If you were prescribed medicine to lower your risk of a heart attack or stroke, would you take it?

Millions of Americans are prescribed statins such as Lipitor, Crestor or generic formulations to lower their cholesterol. But lots of people are hesitant to start the medication.

Some people fret over potential side effects such as leg cramps, which may be - or may not be - linked to the drug. As an alternative, dietary supplements, often marketed to promote heart health, including fish oil and other omega-3 supplements (Omega-3's are essential fatty acids found in fish and flaxseed), are growing in popularity.

So, which is most effective? Researchers at the Cleveland Clinic set out to answer this question by comparing statins to supplements in a clinical trial. They tracked the outcomes of 190 adults, ages 40 to 75. Some participants were given a 5 mg daily dose of rosuvastatin, a statin that is sold under the brand name Crestor for 28 days. Others were given supplements, including fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice for the same period.

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The maker of Crestor, Astra Zeneca sponsored the study, but the researchers worked independently to design the study and run the statistical analysis.

"What we found was that rosuvastatin lowered LDL cholesterol by almost 38% and that was vastly superior to placebo and any of the six supplements studied in the trial," study author Luke Laffin, M.D. of the Cleveland Clinic's Heart, Vascular & Thoracic Institute told NPR. He says this level of reduction is enough to lower the risk of heart attacks and strokes. The findings are published in the Journal of the American College of Cardiology.

"Oftentimes these supplements are marketed as 'natural ways' to lower your cholesterol," says Laffin. But he says none of the dietary supplements demonstrated any significant decrease in LDL cholesterol compared with a placebo. LDL cholesterol is considered the 'bad cholesterol' because it can contribute to plaque build-up in the artery walls – which can narrow the arteries, and set the stage for heart attacks and strokes.

"Clearly, statins do what they're intended to do," the study's senior author Steve Nissen, M.D., a cardiologist and Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic told NPR. By comparison, he says this research shows that supplements are not effective. "They do not promote heart health. They do not improve levels of the bad cholesterol." Nissen says supplements can be expensive compared to statin medications. Depending on insurance, Nissen says people may pay less than $5.00 a month out-of-pocket for rosuvastatin.

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"Statins are the most effective heart attack and stroke prevention drugs that we have really ever seen," says Michael Honigberg, MD, a cardiologist and researcher at Massachusetts General Hospital who is not affiliated with the new study. He says the new findings add to an already large body of evidence showing statins lower LDL cholesterol, and he's not surprised to see that the supplements were not as effective.

However, he says, not everyone with a family history of heart disease or slightly elevated cholesterol should be on a statin. The American College of Cardiology and American Heart Association developed some prescription guidelines. Typically, if a person's LDL cholesterol (bad cholesterol) is 190 or higher, they're often advised to start a statin. Health care professionals use a risk calculator to estimate a person's risk of having a heart attack or stroke over the next 10 years. If the risk is high enough, based on factors including age, blood pressure and smoking status, then a statin may be recommended.

Honingberg says for people who have slightly elevated cholesterol, but are not at high enough risk to be prescribed a statin, he recommends that they focus on diet and exercise, rather than buying supplements. "I tell my patients to save their money and instead spend that money on eating heart healthy, high quality food." He points to studies that show heart-healthy diets, including Mediterranean diets which emphasize healthy fats, lots of fruits, vegetables and whole grains and the DASH diet, significantly reduce the risk of heart disease. "I think a formulation that we perhaps don't use enough is that food is medicine and is probably a more effective medicine than supplements," says Honingberg.

The National Center for Complementary and Integrative Health, part of the National Institutes of Health, has also concluded, based on prior research, that omega-3 supplements do not reduce the risk of heart disease, but eating fish – which contains omega-3 fatty acids – is linked to a reduced risk. This suggests that omega-3 fatty acids are most beneficial as part of a healthy diet. And it's worth noting that the NIH review concludes that omega-3 supplements may help relieve symptoms of rheumatoid arthritis. Omega 3's are also added to baby formulas to promote brain development. The NIH review also concludes that omega-3 supplements can lower triglycerides, a type of fat found in the blood. But Dr. Honingberg says this may be recommended for a "small subset of patients" with very high triglyceride levels.

As for people whose risk of heart disease is high enough to warrant a statin prescription, Dr. Honingberg says he spends a fair amount of time talking through concerns with patients.

"We talk about the excellent safety profile and the very, very low risk of side effects," he says. He describes the risk of serious side effects as "vanishingly small."

Sometimes patients stop taking a statin because they believe it's causing a certain side effect. But Honingberg points to a double-blind research study that showed when patients were given a placebo in place of a statin, patients reported feeling most of the same side effects. "So the punch line of the trial is people blame statins for side effects the statins aren't really causing," he says.


LINK: https://www.npr.org/sections/h...r-to-cut-cholesterol

“Some participants were given a 5 mg daily dose of rosuvastatin, a statin that is sold under the brand name Crestor for 28 days.“

quote:

The maker of Crestor, Astra Zeneca sponsored the study, but the researchers worked independently to design the study and run the statistical analysis.

“What we found was that rosuvastatin lowered LDL cholesterol by almost 38% and that was vastly superior to placebo and any of the six supplements studied in the trial…"


If they hadn’t found that their product was superior do you suppose they’d have let everyone know?

^^^^^^^^^^^
They are tightening up on poor scientific studies. The nonpublication of less favorable results has certainly been discussed. All physicians are not whores for Big Pharma. It is a well done peer reviewed study. If people want to take OTC products which are more expensive and less effective they surely can. Statins are very effective at reducing Cholesterol. You are responsible for your own health. The Cleveland Clinic is a center of Excellence.

LOL, its's an advertisement, what did you expect it to say?

FWIW, there is massive - as much as I hate this word > misinformation on Lipids.

..and for statins vs supplements is not a valid comparison
You can make a study say anything you want with manipulation.

I’ve been on statins since the early 90’s, had X3 CABG in 98.

Late ‘98 my dosage of generic Lipitor was upped to 40mg. Due to Cholesterol numbers spiking this year he changed me to generic Crestor, 20mg. I did have my doubts about this but I totally trust my Cardiologist. Got him as the luck of the draw as I was wheeled into the Cath Lab as an emergency case.

So far the Crestor has brought my numbers back down again.

Huh. "Independent" researchers conducted a study at the behest of a drug manufacturer and found that one of said drug manufacturers products was more effective than alternatives.

Imagine that.

I note the article also fails to mention current research is beginning to suggest blood serum cholesterol perhaps isn't the boogeyman it's long been thought to be.

Oh, and did the study employ real red yeast rice, the stuff Big Pharma strong-armed the FDA into banning--that people in Asia have been using without ill effect for literally centuries, or the weakened, significantly less-effective stuff that's now available?

Astra Zeneca can KMA.

One of the things I hate about statins besides the side effects it that they don't decrease the LDL that does the real damage> small particle LDL.
Large LDL particles are relatively harmless even if they contain more cholesterol.
So focusing simply on LDL is insufficient.


https://pubmed.ncbi.nlm.nih.gov/20844614/

I've been taking statins for over 25 years. Joint pain was always a problem since I was taking 10 to 20 mg/day depending on my blood test results every 6 months. About two years ago my new doctor switched me over to 5mg of Rosuvastatin. Now I'm a very consistent 160-165 and no joint pain.

I understand the arguments and skepticism against this study and the product, and that I am only one data point. All I know is that Rosuvastatin is working very well for me and increases my quality of life.

quote:

Originally posted by ZSMICHAEL:
All physicians are not whores for Big Pharma.

I think you mean "not all physicians are whores for Big Pharma."

Yes, but how do I evaluate my prescribing physician? Should a physician's prescribing history be part of the public record? I am absolutely certain that "Big Pharma" tracks exactly which doctors are more likely to select their product, probably insurance companies too.

^^^^^^^^^^^^^^
Yes, Pharma reps track prescribing habits of the physicians they call upon. Insurance companies typically select the CHEAPEST drug possible and make the other drugs in that category much more expensive. {It is called the Tier system}. Pharmacy benefit managers do most of that.

What about having a proper diet and exercise somewhat? You would need NO meds. Better to fix the underlying problem, than cover it up with meds.

Statins also may cause Type 2 Diabetis in some people. I was taking Simvastatin & my A1C increased every year until I stopped. My A1C dropped 2 points immediately. Some permanent damage had already occured.

quote:

What about having a proper diet and exercise somewhat? You would need NO meds

^^^^^^^^^^^^^^^^
Most Cardilologists do suggest the above, but that is often not effective. Some folks have hyperlipidema which is more difficult to treat.

Hopefully our resident Cardiologist will be along shortly with his opinion.

quote:

Originally posted by ensigmatic:
Oh, and did the study employ real red yeast rice, the stuff Big Pharma strong-armed the FDA into banning--that people in Asia have been using without ill effect for literally centuries, or the weakened, significantly less-effective stuff that's now available?

Astra Zeneca can KMA.

“Real” red yeast rice IS a statin - it contains lovastatin, which is sold under the brand name Mevacor. Red yeast rice just gives you less control over dosage and a higher chance of contamination.

If it contains a recognized drug, it’s a drug, and is subject to FDA regulation, and none of the supplement companies are going to go through the hassle and expense.

quote:

Originally posted by ZSMICHAEL:
^^^^^^^^^^^
They are tightening up on poor scientific studies.

It seems like in just the past few years there has finally been some questioning of the conventional wisdom on a lot of the treatments based on limited data.

Who sponsored the studies? Sample size? Truly random sample? Etc. There is also the issue of relative risk reduction vs absolute. We saw this play out in real time with the Covid deaths and vaccine, but the same is true for many other tests and treatments.

The recent study out of Europe with something like 80,000 patients studied for 10 years indicated that the assertions about the real benefits colonoscopies have either been over stated or at least presented in a way that makes them seem more effective than they are. A 30% relative risk reduction isn't quite as impressive when the absolute risk is in the small single digits.

Similar conflicting information about the benefits of statins in people who haven't had a previous heart attack vs those that have(the original target group).

Twenty years ago men were undergoing biopsies based solely on PSA. Now, we're hearing that the test may be producing more harm from treatments than good by a ratio of almost 50:1.

Paxlovid was tested on elderly patients who were unvaccinated, but we have the CDC director who I think is around 50, seemingly in good health and 4-5 times vaccinated taking it "just in case".

I'm sure we could fill many pages with other examples, but a little skepticism is generally in order for all of these things.

quote:

Originally posted by architect:

quote:

Originally posted by ZSMICHAEL:
All physicians are not whores for Big Pharma.

I think you mean "not all physicians are whores for Big Pharma."

Yes, but how do I evaluate my prescribing physician? Should a physician's prescribing history be part of the public record? I am absolutely certain that "Big Pharma" tracks exactly which doctors are more likely to select their product, probably insurance companies too.

You can look up your provider and see how much they get paid by drug companies and device manufacturers.

https://openpaymentsdata.cms.gov/

quote:

Originally posted by ZSMICHAEL:

quote:

What about having a proper diet and exercise somewhat?
You would need NO meds

^^^^^^^^^^^^^^^^
Most Cardilologists do suggest the above, but that is often not effective.
Some folks have hyperlipidema which is more difficult to treat.

You can't always say NO but no question diet primarily, exercise does help but less so than diet.

Carbs primarily or sugars are the biggest culprit.

One thing that a low carb does in some cases it will raise LDL {gasp} but raises HDL and lower Triglycerides more importantly.

It is why the standard lipid panel that is semi-useless and a tool for pharma.

Get an NMR Lipid Panel and it will tell you much more.

Additionally, there are few cardiologists that understand different diets especially KETO, Carnivore, Low Carb, etc.
They just look at the numbers and write the prescription.
Or just tell you no salt, low fat, no meat ... the (SAD) Standard American Diet is killing us.
Diet is where it is at, but the no-salt-low-fat-no-meat is not.
In some cases, meds will make sense but too often it is just a shortcut.

quote:

Originally posted by ZSMICHAEL:

quote:

What about having a proper diet and exercise somewhat? You would need NO meds

^^^^^^^^^^^^^^^^
Most Cardilologists do suggest the above, ...

Perhaps they do. I've never yet had the need to consult with a cardiologist directly. But, of all the doctors I've seen in my life the only two that ever recommended diet and exercise were DO's. I've never had an MD do so.

In fact: My next-to-last MD, who we felt very attentive and we generally liked, would recommend prescription meds at the drop of a hat. One time, when I was at the top of my game, when I'd gotten my body fat down around 15% or so, he expressed concern I had a health problem. "No, I've just been working out consistently and eating a healthy diet." He looked at me like I was speaking in tongues.

My prior MD, when I went in for a wellness check, heard something she didn't like with her stethoscope, did an EKG, saw something she didn't like, and scheduled me for a heart echo. Tech doing the heart echo finally asked "Why did you doctor prescribe this?" in a puzzled tone of voice. "I dunno," I answered, "something she heard with her stethoscope and saw on an EKG, I suppose." Tech does some more scanning. "Are you a runner?" she asked. "No, but I weight train three times a week and do thirty minutes of HIIT twice a week." "Well, that explains it. You have a runners heart. Your doctor should have known better."

Oh, that same doctor, when I told her I was hitting 172 BPM doing HIIT, freaked out and told me to stop doing that

(Btw: I've since had a heart echo stress test as part of an emergency stroke eval. I warned the attending physician my recovery rate was phenomenal. She checked my pulse shortly after I got off the treadmill, as the were starting part 2. "You weren't kidding," she said, with a note of amazement in her voice.)

These, and a plethora of other experiences, have led me to an undeniably jaundiced view of the American "health care" industry.

quote:

Originally posted by smschulz:
Carbs primarily or sugars are the biggest culprit.

... the (SAD) Standard American Diet is killing us.

It sure is.

People do not understand how carbs, particularly simple and refined carbs, contribute to fat creation and retention.

Every time I've fallen off the wagon and decided "enough is enough, this fat's got to go," the first thing to go has been simple and refined carbs.

I'm doing that right now. Alcohol-Free November and all sweets and low-value snacks are off the table.

I never understand these types of discussions .... If you don't trust your doctor or the drugs, simply quit going to him and quit taking the drug. It's that simple. Life's a gamble and whether you realize it or not, you are gambling with your life everyday. " You pays your money and you takes your chances"... You could get run over by a truck tomorrow....

As for me, I go to the doc and take the pills... (And I can still get run over by a truck as I step out into the parking lot.)

quote:

Originally posted by mike28w:
I never understand these types of discussions .... If you don't trust your doctor or the drugs, simply quit going to him and quit taking the drug. It's that simple. Life's a gamble and whether you realize it or not, you are gambling with your life everyday. " You pays your money and you takes your chances"... You could get run over by a truck tomorrow....

As for me, I go to the doc and take the pills... (And I can still get run over by a truck as I step out into the parking lot.)

Everyone's an internet expert these days.