep, but I’m in menopause, so that could be it. I eat 125-135g of protein a day, almost exclusively from real food (chicken, turkey, seafood, some red meat, Greek yogurt, cottage cheese, etc) not protein supplements) I generally feel like my cholesterol is where my body wants it, but the docs keep trying to tell me otherwise. I just try to ignore it and listen to my body.
Is there a more recent study you would recommend on statins causing diabetes than the 2010 study you pointed out? Excellent article by the way-thank you
I'm sure there are, but finding a study as robust would probably take some digging. At this point, it's so well known that doctors regularly check A1c for patients they put on statins to mitigate risk of diabetes.
But why bring down LDL if cholesterol is vital? There are good studies that show people over 60 with high cholesterol actually live longer…I believe it's the Sardinia study.
There are no spikes on the cholesterol vs health hazard graph. So what health risks related to mortality are doctors reducing by prescribing a statin drug to lower LDL cholesterol from any point on the graph by 7%, 14%, 21%? There's no benefit. Only side effects, aka negative consequences, that lead to the prescribing of several of the over 50 various drugs to treat the side effects of statins, and of themselves.
Ask an AI to list the side effects of Statins. The ask yourself, "WTF!"
*"for each doubling of statin dosage, one should expect to see a 7% reduction in LDL-C".
That's a really good deep dive. I wish you kept going on, but I'm used to reading this kind of literature, so I understand on some level why you felt the need to hold off on your rant. That was a good description of the Mevalonate pathway for people who have never heard of that
Is the science on what is considered high cholesterol uniform across the population? let's start with that because we know people with normal cholesterol have cardiovascular events as well as people with high LDL cholesterol. In my 15 years of looking at lipid profiles, that fact stood out to me as a red flag. It told me that some other mechanism was at play.
My suspicions are logical and demand a closer look. Meta studies show that metabolic factors play a big role when looking at normal LDL and High LDL. Wheather your LDL is high or low, meta studies show conclusively that normal LDL and high LDL in the presence of metabolic dysregulation cause higher rates of cardiovascular events. Dr Peter Attia showed this in a meta study of approximately 200K patients.
UCLA ICU department spoke out that their ICU had cardiovascular patients with normal LDL profiles. So, I strongly believe metabolic dysregulation in the presence of high or low LDL needs to be studied even more.
Excellent article.. If only it could get thru to my father's thick skull. So comprehensive that he probably won't finish the article.
Sad part of our aging population is the absolute trust they continue to have in the (p)harma industry.
I just received a breast cancer diagnosis. My Nurse Practitioner has advised me that my cholesterol is very high and she believes it’s because of the inflammation ( tumour). She thinks I should take Lipitor for a short period of time - six months or so. I’m confused as it is but the thought of a statin ?
I feel good. 65 years old. Physically active. No other prescription drugs. What to do ?
I’ve never heard of anyone prescribing a statin for 6 months, let alone because cholesterol is high from tumor activity.
Sounds odd, I know. Thinking on it, would it be that high cholesterol is causing the inflammation ? I was a little messed up at this appointment as you can well imagine.
if anything, the inflammation is causing the higher cholesterol
Yes, one of my levels was a bit off and they offered me a statin. I said, "no, I'll just eat a bit less bacon". You know what is criminal? They never check your vitamin D levels.
I found out that Medicare will not pay to test D levels, unless you are D deficient.
And how do they know you’re deficient without testing?
And that was my question. It's the basis of the immune system, something most people are deficient in, but we won't test for it.
The number of deaths don't increase by much with increasing cholesterol? I guess animal ag profits are more important than 100s of 1000s of preventable deaths.
As we all know ill and frail people have low LDL- certain cancers eat cholesterol- and are therefore more likely to die. This doesn't mean LDL is not bad. And because risk doesn't increase much doesn't mean you want risk to increase at all. Throwing more matches into a fire ain't gonna make much difference but better not to have a fire in your house.
High cholesterol is not heathy even if it's being used as energy. As is being shown in recent studies.
Of course statins are bad.
https://jowaller.substack.com/p/of-course-statins-dont-work-cholesterol?utm_source=publication-search
If high cholesterol is inherently bad, then why do the longest living people (centenarians) have much higher cholesterol than what is considered "normal"? Including total cholesterol and LDL cholesterol.
Sure, there's probably some upper limit that we should consider.
But, that limit is probably far higher than our common ranges of "normal"
‘At variance with young and aged people, centenarians with high Lp(a) serum levels also had high plasma concentrations of the proinflammatory cytokine IL-6, suggesting that genetic control of the Lp(a) serum level may attenuate with age
‘On the whole, these data support the hypothesis that a continuous and complex reshaping of lipid metabolism occurs in physiological aging, likely contributing to successful aging.’
https://pubmed.ncbi.nlm.nih.gov/9535215/#:~:text=Accordingly%2C%20we%20measured%20Lp(a,likely%20contributing%20to%20successful%20aging.
This seems to say that in centenarians- the control of LDL is diminished-meaning that LDL rises. However, this rise is not from a rise in dietary saturated fat or cholesterol- it’s from a change in internal control. So the high lipoprotein does not show that previously thought unhealthy life style factors are no longer unhealthy. It shows with ageing control of LDL changes.
I agree, high cholesterol is a marker (the risk factor itself is high animal and processed food intake). However, like crossing a busy road, not all people get run over, some get away with it (some of the sardinian blue zone centenarians are smokers or ex-smokers), especially if they have access to other life style benefits, community, high blood pressure medication etc. Cholesterol under 150 and as low as 70 in healthy adults makes one virtually heart attack proof- CVD being the number one cause of death in the west.
Cholesterol levels above normal in old women in Sweden etc shouldn’t be taken as a green light for unlimited saturated animal fat consumption because it doesn’t alter the fact that the longest living populations are plant-based with meat eaten only on special occasions or not at all.
We shouldn’t be obsessing about cholesterol levels but rather overall diet quality- which is one centred around beans, soy, spices, wholegrains, nuts and garden vegetables-eaten- at communal gatherings.
Your vegan evangelism is showing.
So?
As we know cholesterol levels in younger people is just a biomarker of health. The association holds true in younger people. The fact that physiology changes as we age and the biomarker limits also need to change does not mean that biomarkers for younger people, ie for most of most people’s lives, are wrong or unhelpful.
The studies focus on ‘the longest living people’-ie centenarians- this is disingenuous- many other populations including plant based ones are among the longest living ie they having centenarians among them. The studies don’t look at 100 year olds across the world, they look at particular populations.
Studies on 98 year old and older Ashkenazis show a gene that variant that protects against high cholesterol. The Masai also have a variant that enables them to live (to about 40) with high cholesterol.
So if you don’t have this gene but think it’s OK to have high cholesterol….
The range of ‘normal’ or ‘optimal’ may be higher than common ranges in active 100 year olds (which is confounded by other lifestyle factors in these populations and availability of blood pressure meds and other interventions) but that shouldn’t confuse the issue that in under 100 year olds above ‘normal’ is associated as a risk factor.
You have to live through all the other ages to get to 100, and the evidence shows you’re morely likely to have higher risk of CDV with higher than normal total and LDL.
Do you have information on statins and stroke prevention? My mom had a stroke 2 years ago and it was attributed to her genetically high cholesterol and was put on a statin because she already lived quite a healthy lifestyle. She has cognitively declined since starting the statin.
The best way to know if you have a problem that even requires a statin is to have a calcium score test (Google it). It is not usually covered by health insurance but costs $100-$150 and will tell you if you need a statin (or a bypass, or a stent) without the guessing.
I don’t think calcium scores are all they are cracked up to be.
How so? Can you explain in more detail?
Unmoving
I’ve had calcium scores and they do show some things. The problem with them is that they only show hard plaque. They do not show the soft plaque which will kill you. The hard plaque is normally anchored and moving, but soft plaque can drop and close an artery.
https://www.remnantmd.com/p/monologues-4-heart-disease-and-cholesterol
Thank you
Please keep writing on this—I believe patients and the general public are getting the message. I recently had a patient with pretty high cholesterol according to the current guidelines—started on a statin by another provider although her 10-year CV risk is pretty low—under 5%. On the statin her A1c jumped to nearly equal a diabetes diagnosis and nothing else had changed. In UpToDate —there is a section on “significant” adverse effects—and then, relegated to a different section—a 3% incidence of new diabetes diagnosis is reported for the statin. I’m disgusted—seems to me a new diagnosis of diabetes is very significant.
Yeah, and that's for two reasons:
- the first, self evident, is that diabetes is not good for your body and then you need to take another bunch of meds (with a whole set of adverse effects) to manage your blood glucose
- since having diabetes puts you automatically at higher risk of heart disease, cardiologists and diabetologists want your cholesterol to be even lower, so they are going to increase your statin doses
Hey Remnant, I'm a paid subscriber and noticed that I have not been receiving all your stacks. Found this one on notes, cross checked my inbox and did not see this one.
So here is something interesting for you. I come from a long lived family, my grandpa was the youngest who died just before his 90th birthday, but he had developed diabetes Late in life. Everyone else has lived to mid 90s at least. My mom is 88, my dad 90. I’m 55. My dads cholesterol, combined, is under 100. It’s so low that he is supposed to be taking meds to raise it but he can’t tolerate the, so he doesn’t. However, he eats SO MUCH fat, like a 1/4” thick on a roll at dinner. He goes through a tub of butter at least once a week, and that’s only one of his fat sources. He hates ‘bird’ so eats beef and pork almost exclusively. I won’t even go into the amount of butter and sour cream he puts on a potato, you get the picture. My dad is mentally sharp as a tack (he’s awesome).
Then there’s me. I have always exercised multiple times a week, I am careful about my diet but I don’t do keto or anything,just try to get whole foods and complex carbs, lots of fruits and veg, lean meats, etc. I track what 8 eat and focus on getting enough protein and fiber. My weight is great. (Upper 130s at 5’7”). My cholesterol is ‘high’. Specifically, my total runs in the 230s, last check LDL was 146, HDL 79, and triglycerides 42. So my triglyceride to HDL ratio is .53. When I had the cardiac IQ test done, my small particle LDL was around 1900. So definitely ‘too high’. I don’t know my moms specific numbers, but her cholesterol has a
My cholestrol levels dramatically increased after going through the menopause. A question for my GP who wanted to put me on statins is; surely the decrease in oestrogen levels suggests it's absence is a determining factor for increased cholestrol production in women, therefore it doesn't it serve a protective purpose. My mother's and brother's statin experiences underline the connection between statins and the onset of diabetes and mental decline. They both take far too many drugs. Some of which are to counteract the side effects of other drugs. Their quality of life has plummeted. My GP has, to her credit, acknowledged the statin- diabetes link. Thankfully, I live in the UK where I am not beholden to medical insurance demands that I be drugged against common sense.
Good point. Also worth considering the role of low progesterone (not estrogen).
Whoops, accidentally hit enter too soon.
Anyway, my moms cholesterol has always been in the normal range. So my question is... what do you think? Am I just unlucky or is there something I could be doing indifferently? Also, I will never go on a statin. The only prescription I have is estrogen and progesterone because of menopause, but the cholesterol thing has been going on for a few years.
Hi Valerie,
The comparison between your parents and yourself is quite telling.
Namely, that you more or less keep your diet to the typical medical recommendation from most sought after cardiologists, primary care providers: whole food, carbs, fruit, veg, lean meat.
Yet, for some reason, your body seems to be responding with a lipid panel that is higher than "normal."
If this should tell you anything, it is that the mainstream understanding and recommendation is faulty at best.
The important things to consider are: how do you feel? Have you noticed any deficiencies in your body or mind's capacity to do tasks it could before, or overcome an obstacle that was previously not a problem?
If I had your lipid panel, I wouldn't really give it much thought. Triglycerides look great. High cholesterol is not necessarily a bad thing.
If I were to make any suggestion: enjoy more animal fat and protein. Enjoy fruit and veggies that are in season and well sourced (avoiding industrial fertilizer and herbicides). Listen to your body.
Thanks! I am active and healthy. The only real issue is trouble getting good deep sleep, but I’m in menopause, so that could be it. I eat 125-135g of protein a day, almost exclusively from real food (chicken, turkey, seafood, some red meat, Greek yogurt, cottage cheese, etc) not protein supplements) I generally feel like my cholesterol is where my body wants it, but the docs keep trying to tell me otherwise. I just try to ignore it and listen to my body.
Is there a more recent study you would recommend on statins causing diabetes than the 2010 study you pointed out? Excellent article by the way-thank you
I'm sure there are, but finding a study as robust would probably take some digging. At this point, it's so well known that doctors regularly check A1c for patients they put on statins to mitigate risk of diabetes.
Great points. I’ve seen a lot of issues regarding the need to rethink cholesterol management.
Years ago, One of my Drs made me swear never to take a statin & get my numbers down naturally
But why bring down LDL if cholesterol is vital? There are good studies that show people over 60 with high cholesterol actually live longer…I believe it's the Sardinia study.
Sounds like a keeper.